Thursday, October 19, 2017

Pfister Award Winner Describes Brief Psychotherapy Modules for Hope in the Midst of Demoralization

Hope is a natural antidote to despair and demoralization experienced by psychiatric patients that can be encouraged and supported through brief “hope” interventions that can be employed in crisis situations, according to James L. Griffith, M.D. Griffith delivered APA’s 2017 Oskar Pfister Award lecture today at IPS: The Mental Health Services Conference in New Orleans.

Griffith, the chair of psychiatry at George Washington University (GWU) School of Medicine, described his work developing brief intervention modules that help patients practice hope in demoralizing life situations and that can be taught to trainees and other mental health clinicians. His work on the subject was published in an article in Academic Psychiatry (July 2017).

“Despair from demoralization is a constant threat to patients with chronic mental illnesses, refugees fleeing persecution, elderly who are socially isolated, the medically disabled, and other marginalized or displaced people,” Griffith said.

Griffith said that he and his colleagues have identified 14 discrete psychotherapeutic practices, or interventions, in the psychotherapy literature that foster hope in patients. These practices correspond to one of four types of coping (problem solving and goal seeking, activating a core identity, emotion regulation, and relational coping) that clinicians can use depending on the strengths of the specific patient. Moreover, they can be employed in a crisis situation without formal psychotherapeutic training.

He described several clinical vignettes in which the “hope” modules were employed to meet and challenge the demoralizing life situations faced by individual patients. For instance, he described a suicidal patient in despair because her house was being foreclosed, and her dog—a companion of many years—had recently died.

A second-year resident at GWU, with no formal training in psychotherapy, asked the patient, “In the past when you faced adversity, what did you do?” The patient recalled when her father, on his deathbed, told her she “was a strong fighter” and the “glue that held the family together.”

These were affirmations that drew on this patient’s strength, activating her core identity. The resident advised the patient to find a picture of her father and look to it whenever she felt despair. The resident also advised the patient to reach out to her children. These actions began a process of rebuilding the patient’s sense of self-efficacy and control over her own fate.

Griffith said that to design psychotherapeutic interventions that help people practice hope, they must be usable in the real-life conditions in which patients find themselves. 

“They must be usable under the often-chaotic conditions of refugee life, homelessness, poverty, or medical or psychiatric illness where a clinician may have only one or two conversations in settings ill-suited for psychotherapy,” he said.

Look for further coverage of IPS: The Mental Health Services conference in upcoming editions of Psychiatric News.

(Image: Ellen M. Dallager)


The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.