Ottar Ness

Considerations for a discourse of collaboration in counseling

In this paper we consider a discourse of collaborative counseling practice drawing from developments in discourse and social constructionist theory. Collaboration, as we shall refer to it, speaks to negotiating and hopefully sharing initiatives, knowledge and judgment in counselor–client dialogues. However, such negotiations and sharing occur within perceived constraints associated with institutional and professional accountabilities, and are related to unequal powers seen as exercisable by clients and counselors. With these possibilities and constraints in mind, we articulate a discourse of collaborative practice based on counselors and clients sharing content and process expertise in areas often considered the sole prerogative of the counselor.

Learning New Ideas and Practices Together: A Cooperative Inquiry

This article recounts the learning processes and experiences of five family therapist colleagues from the Trondheim Family Therapy Center in Norway in learning to use challenging new conversational practices in their work with couples. These therapists undertook their learning together, adapting John Herons Co-operative Inquiry to also make sense of the learning process itself. Through reading and viewing videotaped demonstrations, through team discussion and practice, from personal reflections, and through feedback from clients, these therapists learned to use Johnella Birds relational language-making approach. Data from these different aspects of the learning process were mapped using Adele Clarkes Situational Analysis to depict the complexities of that process. The results are discussed with respect to the challenges faced by therapist teams wanting to learn and use new ideas and practices in a practice setting.

A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 1. Patient characteristics at admission and referral

BackgroundCrisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the first paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on describing the characteristics of the patients at admission.MethodsThe study was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, were the complete registration of patients of this team in the period from February 2008 to July 2009.ResultsAlthough diverse in their characteristics, the patients were over represented by females, young to middle aged, and people on public support. The patients were mostly referred to the team by self/family members and primary care physicians. At admission, depression was the most prevalent symptom, the overall intensity level of mental health problems was low, and most of the patients had long-standing mental health problems.ConclusionsSelf/family referral seems to be a critical route to receive services by CRTH teams as shown in our study, suggesting a need to examine policies that disallow this form of referral in some communities. The findings from our study show that the patients of the CRHT team, while mostly having long-standing mental health problems and had been receiving healthcare for them, did not have severe mental health problems at admission, although could have been in crises. There is a need for further studies to examine how people with severe mental health problems obtain services in time of crises, and to address the need to gain a greater understanding of the role of CRHT.

A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 3. Changes in morbidity and clinical problems from admission to discharge

BackgroundCrisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the third paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the changes in morbidity and clinical problems from admission to discharge and the length of service.MethodsThe study was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, were the complete registration of patients of this team in the period from February 2008 to July 2009.ResultsThe findings indicate that the patients´ mental health status improved from admission to discharge, although many patients were discharged with the same mental health symptoms as those present at admission. However, one third of the patients were discharged with no clinically significant mental health problems. The majority of the patients of the CRHT team on the other hand seemed to be those with long-standing mental health problems, who were likely to be in need of continuing mental health care even after the resolution of mental health crises. There is a need for a coordinated system of community-based mental health services for patients with long-standing mental health problems, within which CRHT teams can play a pivotal role in making connections between the crisis-care and the recovery-oriented care. The mean length of service was around 15 days with variations by the clinical problem types, with the patients in the psychosis group having the shortest duration and the patients in the depression group having the longest duration.