Jan-Åke Jansson

The Tree Theme Method in psychosocial occupational therapy: a case study.

This study aimed to describe the Tree Theme Method (TTM) as a method for intervention in psychosocial occupational therapy. The TTM is based on theories concerning creative activities and occupational storytelling and story making. In order to exemplify the method a case study of a treatment process with follow up was undertaken. The participant was a female client suffering from anxiety and depression. During an interview the client painted symbolic trees on five different occasions with specific variations of the tree theme: a tree symbolizing her present life, her childhood, adolescence, adulthood, and, finally, a tree representing her future. The trees were used as starting points for the client to tell her life story. The intention was that she would find new strategies for how to change her daily life. Three years later there was a follow up stage where the client painted new trees and told her story. Some life themes were identified. The TTM appears suitable for intervention in psychosocial occupational therapy. In future studies the TTM should be subjected to evaluation research based on several clients in order to develop a deeper understanding of the process and what kind of results changes in the TTM intervention may provide.

Therapeutic alliance and outcome in routine psychiatric out-patient treatment: Patient factors and outcome

OBJECTIVE This study investigated the importance of the therapeutic alliance in a routine psychiatric out-patient unit regarding treatment outcome and the influence of patient factors. DESIGN The study had a naturalistic and longitudinal design where the treatments the patient received were determined by the normal routines at the unit and were performed by a variety of staff representative of a psychiatric out-patient unit. METHOD Newly admitted patients were diagnosed according to the International Classification of Diseases-10th Revision and completed questionnaires regarding the therapeutic alliance, symptoms, and interpersonal problems at the beginning and termination of their treatment (N=76). The time limit for the termination assessments was set at 18 months. RESULTS The therapeutic alliance at the beginning of treatment did not correlate with outcome, however, at the end of the treatment the alliance significantly explained about 15% of the variance of the outcome (global severity index). An improvement of the alliance during the treatment significantly correlated with most of the outcome variables. The relation of the alliance to outcome was equal among the different diagnosis groups and treatment forms. CONCLUSION The results showed that the therapeutic alliance is an important variable for treatment outcome in routine psychiatric treatment, and improving the therapeutic alliance may be one of the most important factors for increasing the total effectiveness of a treatment unit.

How the inner world is reflected in relation to perceived ward atmosphere among patients with psychosis

Abstract.Background: This study focused on how cognitive ability, personality traits, self-rated psychiatric symptoms, and social functioning were related to the way in which patients with psychosis perceived supportive aspects of the ward atmosphere. Methods: Patients at a psychiatric rehabilitation unit (PRU) in southern Sweden completed a ward atmosphere questionnaire (COPES), rated their psychiatric symptoms (SCL-90), self-image (SASB), and were tested on cognitive functioning (WAIS-R) and global social functioning (GAF). They were diagnosed according to ICD-10. Data were analysed by means of logistic regression analyses. Results: Self-monitoring and restraining (self-control), one cluster in the SASB, was the strongest factor associated with how the patients perceived the ward atmosphere. A perceived high level of self-control indicated high levels of perceived Support, Practical orientation, and Order and organisation of the ward atmosphere. A high level of self-rated paranoid symptoms (SCL-90) increased the risk of perceiving a high level of Anger and aggression and a low level of Program clarity. Regarding cognitive ability (WAIS-R), two factors were important for predicting perceived ward atmosphere. A low level of social competence was associated with a low level of perceived Order and organisation. Furthermore, a low level of abstract thinking was related to a low level of perceived Anger and aggression, while a high level of abstract thinking was associated with a low level of Program clarity. Patients with schizophrenia exhibited a lower level of Self-monitoring and restraining than patients with other psychoses. Conclusion: The results from this study indicate that individual factors such as self-control, paranoid symptoms and social competence may be important for how the ward atmosphere is perceived. This is important knowledge when monitoring the ward atmosphere to better fit a units target group.

Stability of perceived ward atmosphere over time, diagnosis and gender for patients with psychosis

In this study the focus was on patients with psychosis treated in a psychiatric rehabilitation unit in southern Sweden. The study described the stability of the ward atmosphere over 2 years, as well as differences between subgroups of patients regarding gender and diagnosis. Furthermore, the perceived ward atmosphere was compared with what has been recommended in the literature. The ward atmosphere was measured by The Community-Oriented Programs Environment Scale (COPES) five times during a 2-year period. The ward atmosphere was fairly stable over time, and in several respects it met the recommendations suggested for psychotic patients. There were few differences between schizophrenia patients and patients with other psychoses. No difference was found in perceived ward atmosphere with respect to gender. The study showed that the investigated unit, admitting almost only patients with psychosis, could provide a ward atmosphere accordance with the recommendations, probably due to a carefully planned program with a psychodynamically oriented supportive treatment milieu.

The Psychosocial Atmosphere in Community-Based Activity Centers for People with Psychiatric Disabilities: Visitor and Staff Perceptions.

Abstract This study investigated how visitors and staff in community-based activity centers in Sweden perceived the psychosocial atmosphere and whether this could be explained by the centers’ orientation (work-oriented versus meeting place-oriented centers). Eighty-eight visitors and 37 staff members at three work-oriented and three meeting place-oriented centers participated. The Community-oriented Programs Environmental Scale was used to estimate the psychosocial atmosphere. The result showed that the psychosocial atmosphere at the centers was in accordance with a supportive ward atmosphere profile. Visitors and staff perceived several aspects of the psychosocial atmosphere differently, especially in the meeting place-oriented centers. The visitors in the meeting place-oriented centers did not perceive the psychosocial atmosphere differently from those visiting the work-oriented centers. The results indicated that the psychosocial atmosphere at the centers was in line with what previous research has shown to be beneficial for visitors regarding outcome and favorable for promoting a good therapeutic alliance and a good functioning in daily life.

Reading times and adpative styles among patients diagnosed with psychosis as assessed by the serial color-word test

The present study focuses on how patients diagnosed with psychosis deal with a conflicting situation. In the study, two groups of patients were assessed. One group consisted of patients diagnosed with psychosis (n = 41), while the comparison group (n = 135) consisted of inpatients diagnosed either with anorexia nervosa or with bulimia nervosa. The groups were assessed using the Serial Color Word Test (S–CWT), designed for studying an individuals successive adaptation over time to a conflicting situation. The S–CWT differentiated the two groups regarding both reading time and adaptive styles. Patients diagnosed with psychosis had longer reading times and an adaptive style that was deviant throughout the test, indicating poorer cognitive functioning and more serious psychopathology. These problems may in turn influence functioning in work or study and daily living, all of which are important in treatment planning.