Carlos E. Sluzki

A family approach to severe mental illness in post-war Kosovo.

Abstract This study describes the effects of a psychoeducational multiple—family group program for families of people with severe mental illness in post—war Kosovo that was developed by a Kosovar—American professional collaborative. The subjects were 30 families of people with severe mental illnesses living in two cities in Kosovo. All subjects participated in multiple—family groups and received family home visits. The program documented medication compliance, number of psychiatric hospitalizations, family mental health services use, and several other characteristics, for the year prior to the groups and the first year of the groups. The families attended an average of 5.5 (out of 7) groups, and 93% of these families attended four or more meetings. The uncontrolled pre- to post—intervention comparison demonstrated decreases in medication non—compliance and hospitalizations, and increases in family mental health service use. The program provided training for mental health professionals, led to policy change in the Ministry of Health, and resulted in dissemination to other community mental health centers. This study provides preliminary evidence that a collaboratively designed and implemented psychoeducational, multiple—family program is a feasible and beneficial intervention for families of people with severe mental illness in impoverished post—war settings.

Toward a model of family and political victimization: implications for treatment and recovery

Political violence, in any of its ugly guises, has a devastating and long-lasting effect on its victims. This effect derives, in my view, from the concurrence of two factors: (1) the physical and emotional violence is perpetrated by the very agencies of society (such as the police and the armed forces) entrusted with the care and protection of individuals, with maintaining order in their world, with enforcing stability, and predictability; and (2) a context or a discourse that destroys or mystifies meanings so that recognition of that shift from protection to violence is blurred.

The Pathway Between Conflict and Reconciliation: Coexistence as an Evolutionary Process

A normative sequence of six stages is proposed to describe the process of evolution from open conflict to harmonious coexistence, as well at its devolution from the latter to the former. The stages may be termed Confrontation , Truce, Collaboration, Cooperation, Interdependence and Integration. Each of the six stages constitutes an amalgam of practices, narratives and prevalent emotions in a relational “game” that tends to resist change. At the stage of Confrontation, each party assumes that any act of the other is motivated by ill intent, and active hostility prevails. In Truce or Freeze, acts of hostility are curtailed by a real or virtual “neutral zone” controlled by powerful third parties. The dominant emotions are resentment, anger, and mistrust. Collaboration retains some assumptions of ill intent while certain activities in common are carried out. The third party looses visibility, and the dominant emotions include ambivalence. Cooperation entails the assumption of neutral intent of self and other, while activities in common are planned and carried out. Key emotions include cautious compassion for the other. Interdependence is characterized by active involvement in planning toward the common good. The dominant emotions are trust and forgiveness. At the other end of the spectrum, parties at the stage of Integration are actively involved in projects aimed at the common good and each supports the other’s growth. The dominant emotions are solidarity and a friendly trust. Movement from one stage to another shares certain characteristics with other complex systems. For professionals aiming to facilitate evolutionary change, whether in interpersonal or in international relations, the systemic cohesion of each stage constitutes the main challenge, and the promise of similar cohesion at the next stage provides the main hope.

In search of a new identity: An institutional consultation at a sub-acute inpatient unit in a general hospital.

Introduction: Hospitals are constantly morphing under the pressure of ever-evolving health care technologies, procedures, and reimbursement practices. In turn, healthy institutional identities and personnel allegiance contribute to counterbalance the potentially destabilizing effects of those changes. An institutional consultation was requested at a general hospital recently created sub-acute unit (SAU) due to malaise and dissatisfaction in the nursing staff. Method: The consultation included a total of 3 group meetings with the SAU nursing staff as well as observation of procedures and milieu in this and adjacent units. In the course of this process, a structure of demeaning narratives about the unit and the nursing personnel’s own role in the context of changes within the hospital was detected, destabilized, and transformed, and the kernel of a new identity for the unit was developed, using a shift in a routine evaluation procedure for patient’s progress as a fulcrum for generating change. Results: Follow-up evaluation indicated a qualitative improvement in the unit milieu and nurses’ job satisfaction, resonating with an enhancement in the staff’s identification with the unit’s reformulated mission as part of a constructive continuum of care. This improvement was also acknowledged and rewarded by hospital administration. Discussion: While maintaining a stance of positive connotation, assumptions of good intent, and a systemic view of the organization, demeaning collective narratives can be transformed through timely interventions that restitute pride and meaningfulness to the personnel and improve the unit’s quality of care.