The International Journal of Psychoanalysis is an academic journal in the field of psychoanalysis. The idea of the journal was proposed by Ernest Jones in a letter to Sigmund Freud dated 7 December 1918. The journal itself was established in 1920, with Jones serving as editor until 1939, the year of Freud’s death.
Background
The International Journal of Psychoanalysis incorporates the International Review of Psycho-Analysis, founded in 1974 by Joseph Sandler. It is run by the Institute of Psychoanalysis. For the last 95 years, the IJP has enjoyed its role as the main international vehicle for communication about psychoanalysis, enjoying a wide international readership from Europe, the Middle East, Africa, Asia-Pacific, North America, and Latin America. Past Editors of the International Journal have included Ernest Jones, James Strachey, Joseph Sandler, and David Tuckett. In 2015 the IJP had around 9000 subscribers.
Dana Birksted-Breen is the current Editor in Chief of The International Journal of Psychoanalysis. In 2012, she integrated the four regional boards into one large Editorial Board currently composed of over 100 members. There are five Associate Editors from four different geographic regions: Alessandra Lemma (UK), Jorge Canestri (Europe), Lucy LaFarge (North America), Beatriz de León de Bernardi (Latin America), Georg Bruns (representing no region); an Executive Editor, Gráinne Lucey (London); and Editors of specific sections, such as Education, The Analyst at Work, Psychoanalytic Controversies, Book Reviews, and Film Essays.
In recent years, the IJP has worked to strengthen dialogues between different psychoanalytic cultures. 2015 saw the launch of the Spanish edition of the journal – IJP en español. In 2013 the journal established the online open peer review, multi-language site IJP-Open (www.ijp-open.org). With the IJP Annuals (www.annualsofpsychoanalysis.com), each year papers from the journal are selected and translated into eight different languages: French, Spanish, German, Italian, Portuguese, Russian, Greek, and Turkish, with plans to launch a Chinese Annual in 2017.
Suicide care from the nursing perspective: A meta-synthesis of qualitative studies.
Background
To explore nurses’ experiences of suicide care and to identify and synthesize the most suitable interventions for the care of people with suicidal behaviour from a nursing perspective. A qualitative meta-synthesis.
Methods
Comprehensive search of five electronic databases for qualitative studies published between January 2015 and June 2019.
The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso’s method.
Results
Seventeen articles met the inclusion criteria. The data analysis revealed 13 subcategories from which four main categories emerged: ‘Understanding suicidal behaviour as a consequence of suffering’, ‘Nurses’ personal distress in suicide care’, ‘The presence of the nurse as the axis of suicide care’ and, ‘Improving nurses’ relational competences for a better therapeutic environment’.
Conclusions
Further training of nurses on the therapeutic relationship, particularly in non-mental health care work settings, and monitoring of the emotional impact on nurses in relation to suicide is required to promote more effective prevention and care.
Impact
This review provides new insights on how suicide is interpreted, the associated emotions, the way suicide is approached and proposals for improving clinical practice from the point of view of nurses. The results demonstrate that the nurse-patient relationship, ongoing assessment, and the promotion of a sense of security and hope are critical in nursing care for patients who exhibit suicidal behaviour. Consequently, to promote an effective nursing care of suicide, nurses should be provided with further training on the therapeutic relationship. Thus, health institutions do not only provide the time and space to conduct an adequate therapeutic relationship, but also, through their managers, they should supervise and address the emotional impact that is generated in nurses caring for patients who exhibit suicidal behaviour.
Reference
Clua-Garcia, R., Casanova-Garrigos, G. & Moreno-Poyato, A.R. (2021) Suicide care from the nursing perspective: A meta-synthesis of qualitative studies. Journal of Advanced Nursing. doi: 10.1111/jan.14789. Online ahead of print.
In psychology and cognitive science, a schema (plural schemata or schemas) describes a pattern of thought or behaviour that organises categories of information and the relationships among them. It can also be described as a mental structure of preconceived ideas, a framework representing some aspect of the world, or a system of organising and perceiving new information. Schemata influence attention and the absorption of new knowledge: people are more likely to notice things that fit into their schema, while re-interpreting contradictions to the schema as exceptions or distorting them to fit. Schemata have a tendency to remain unchanged, even in the face of contradictory information. Schemata can help in understanding the world and the rapidly changing environment. People can organise new perceptions into schemata quickly as most situations do not require complex thought when using schema, since automatic thought is all that is required.
People use schemata to organise current knowledge and provide a framework for future understanding. Examples of schemata include academic rubrics, social schemas, stereotypes, social roles, scripts, worldviews, and archetypes. In Piaget’s theory of development, children construct a series of schemata, based on the interactions they experience, to help them understand the world.
Brief History
“Schema” comes from the Greek word schēmat or schēma, meaning “figure”.
Prior to its use in psychology, the term “schema” had primarily seen use in philosophy. For instance, “schemata” (especially “transcendental schemata”) are crucial to the architectonic system devised by Immanuel Kant in his Critique of Pure Reason.
Early developments of the idea in psychology emerged with the gestalt psychologists and Jean Piaget: the term schéma was introduced by Piaget in 1923. In Piaget’s later publications, action (operative or procedural) schémes were distinguished from figurative (representational) schémas, although together they may be considered a schematic duality. In subsequent discussions of Piaget in English, schema was often a mistranslation of Piaget’s original French schéme. The distinction has been of particular importance in theories of embodied cognition and ecological psychology.
The concept was popularised in psychology and education through the work of the British psychologist Frederic Bartlett, who drew on the term body schema used by neurologist Henry Head. It was expanded into schema theory by educational psychologist Richard C. Anderson. Since then, other terms have been used to describe schema such as “frame”, “scene”, and “script”.
Schematic Processing
Through the use of schemata, a heuristic technique to encode and retrieve memories, the majority of typical situations do not require much strenuous processing. People can quickly organise new perceptions into schemata and act without effort.
However, schemata can influence and hamper the uptake of new information (proactive interference), such as when existing stereotypes, giving rise to limited or biased discourses and expectations (prejudices), lead an individual to “see” or “remember” something that has not happened because it is more believable in terms of his/her schema. For example, if a well-dressed businessman draws a knife on a vagrant, the schemata of onlookers may (and often do) lead them to “remember” the vagrant pulling the knife. Such distortion of memory has been demonstrated. (See Background Research below.)
Schemata are interrelated and multiple conflicting schemata can be applied to the same information. Schemata are generally thought to have a level of activation, which can spread among related schemata. Which schema is selected can depend on factors such as current activation, accessibility, priming and emotion.
Accessibility is how easily a schema comes to mind, and is determined by personal experience and expertise. This can be used as a cognitive shortcut; it allows the most common explanation to be chosen for new information.
With priming, a brief imperceptible stimulus temporarily provides enough activation to a schema so that it is used for subsequent ambiguous information. Although this may suggest the possibility of subliminal messages, the effect of priming is so fleeting that it is difficult to detect outside laboratory conditions.
Background Research
The original concept of schemata is linked with that of reconstructive memory as proposed and demonstrated in a series of experiments by Frederic Bartlett. By presenting participants with information that was unfamiliar to their cultural backgrounds and expectations and then monitoring how they recalled these different items of information (stories, etc.), Bartlett was able to establish that individuals’ existing schemata and stereotypes influence not only how they interpret “schema-foreign” new information but also how they recall the information over time. One of his most famous investigations involved asking participants to read a Native American folk tale, “The War of the Ghosts”, and recall it several times up to a year later. All the participants transformed the details of the story in such a way that it reflected their cultural norms and expectations, i.e. in line with their schemata. The factors that influenced their recall were:
Omission of information that was considered irrelevant to a participant;
Transformation of some of the details, or of the order in which events, etc., were recalled; a shift of focus and emphasis in terms of what was considered the most important aspects of the tale;
Rationalization: details and aspects of the tale that would not make sense would be “padded out” and explained in an attempt to render them comprehensible to the individual in question; and
Cultural shifts: the content and the style of the story were altered in order to appear more coherent and appropriate in terms of the cultural background of the participant.
Bartlett’s work was crucially important in demonstrating that long-term memories are neither fixed nor immutable but are constantly being adjusted as schemata evolve with experience. In a sense it supports the existentialist view that people construct the past and present in a constant process of narrative/discursive adjustment, and that much of what people “remember” is actually confabulated (adjusted and rationalised) narrative that allows them to think of the past as a continuous and coherent string of events, even though it is probable that large sections of memory (both episodic and semantic) are irretrievable at any given time.
An important step in the development of schema theory was taken by the work of D.E. Rumelhart describing the understanding of narrative and stories. Further work on the concept of schemata was conducted by W.F. Brewer and J.C. Treyens, who demonstrated that the schema-driven expectation of the presence of an object was sometimes sufficient to trigger its erroneous recollection. An experiment was conducted where participants were requested to wait in a room identified as an academic’s study and were later asked about the room’s contents. A number of the participants recalled having seen books in the study whereas none were present. Brewer and Treyens concluded that the participants’ expectations that books are present in academics’ studies were enough to prevent their accurate recollection of the scenes.
In the 1970s, computer scientist Marvin Minsky was trying to develop machines that would have human-like abilities. When he was trying to create solutions for some of the difficulties he encountered he came across Bartlett’s work and decided that if he was ever going to get machines to act like humans he needed them to use their stored knowledge to carry out processes. To compensate for that he created what was known as the frame construct, which was a way to represent knowledge in machines. His frame construct can be seen as an extension and elaboration of the schema construct. He created the frame knowledge concept as a way to interact with new information. He proposed that fixed and broad information would be represented as the frame, but it would also be composed of slots that would accept a range of values; but if the world did not have a value for a slot, then it would be filled by a default value. Because of Minsky’s work, computers now have a stronger impact on psychology. In the 1980s, David Rumelhart extended Minsky’s ideas, creating an explicitly psychological theory of the mental representation of complex knowledge.
Roger Schank and Robert Abelson developed the idea of a script, which was known as a generic knowledge of sequences of actions. This led to many new empirical studies, which found that providing relevant schema can help improve comprehension and recall on passages.
Modification
New information that falls within an individual’s schema is easily remembered and incorporated into their worldview. However, when new information is perceived that does not fit a schema, many things can happen. The most common reaction is to simply ignore or quickly forget the new information. This can happen on an unconscious level – frequently an individual may not even perceive the new information. People may also interpret the new information in a way that minimizes how much they must change their schemata. For example, Bob thinks that chickens do not lay eggs. He then sees a chicken laying an egg. Instead of changing the part of his schema that says “chickens do not lay eggs”, he is likely to adopt the belief that the animal in question that he has just seen laying an egg is not a real chicken. This is an example of disconfirmation bias, the tendency to set higher standards for evidence that contradicts one’s expectations. However, when the new information cannot be ignored, existing schemata must be changed or new schemata must be created (accommodation).
Jean Piaget (1896-1980) was known best for his work with development of human knowledge. He believed knowledge was constructed on cognitive structures, and he believed people develop cognitive structures by accommodating and assimilating information. Accommodation is creating new schema that will fit better with the new environment or adjusting old schema. Accommodation could also be interpreted as putting restrictions on a current schema. Accommodation usually comes about when assimilation has failed. Assimilation is when people use a current schema to understand the world around them. Piaget thought that schemata are applied to everyday life and therefore people accommodate and assimilate information naturally. For example, if this chicken has red feathers, Bob can form a new schemata that says “chickens with red feathers can lay eggs”. This schemata will then be either changed or removed, in the future.
Assimilation is the reuse of schemata to fit the new information. For example, when a person sees an unfamiliar dog, they will probably just integrate it into their dog schema. However, if the dog behaves strangely, and in ways that does not seem dog-like, there will be accommodation as a new schema is formed for that particular dog. With Accommodation and Assimilation comes the idea of equilibrium. Piaget describes equilibrium as a state of cognition that is balanced when schema are capable of explaining what it sees and perceives. When information is new and cannot fit into existing schema this is called disequilibrium and this is an unpleasant state for the child’s development. When disequilibrium happens, it means the person is frustrated and will try to restore the coherence of his or her cognitive structures through accommodation. If the new information is taken then assimilation of the new information will proceed until they find that they must make a new adjustment to it later down the road, but for now the child remains at equilibrium again. The process of equilibration is when people move from the equilibrium phase to the disequilibrium phase and back into equilibrium.
Self-Schema
Schemata about oneself are considered to be grounded in the present and based on past experiences. Memories are framed in the light of one’s self-conception. For example, people who have positive self-schemata (i.e. most people) selectively attend to flattering information and selectively ignore unflattering information, with the consequence that flattering information is subject to deeper encoding, and therefore superior recall. Even when encoding is equally strong for positive and negative feedback, positive feedback is more likely to be recalled. Moreover, memories may even be distorted to become more favourable, for example, people typically remember exam grades as having been better than they actually were. However, when people have negative self views, memories are generally biased in ways that validate the negative self-schema; people with low self-esteem, for instance, are prone to remember more negative information about themselves than positive information. Thus, memory tends to be biased in a way that validates the agent’s pre-existing self-schema.
There are three major implications of self-schemata. First, information about oneself is processed faster and more efficiently, especially consistent information. Second, one retrieves and remembers information that is relevant to one’s self-schema. Third, one will tend to resist information in the environment that is contradictory to one’s self-schema. For instance, students with a particular self-schema prefer roommates whose view of them is consistent with that schema. Students who end up with roommates whose view of them is inconsistent with their self-schema are more likely to try to find a new roommate, even if this view is positive. This is an example of self-verification.
As researched by Aaron Beck, automatically activated negative self-schemata are a large contributor to depression. According to Cox, Abramson, Devine, and Hollon (2012), these self-schemata are essentially the same type of cognitive structure as stereotypes studied by prejudice researchers (e.g. they are both well-rehearsed, automatically activated, difficult to change, influential toward behaviour, emotions, and judgments, and bias information processing).
The self-schema can also be self-perpetuating. It can represent a particular role in society that is based on stereotype, for example: “If a mother tells her daughter she looks like a tom boy, her daughter may react by choosing activities that she imagines a tom boy would do. Conversely, if the mother tells her she looks like a princess, her daughter might choose activities thought to be more feminine.” This is an example of the self-schema becoming self-perpetuating when the person at hand chooses an activity that was based on an expectation rather than their desires.
Schema Therapy
Schema therapy was founded by Jeffrey Young and represents a development of cognitive behavioural therapy (CBT) specifically for treating personality disorders. Early maladaptive schemata are described by Young as broad and pervasive themes or patterns made up of memories, feelings, sensations, and thoughts regarding oneself and one’s relationships with others. They are considered to develop during childhood or adolescence, and to be dysfunctional in that they lead to self-defeating behaviour. Examples include schemata of abandonment/instability, mistrust/abuse, emotional deprivation, and defectiveness/shame.
Schema therapy blends CBT with elements of Gestalt therapy, object relations, constructivist and psychoanalytic therapies in order to treat the characterological difficulties which both constitute personality disorders and which underlie many of the chronic depressive or anxiety-involving symptoms which present in the clinic. Young said that CBT may be an effective treatment for presenting symptoms, but without the conceptual or clinical resources for tackling the underlying structures (maladaptive schemata) which consistently organize the patient’s experience, the patient is likely to lapse back into unhelpful modes of relating to others and attempting to meet their needs. Young focused on pulling from different therapies equally when developing schema therapy. The difference between cognitive behavioural therapy and schema therapy is the latter “emphasizes lifelong patterns, affective change techniques, and the therapeutic relationship, with special emphasis on limited reparenting”. He recommended this therapy would be ideal for clients with difficult and chronic psychological disorders. Some examples would be eating disorders and personality disorders. He has also had success with this therapy in relation to depression and substance abuse.
Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries.
Background
The prevalence of type 2 diabetes is increased in individuals with mental disorders. Much of the burden of disease falls on the populations of low- and middle-income countries (LMICs).
Therefore the aim of this study was to assess the effects of pharmacological, behaviour change, and organisational interventions versus active and non-active comparators in the prevention or delay of type 2 diabetes among people with mental illness in LMICs.
Methods
The researchers searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase and six other databases, as well as three international trials registries. They also searched conference proceedings and checked the reference lists of relevant systematic reviews. Searches are current up to 20 February 2020.
A randomised controlled trials (RCTs) of pharmacological, behavioural or organisational interventions targeting the prevention or delay of type 2 diabetes in adults with mental disorders in LMICs.
Pairs of review authors working independently performed data extraction and risk of bias assessments. They conducted meta-analyses using random-effects models.
Results
One hospital-based RCT with 150 participants (99 participants with schizophrenia) addressed our review’s primary outcome of prevention or delay of type 2 diabetes onset. Low-certainty evidence from this study did not show a difference between atypical and typical antipsychotics in the development of diabetes at six weeks (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.03 to 7.05) (among a total 99 participants with schizophrenia, 68 were in atypical and 31 were in typical antipsychotic groups; 55 participants without mental illness were not considered in the analysis). An additional 29 RCTs with 2481 participants assessed one or more of the review’s secondary outcomes. All studies were conducted in hospital settings and reported on pharmacological interventions.
One study, which the researchers could not include in our meta-analysis, included an intervention with pharmacological and behaviour change components. They identified no studies of organisational interventions. Low- to moderate-certainty evidence suggests there may be no difference between the use of atypical and typical antipsychotics for the outcomes of drop-outs from care (RR 1.31, 95% CI 0.63 to 2.69; two studies with 144 participants), and fasting blood glucose levels (mean difference (MD) 0.05 lower, 95% CI 0.10 to 0.00; two studies with 211 participants). Participants who receive typical antipsychotics may have a lower body mass index (BMI) at follow-up than participants who receive atypical antipsychotics (MD 0.57, 95% CI 0.33 to 0.81; two studies with 141 participants; moderate certainty of evidence), and may have lower total cholesterol levels eight weeks after starting treatment (MD 0.35, 95% CI 0.27 to 0.43; one study with 112 participants). There was moderate certainty evidence suggesting no difference between the use of metformin and placebo for the outcomes of drop-outs from care (RR 1.22, 95% CI 0.09 to 16.35; three studies with 158 participants).
There was moderate-to-high certainty evidence of no difference between metformin and placebo for fasting blood glucose levels (endpoint data: MD -0.35, 95% CI -0.60 to -0.11; change from baseline data: MD 0.01, 95% CI -0.21 to 0.22; five studies with 264 participants). There was high certainty evidence that BMI was lower for participants receiving metformin compared with those receiving a placebo (MD -1.37, 95% CI -2.04 to -0.70; five studies with 264 participants; high certainty of evidence). There was no difference between metformin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Low-certainty evidence from one study (48 participants) suggests there may be no difference between the use of melatonin and placebo for the outcome of drop-outs from care (RR 1.00, 95% CI 0.38 to 2.66). Fasting blood glucose is probably reduced more in participants treated with melatonin compared with placebo (endpoint data: MD -0.17, 95% CI -0.35 to 0.01; change from baseline data: MD -0.24, 95% CI -0.39 to -0.09; three studies with 202 participants, moderate-certainty evidence).
There was no difference between melatonin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Very low-certainty evidence from one study (25 participants) suggests that drop-outs may be higher in participants treated with a tricyclic antidepressant (TCA) compared with those receiving a selective serotonin reuptake inhibitor (SSRI) (RR 0.34, 95% CI 0.11 to 1.01). It is uncertain if there is no difference in fasting blood glucose levels between these groups (MD -0.39, 95% CI -0.88 to 0.10; three studies with 141 participants, moderate-certainty evidence). It is uncertain if there is no difference in BMI and depression between the TCA and SSRI antidepressant groups.
Conclusions
Only one study reported data on the primary outcome of interest, providing low-certainty evidence that there may be no difference in risk between atypical and typical antipsychotics for the outcome of developing type 2 diabetes. The researchers are therefore not able to draw conclusions on the prevention of type 2 diabetes in people with mental disorders in LMICs. For studies reporting on secondary outcomes, there was evidence of risk of bias in the results. There is a need for further studies with participants from LMICs with mental disorders, particularly on behaviour change and on organisational interventions targeting prevention of type 2 diabetes in these populations.
Reference
Mishu, M.P., Uphoff, E., Aslam, F., Philip, S., Wright, J., Tirbhowan, N., Ajjan, R.A., Azdi, Z.A., Stubbs, B., Chhurchill, R. & Siddiqi, N. (2021) Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries. The Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD013281.pub2.
1916 – Hans Eysenck, German-English psychologist and theorist (d. 1997).
People (Deaths)
1925 – James Ward, English psychologist and philosopher (b. 1843).
Hans Eysenck
Hans Jürgen Eysenck (04 March 1916 to 04 September 1997) was a German-born British psychologist who spent his professional career in Great Britain. He is best remembered for his work on intelligence and personality, although he worked on other issues within psychology. At the time of his death, Eysenck was the living psychologist most frequently cited in the peer-reviewed scientific journal literature. A 2019 study found him to be the third most controversial of 55 intelligence researchers.
Eysenck’s research purported to show that certain personality types had an elevated risk of cancer and heart disease. Scholars have identified errors and suspected data manipulation in Eysenck’s work, and large replications have failed to confirm the relationships that he purported to find. An enquiry on behalf of King’s College London found the papers by Eysenck to be “incompatible with modern clinical science”.
In 2019, 26 of his papers (all co-authored with Ronald Grossarth-Maticek) were considered “unsafe” by an enquiry on behalf of King’s College London. 14 of his papers were retracted in 2020, and journals issued 64 statements of concern about publications by him. Rod Buchanan, a biographer of Eysenck, has argued that 87 publications by Eysenck should be retracted.
James Ward
James Ward FBA (27 January 1843 to 04 March 1925) was an English psychologist and philosopher. He was a Cambridge Apostle.
Apprenticed to a Liverpool architect for four years, Ward studied Greek and logic and was a Sunday school teacher. In 1863, he entered Spring Hill College, near Birmingham, to train for the Congregationalist ministry. An eccentric and impoverished student, he remained at Spring Hill until 1869, completing his theological studies as well as gaining a University of London BA degree.
In 1869-1870, Ward won a scholarship to Germany, where he attended the lectures of Isaac Dormer in Berlin before moving to Göttingen to study under Hermann Lotze. On his return to Britain Ward became minister at Emmanuel Congregational Church in Cambridge, where his theological liberalism unhappily antagonised his congregation. Sympathetic to Ward’s predicament, Henry Sidgwick encouraged Ward to enter Cambridge University. Initially a non-collegiate student, Ward won a scholarship to Trinity College in 1873, and achieved a first class in the moral sciences tripos in 1874.
With a dissertation entitled The Relation of Physiology to Psychology, Ward won a Trinity fellowship in 1875. Some of this work, An interpretation of Fechner’s Law, was published in the first volume of the new journal Mind (1876).
During 1876-1877 he returned to Germany, studying in Carl Ludwig’s Leipzig physiological institute. Back in Cambridge, Ward continued physiological research under Michael Foster, publishing a pair of physiological papers in 1879 and 1880.
However, from 1880 onwards Ward moved away from physiology to psychology. His article Psychology for the ninth edition of the Encyclopaedia Britannica was enormously influential – criticising associationist psychology with an emphasis upon the mind’s active attention to the world.
He was elected to the new Chair of Mental Philosophy and Logic in 1897 and his students included G.E. Moore, Bertrand Russell, Sir Mohammed Iqbal and George Stout.
He was president of the Aristotelian Society from 1919 to 1920; his wife Mary (née Martin) was a lecturer in moral sciences at Newnham College, a suffragist and a member of the Ladies Dining Society in Cambridge.
Ward died in Cambridge, and was cremated at Cambridge Crematorium.
Rational emotive behaviour therapy (REBT), previously called rational therapy and rational emotive therapy, is an active-directive, philosophically and empirically based psychotherapy, the aim of which is to resolve emotional and behavioural problems and disturbances and to help people to lead happier and more fulfilling lives.
REBT posits that people have erroneous beliefs about situations they are involved in, and that these beliefs cause disturbance, but can be disputed with and changed.
Brief History
Rational emotive behaviour therapy (REBT) was created and developed by the American psychotherapist and psychologist Albert Ellis, who was inspired by many of the teachings of Asian, Greek, Roman and modern philosophers. REBT is the first form of cognitive behavioural therapy (CBT) and was first expounded by Ellis in the mid-1950s; development continued until his death in 2007. Ellis became synonymous with the highly influential therapy. Psychology Today noted, “No individual—not even Freud himself—has had a greater impact on modern psychotherapy.”
REBT is both a psychotherapeutic system of theory and practices and a school of thought established by Ellis. He first presented his ideas at a conference of the American Psychological Association in 1956 then published a seminal article in 1957 entitled “Rational psychotherapy and individual psychology”, in which he set the foundation for what he was calling rational therapy (RT) and carefully responded to questions from Rudolf Dreikurs and others about the similarities and differences with Alfred Adler’s Individual psychology. This was around a decade before psychiatrist Aaron Beck first set forth his “cognitive therapy”, after Ellis had contacted him in the mid 1960s. Ellis’ own approach was renamed Rational Emotive Therapy in 1959, then the current term in 1992.
Precursors of certain fundamental aspects of rational emotive behaviour therapy have been identified in ancient philosophical traditions, particularly to Stoicists Marcus Aurelius, Epictetus, Zeno of Citium, Chrysippus, Panaetius of Rhodes, Cicero, and Seneca, and early Asian philosophers Confucius and Gautama Buddha. In his first major book on rational therapy, Ellis wrote that the central principle of his approach, that people are rarely emotionally affected by external events but rather by their thinking about such events, “was originally discovered and stated by the ancient Stoic philosophers”. Ellis illustrates this with a quote from the Enchiridion of Epictetus: “Men are disturbed not by things, but by the views which they take of them.” Ellis noted that Shakespeare expressed a similar thought in Hamlet: “There’s nothing good or bad but thinking makes it so.” Ellis also acknowledges early 20th century therapists, particularly Paul Charles Dubois, though he only read his work several years after developing his therapy.
Theoretical Assumptions
The REBT framework posits that humans have both innate rational (meaning self-helping, socially helping, and constructive) and irrational (meaning self-defeating, socially defeating, and unhelpful) tendencies and leanings. REBT claims that people to a large degree consciously and unconsciously construct emotional difficulties such as self-blame, self-pity, clinical anger, hurt, guilt, shame, depression and anxiety, and behaviours and behaviour tendencies like procrastination, compulsiveness, avoidance, addiction and withdrawal by the means of their irrational and self-defeating thinking, emoting and behaving.
REBT is then applied as an educational process in which the therapist often active-directively teaches the client how to identify irrational and self-defeating beliefs and philosophies which in nature are rigid, extreme, unrealistic, illogical and absolutist, and then to forcefully and actively question and dispute them and replace them with more rational and self-helping ones. By using different cognitive, emotive and behavioural methods and activities, the client, together with help from the therapist and in homework exercises, can gain a more rational, self-helping and constructive rational way of thinking, emoting and behaving.
One of the main objectives in REBT is to show the client that whenever unpleasant and unfortunate activating events occur in people’s lives, they have a choice between making themselves feel healthily or, self-helpingly, sorry, disappointed, frustrated, and annoyed or making themselves feel unhealthily and self-defeatingly horrified, terrified, panicked, depressed, self-hating and self-pitying. By attaining and ingraining a more rational and self-constructive philosophy of themselves, others and the world, people often are more likely to behave and emote in more life-serving and adaptive ways.
Beliefs about Circumstances, and Disputing the Beliefs
A fundamental premise of REBT is humans do not get emotionally disturbed by unfortunate circumstances, but by how they construct their views of these circumstances through their language, evaluative beliefs, meanings and philosophies about the world, themselves and others. This concept has been attributed as far back as the Roman philosopher Epictetus, who is often cited as utilising similar ideas in antiquity.
In REBT, clients usually learn and begin to apply this premise by learning the A-B-C-D-E-F model of psychological disturbance and change. The following letters represent the following meanings in this model:
A – The adversity.
B – The developed belief in the person of the Adversity.
C – The consequences of that person’s Beliefs i.e., B.
D – The person’s disputes of A, B, and C. In latter thought.
E – The effective new philosophy or belief that develops in that person through the occurrence of D in their minds of A and B.
F – The developed feelings of one’s self either at point and after point C or at point after point E.
The A-B-C model states that it is not an A, adversity (or activating event) that cause disturbed and dysfunctional emotional and behavioural Cs, consequences, but also what people B, irrationally believe about the A, adversity. A, adversity can be an external situation, or a thought, a feeling or other kind of internal event, and it can refer to an event in the past, present, or future.
The Bs, irrational beliefs that are most important in the A-B-C model are explicit and implicit philosophical meanings and assumptions about events, personal desires, and preferences. The Bs, beliefs that are most significant are highly evaluative and consist of interrelated and integrated cognitive, emotional and behavioural aspects and dimensions. According to REBT, if a person’s evaluative B, belief about the A, activating event is rigid, absolutistic, fictional and dysfunctional, the C, the emotional and behavioural consequence, is likely to be self-defeating and destructive. Alternatively, if a person’s belief is preferential, flexible and constructive, the C, the emotional and behavioural consequence is likely to be self-helping and constructive.
Through REBT, by understanding the role of their mediating, evaluative and philosophically based illogical, unrealistic and self-defeating meanings, interpretations and assumptions in disturbance, individuals can learn to identify them, then go to D, disputing and questioning the evidence for them. At E, effective new philosophy, they can recognise and reinforce the notion no evidence exists for any psychopathological must, ought or should and distinguish them from healthy constructs, and subscribe to more constructive and self-helping philosophies. This new reasonable perspective leads to F, new feelings and behaviours appropriate to the A they are addressing in the exercise.
Psychological Dysfunction
One of the main pillars of REBT is that irrational and dysfunctional ways and patterns of thinking, feeling, and behaving are contributing to human disturbance and emotional and behavioural self-defeatism and social defeatism. REBT generally teaches that when people turn flexible preferences, desires and wishes into grandiose, absolutistic and fatalistic dictates, this tends to contribute to disturbance and upset. These dysfunctional patterns are examples of cognitive distortions.
Core Beliefs that Disturb Humans
Albert Ellis has suggested three core beliefs or philosophies that humans tend to disturb themselves through:
“I absolutely MUST, under practically all conditions and at all times, perform well (or outstandingly well) and win the approval (or complete love) of significant others. If I fail in these important—and sacred—respects, that is awful and I am a bad, incompetent, unworthy person, who will probably always fail and deserves to suffer.”
“Other people with whom I relate or associate, absolutely MUST, under practically all conditions and at all times, treat me nicely, considerately and fairly. Otherwise, it is terrible and they are rotten, bad, unworthy people who will always treat me badly and do not deserve a good life and should be severely punished for acting so abominably to me.”
“The conditions under which I live absolutely MUST, at practically all times, be favorable, safe, hassle-free, and quickly and easily enjoyable, and if they are not that way it’s awful and horrible and I can’t bear it. I can’t ever enjoy myself at all. My life is impossible and hardly worth living.”
Holding this belief when faced with adversity tends to contribute to feelings of anxiety, panic, depression, despair, and worthlessness.
Holding this belief when faced with adversity tends to contribute to feelings of anger, rage, fury, and vindictiveness.
Holding this belief when faced with adversity tends to contribute to frustration and discomfort, intolerance, self-pity, anger, depression, and to behaviours such as procrastination, avoidance, addictive behaviours and inaction.
Rigid Demands that Humans Make
REBT commonly posits that at the core of irrational beliefs there often are explicit or implicit rigid demands and commands, and that extreme derivatives like awfulising, low frustration tolerance, people deprecation and over-generalisations are accompanied by these. According to REBT the core dysfunctional philosophies in a person’s evaluative emotional and behavioural belief system, are also very likely to contribute to unrealistic, arbitrary and crooked inferences and distortions in thinking. REBT therefore first teaches that when people in an insensible and devout way overuse absolutistic, dogmatic and rigid “shoulds”, “musts”, and “oughts”, they tend to disturb and upset themselves.
Over-Generalisation
Further, REBT generally posits that disturbed evaluations to a large degree occur through over-generalisation, wherein people exaggerate and globalise events or traits, usually unwanted events or traits or behaviour, out of context, while almost always ignoring the positive events or traits or behaviours. For example, awfulising is partly mental magnification of the importance of an unwanted situation to a catastrophe or horror, elevating the rating of something from bad to worse than it should be, to beyond totally bad, worse than bad to the intolerable and to a “holocaust”. The same exaggeration and overgeneralising occurs with human rating, wherein humans come to be arbitrarily and axiomatically defined by their perceived flaws or misdeeds. Frustration intolerance then occurs when a person perceives something to be too difficult, painful or tedious, and by doing so exaggerates these qualities beyond one’s ability to cope with them.
Secondary Disturbances
Essential to REBT theory is also the concept of secondary disturbances which people sometimes construct on top of their primary disturbance. As Ellis emphasizes:
“Because of their self-consciousness and their ability to think about their thinking, they can very easily disturb themselves about their disturbances and can also disturb themselves about their ineffective attempts to overcome their emotional disturbances.”
Origins of Dysfunction
Regarding cognitive-affective-behavioral processes in mental functioning and dysfunctioning, originator Albert Ellis explains:
“REBT assumes that human thinking, emotion, and action are not really separate or disparate processes, but that they all significantly overlap and are rarely experienced in a pure state. Much of what we call emotion is nothing more nor less than a certain kind—a biased, prejudiced, or strongly evaluative kind—of thought. But emotions and behaviors significantly influence and affect thinking, just as thinking influences emotions and behaviors. Evaluating is a fundamental characteristic of human organisms and seems to work in a kind of closed circuit with a feedback mechanism: First, perception biases response, and then response tends to bias subsequent perception. Also, prior perceptions appear to bias subsequent perceptions, and prior responses appear to bias subsequent responses. What we call feelings almost always have a pronounced evaluating or appraisal element.”
REBT then generally proposes that many of these self-defeating cognitive, emotive and behavioural tendencies are both innately biological and indoctrinated early in and during life, and further grow stronger as a person continually revisits, clings and acts on them. Ellis alludes to similarities between REBT and the general semantics when explaining the role of irrational beliefs in self-defeating tendencies, citing Alfred Korzybski as a significant modern influence on this thinking.
REBT differs from other clinical approaches like psychoanalysis in that it places little emphasis on exploring the past, but instead focuses on changing the current evaluations and philosophical thinking-emoting and behaving in relation to themselves, others and the conditions under which people live.
Irrational Beliefs
REBT proposes four core irrational beliefs;
Demands: The tendency to demand success, fair treatment, and respect (e.g. I must be treated fairly).
Awfulizing: The tendency to consider adverse events as awful or terrible (e.g. It is awful when I am disrespected).
Low Frustration Tolerance (LFT): The belief that one could not stand or tolerate adversity (e.g. I cannot stand being treated unfairly).
Depreciation: The belief that one event reflects the person as a whole (e.g. When I fail it shows that I am a complete failure).
Other Insights
Other insights of REBT (some referring to the ABCDEF model above) are:
Insight 1:
People seeing and accepting the reality that their emotional disturbances at point C are only partially caused by the activating events or adversities at point A that precede C.
Although A contributes to C, and although disturbed Cs (such as feelings of panic and depression) are much more likely to follow strong negative As (such as being assaulted or raped), than they are to follow weak.
As (such as being disliked by a stranger), the main or more direct cores of extreme and dysfunctional emotional disturbances (Cs) are people’s irrational beliefs – the “absolutistic” (inflexible) “musts” and their accompanying inferences and attributions that people strongly believe about the activating event.
Insight 2:
No matter how, when, and why people acquire self-defeating or irrational beliefs (i.e. beliefs that are the main cause of their dysfunctional emotional-behavioural consequences), if they are disturbed in the present, they tend to keep holding these irrational beliefs and continue upsetting themselves with these thoughts.
They do so not because they held them in the past, but because they still actively hold them in the present (often unconsciously), while continuing to reaffirm their beliefs and act as if they are still valid.
In their minds and hearts, the troubled people still follow the core “musturbatory” philosophies they adopted or invented long ago, or ones they recently accepted or constructed.
Insight 3:
No matter how well they have gained insights 1 and 2, insight alone rarely enables people to undo their emotional disturbances.
They may feel better when they know, or think they know, how they became disturbed, because insights can feel useful and curative.
But it is unlikely that people will actually get better and stay better unless they have and apply insight 3, which is that there is usually no way to get better and stay better except by continual work and practice in looking for and finding one’s core irrational beliefs; actively, energetically, and scientifically disputing them; replacing one’s absolute “musts” (rigid requirements about how things should be) with more flexible preferences; changing one’s unhealthy feelings to healthy, self-helping emotions; and firmly acting against one’s dysfunctional fears and compulsions.
Only by a combined cognitive, emotive, and behavioural, as well as a quite persistent and forceful attack on one’s serious emotional problems, is one likely to significantly ameliorate or remove them, and keep them removed.
Intervention
As explained, REBT is a therapeutic system of both theory and practice; generally one of the goals of REBT is to help clients see the ways in which they have learned how they often needlessly upset themselves, teach them how to “un-upset” themselves and then how to empower themselves to lead happier and more fulfilling lives. The emphasis in therapy is generally to establish a successful collaborative therapeutic working alliance based on the REBT educational model. Although REBT teaches that the therapist or counsellor is better served by demonstrating unconditional other-acceptance or unconditional positive regard, the therapist is not necessarily always encouraged to build a warm and caring relationship with the client. The tasks of the therapist or counsellor include understanding the client’s concerns from his point of reference and work as a facilitator, teacher and encourager.
In traditional REBT, the client together with the therapist, in a structured active-directive manner, often work through a set of target problems and establish a set of therapeutic goals. In these target problems, situational dysfunctional emotions, behaviours and beliefs are assessed in regards to the client’s values and goals. After working through these problems, the client learns to generalise insights to other relevant situations. In many cases after going through a client’s different target problems, the therapist is interested in examining possible core beliefs and more deep rooted philosophical evaluations and schemas that might account for a wider array of problematic emotions and behaviours. Although REBT much of the time is used as a brief therapy, in deeper and more complex problems, longer therapy is promoted.
In therapy, the first step often is that the client acknowledges the problems, accepts emotional responsibility for these and has willingness and determination to change. This normally requires a considerable amount of insight, but as originator Albert Ellis explains:
“Humans, unlike just about all the other animals on earth, create fairly sophisticated languages which not only enable them to think about their feeling, their actions, and the results they get from doing and not doing certain things, but they also are able to think about their thinking and even think about thinking about their thinking.”
Through the therapeutic process, REBT employs a wide array of forceful and active, meaning multimodal and disputing, methodologies. Central through these methods and techniques is the intent to help the client challenge, dispute and question their destructive and self-defeating cognitions, emotions and behaviours. The methods and techniques incorporate cognitive-philosophic, emotive-evocative-dramatic, and behavioural methods for disputation of the client’s irrational and self-defeating constructs and helps the client come up with more rational and self-constructive ones. REBT seeks to acknowledge that understanding and insight are not enough; in order for clients to significantly change, they need to pinpoint their irrational and self-defeating constructs and work forcefully and actively at changing them to more functional and self-helping ones.
REBT posits that the client must work hard to get better, and in therapy this normally includes a wide array of homework exercises in day-to-day life assigned by the therapist. The assignments may for example include desensitisation tasks, i.e. by having the client confront the very thing he or she is afraid of. By doing so, the client is actively acting against the belief that often is contributing significantly to the disturbance.
Another factor contributing to the brevity of REBT is that the therapist seeks to empower the client to help himself through future adversities. REBT only promotes temporary solutions if more fundamental solutions are not found. An ideal successful collaboration between the REBT therapist and a client results in changes to the client’s philosophical way of evaluating himself or herself, others, and his or her life, which will likely yield effective results. The client then moves toward unconditional self-acceptance, other-acceptance and life-acceptance while striving to live a more self-fulfilling and happier life.
Applications and Interfaces
Applications and interfaces of REBT are used with a broad range of clinical problems in traditional psychotherapeutic settings such as individual-, group- and family therapy. It is used as a general treatment for a vast number of different conditions and psychological problems normally associated with psychotherapy.
In addition, REBT is used with non-clinical problems and problems of living through counselling, consultation and coaching settings dealing with problems including relationships, social skills, career changes, stress management, assertiveness training, grief, problems with aging, money, weight control etc. More recently, the reported use of REBT in sport and exercise settings has grown, with the efficacy of REBT demonstrated across a range of sports.
REBT also has many interfaces and applications through self-help resources, phone and internet counselling, workshops & seminars, workplace and educational programmes, etc. This includes Rational Emotive Education (REE) where REBT is applied in education settings, Rational Effectiveness Training in business and work-settings and SMART Recovery (Self Management And Recovery Training) in supporting those in addiction recovery, in addition to a wide variety of specialised treatment strategies and applications.
Efficacy
REBT and CBT in general have a substantial and strong research base to verify and support both their psychotherapeutic efficiency and their theoretical underpinnings. Meta-analyses of outcome-based studies reveal REBT to be effective for treating various psychopathologies, conditions and problems. Recently, REBT randomised clinical trials have offered a positive view on the efficacy of REBT.
In general REBT is arguably one of the most investigated theories in the field of psychotherapy and a large amount of clinical experience and a substantial body of modern psychological research have validated and substantiated many of REBTs theoretical assumptions on personality and psychotherapy.
REBT may be effective in improving sports performance and mental health.
Limitations and Critique
The clinical research on REBT has been criticised both from within and by others. For instance, originator Albert Ellis has on occasions emphasized the difficulty and complexity of measuring psychotherapeutic effectiveness, because many studies only tend to measure whether clients merely feel better after therapy instead of them getting better and staying better. Ellis has also criticised studies for having limited focus primarily to cognitive restructuring aspects, as opposed to the combination of cognitive, emotive and behavioural aspects of REBT. As REBT has been subject to criticisms during its existence, especially in its early years, REBT theorists have a long history of publishing and addressing those concerns. It has also been argued by Ellis and by other clinicians that REBT theory on numerous occasions has been misunderstood and misconstrued both in research and in general.
Some have criticised REBT for being harsh, formulaic and failing to address deep underlying problems. REBT theorists have argued in reply that a careful study of REBT shows that it is both philosophically deep, humanistic and individualised collaboratively working on the basis of the client’s point of reference. They have further argued that REBT utilises an integrated and interrelated methodology of cognitive, emotive-experiential and behavioural interventions. Others have questioned REBTs view of rationality, both radical constructivists who have claimed that reason and logic are subjective properties and those who believe that reason can be objectively determined. REBT theorists have argued in reply that REBT raises objections to clients’ irrational choices and conclusions as a working hypothesis and through collaborative efforts demonstrate the irrationality on practical, functional and social consensual grounds. In 1998 when asked what the main criticism on REBT was, Albert Ellis replied that it was the claim that it was too rational and not dealing sufficiently enough with emotions. He repudiated the claim by saying that REBT on the contrary emphasizes that thinking, feeling, and behaving are interrelated and integrated, and that it includes a vast amount of both emotional and behavioural methods in addition to cognitive ones.
Ellis has himself in very direct terms criticised opposing approaches such as psychoanalysis, transpersonal psychology and abreactive psychotherapies in addition to on several occasions questioning some of the doctrines in certain religious systems, spiritualism and mysticism. Many, including REBT practitioners, have warned against dogmatising and sanctifying REBT as a supposedly perfect psychological panacea. Prominent REBTers have promoted the importance of high quality and programmatic research, including originator Ellis, a self-proclaimed “passionate sceptic”. He has on many occasions been open to challenges and acknowledged errors and inefficiencies in his approach and concurrently revised his theories and practices. In general, with regard to cognitive-behavioural psychotherapies’ interventions, others have pointed out that as about 30-40% of people are still unresponsive to interventions, that REBT could be a platform of reinvigorating empirical studies on the effectiveness of the cognitive-behavioural models of psychopathology and human functioning.
REBT has been developed, revised and augmented through the years as understanding and knowledge of psychology and psychotherapy have progressed. This includes its theoretical concepts, practices and methodology. The teaching of scientific thinking, reasonableness and un-dogmatism has been inherent in REBT as an approach, and these ways of thinking are an inextricable part of REBT’s empirical and sceptical nature.
I hope I am also not a devout REBTer, since I do not think it is an unmitigated cure for everyone and do accept its distinct limitations. (Albert Ellis).
Mental Wellness
As would be expected, REBT argues that mental wellness and mental health to a large degree results from an adequate amount of self-helping, flexible, logico-empirical ways of thinking, emoting and behaving. When a perceived undesired and stressful activating event occurs, and the individual is interpreting, evaluating and reacting to the situation rationally and self-helpingly, then the resulting consequence is, according to REBT, likely to be more healthy, constructive and functional. This does not by any means mean that a relatively un-disturbed person never experiences negative feelings, but REBT does hope to keep debilitating and un-healthy emotions and subsequent self-defeating behaviour to a minimum. To do this, REBT generally promotes a flexible, un-dogmatic, self-helping and efficient belief system and constructive life philosophy about adversities and human desires and preferences.
REBT clearly acknowledges that people, in addition to disturbing themselves, also are innately constructivists. Because they largely upset themselves with their beliefs, emotions and behaviours, they can be helped to, in a multimodal manner, dispute and question these and develop a more workable, more self-helping set of constructs.
REBT generally teaches and promotes:
That the concepts and philosophies of life of unconditional self-acceptance, other-acceptance, and life-acceptance are effective philosophies of life in achieving mental wellness and mental health.
That human beings are inherently fallible and imperfect and that they are better served by accepting their and other human beings’ totality and humanity, while at the same time they may not like some of their behaviours and characteristics.
That they are better off not measuring their entire self or their “being” and give up the narrow, grandiose and ultimately destructive notion to give themselves any global rating or report card.
This is partly because all humans are continually evolving and are far too complex to accurately rate; all humans do both self-defeating/socially defeating and self-helping / socially helping deeds, and have both beneficial and un-beneficial attributes and traits at certain times and in certain conditions.
REBT holds that ideas and feelings about self-worth are largely definitional and are not empirically confirmable or falsifiable.
That people had better accept life with its hassles and difficulties not always in accordance with their wants, while trying to change what they can change and live as elegantly as possible with what they cannot change.
Factors that hinder or facilitate the continuous pursuit of education, training, and employment among young adults with serious mental health conditions.
Background
This study can inform psychiatric rehabilitation practice by describing the patterns of education, training, and employment activities among young adults with serious mental health conditions and identify potentially malleable factors that hinder or facilitate their ability to continuously pursue these activities.
Methods
One-time, in-person interviews were conducted with 55 young adults, ages 25-30, with serious mental health conditions in Massachusetts. The life story interview script asked participants about key life and mental health experiences and details about their education, training, and employment experiences.
Results
Young adult paths’ through post-secondary school, training, and work were often non-linear and included multiple starts and stops. Many young adults reported unsteady and inconsistent patterns of school and work engagement and only half were meaningfully engaged in education, employment, or training at the time of the interview. Employment often included service industry jobs with short tenures and most who had attempted post-secondary college had not obtained a degree. Barriers to continuous pursuit of school, training, or work included stress-induced anxiety or panic, increased symptomatology related to their mental health condition, and interpersonal conflicts. Flexible school, training, and work environments with supportive supervisors helped facilitate the continuous pursuit of these activities.
Conclusions
Psychiatric rehabilitation professionals need to help young adults with serious mental health conditions manage stress and anxiety and periods of increased symptomatology, navigate interpersonal challenges, and advocate for flexible and supportive accommodations. Early and blended education and employment supports would also be beneficial.
Reference
Sabella, K. (2021) Factors that hinder or facilitate the continuous pursuit of education, training, and employment among young adults with serious mental health conditions. Psychiatric Rehabilitation Journal. doi: 10.1037/prj0000470. Online ahead of print.
1883 – Cyril Burt, English psychologist and geneticist (d. 1971).
Cyril Burt
Sir Cyril Lodowic Burt, FBA (03 March 1883 to 10 October 1971) was an English educational psychologist and geneticist who also made contributions to statistics. He is known for his studies on the heritability of IQ. Shortly after he died, his studies of inheritance of intelligence were discredited after evidence emerged indicating he had falsified research data, inventing correlations in separated twins which did not exist.
PARfessionals is an US, Arkansas-based, private research development firm for Peer Support and Recovery Providers in Addictions.
Background
The company was founded in 2011 by Jorea M. Kelley-Hardison She self-published the book “Getting Ahead: An Ex-Offenders Guide to Getting Ahead in Today’s Society”, where she encourages ex-offenders to participate in clinical research trials. She is mentioned in Dr. Jon Marc Taylor’s book “Prisoners’ Guerrilla Handbook to Correspondence Programs in the United States and Canada,” published by Prison Legal News in 2008.
Jorea Kelley-Hardison was taking classes to become a Clinical Research Coordinator (CRC) before she decided to transition into the addiction industry to become an Addictions Counsellor in 2009. Around that time, she received her CCJP – a status from the Texas Certification Board of Addiction Professionals and has been granted numerous credentials from the board, including the Peer Recovery Specialist (PRS), Peer Mentor/Peer Recovery Coach (PM-PRC) and the Associate Prevention Specialist (APS) credentials, but has since retired those credentials.
Jorea Kelley-Hardison earned a B.S. degree in Management in 2009 and has completed degree requirements in order to graduate with a M.A. in Criminal Justice from the American (Military) Public University System. She has also earned a graduate certificate in Applied Forensic Psychology Services from The Chicago School of Professional Psychology. In addition, she has obtained certificates in mental health, non-profit management, applied forensic psychology services, basic clinic research, family and business mediation, substance abuse, as well as emergency management. In addition, she has received training throughout the years in various important topics such as rape/domestic violence crisis intervention, hospice, and health unit coordination from various organizations and colleges including Parkland Health & Hospital System, Brookhaven College, Lakewood College, Centre for Degree Studies, Northwestern University Feinberg School of Medicine, Thomas Edison State College, University of Texas at Arlington-Continuing Education Division, and Richland College.
She is currently a member of the American Association on Intellectual and Developmental Disabilities, NAADAC – The Association of Addiction Professionals, National Alliance for Direct Support Professionals, National Association of Health Unit Coordinators, Psychiatric Rehabilitation Association and the International Association for Correctional and Forensic Psychology.
Brief History
In 2011, the word ” PARfessionals” was created by the company’s founder. In 2012, PARfessionals decided to develop the first peer-based online recovery coach training programme designed for those interested in mentoring individuals into and through long-term recovery from co-occurring disorders and other addictions and addictive behaviours.
In 2013, PARfessionals developed the first Peer Recovery/Addiction Recovery Coach Study Guide, a free Peer Recovery/Addiction Recovery Coach Curriculum Guide, a free Peer Recovery/Addiction Recovery Coach Practicum Guide and an online Peer Recovery/Addiction Recovery Coach Train the Trainers course. Additionally, PARfessionals’ founder and several family members applied for an ACE college credit review with The American Council On Education and then to Distance Education Accreditation Council (DEAC) in August 2015. After being rejected by DEAC, the founder contacted Charter State Oak College who in November 2015 about their program being recognised for college credit under their college assessment programme.
PARfessionals designed a Peer Recovery Facilitator Development e-Course in an effort to support the ongoing efforts of social service agencies, foundations, government agencies, and employers worldwide. This course would also work towards the development of community re-entry programs for inmates and workforce development skills for disadvantaged individuals such as ex-offenders, disabled individuals, low-income communities and minorities.
It was developed in collaboration with post-secondary educators and coaching experts for a diverse population with an array of learning skills who may be teaching, employing or supporting those who may be inmates, ex-offenders, mental health consumers, recovering addicts and individuals with intellectual and developmental disabilities. It provides adult-oriented learning strategies for a diverse group of individuals with different learning abilities.
The online Peer Recovery Facilitator Development e-Course was officially approved in 2014, by the Association for Addiction Professionals, also known as NAADAC.
In 2014, PARfessionals developed the first free Peer Recovery Support Specialist/Addiction Recovery Coach classroom curriculum kits in addition to a home study course, a correctional correspondence course for inmates, research journal, universal Code of Ethics and an international certification board. Additionally, PARfessionals’ founder created an in-house private virtual research institute, the Powell Leary Jacobs (PLJ) Multicultural Institute for Transformation Research in Addictions, to self-fund resources on Peer Recovery and Prevention. It was internally closed in 2014.
From 2013-2014, PARfessionals and its parent organisation, the SJM Family Foundation (which closed in January 2015 through the Texas Secretary of State) provided seven scholarships for eligible candidates from the general public who were devoted to seeking training for addiction treatment and peer recovery services.
Kelley-Hardison also established the International Certification Board of Recovery Professionals (ICBRP), the first ever, peer-run certification board created for peer recovery professionals in the world. The ICBRP’s mission was to be an independent, informal ad-hoc advisory board that provides guidance and accountability for the National Certified Peer Recovery Professionals (NCPRP) credentialing programme. However, it was later dissolved (through the Georgia Secretary of State in March 2015), and merged into PARfessionals’ private corporate structure.
In Spring 2017, The PARfessionals’ Cultural Intelligence in Addictions course supplemental student workbook was included in the German National Library.
As of August 2018, PARfessionals is a private product design and consulting firm doing business as PARfessionals Behavioural Health Research Development Corporation. The founder, Jorea Kelley-Hardison is a nationally certified psychiatric technician and social impact artist that has successfully worked with dozens of licensed professional clinicians and medical staff worldwide, including professionals from Harvard Medical School and the National Institute of Health. to create 45+ PARfessionals’ branded resources, including Peer Recovery Practicum Guide, a Peer Recovery Pre-Certification Review e-Course. a Peer Recovery Supervision Training Course, and Peer Recovery classroom curriculum kits.
In order to accomplish the company’s goals, Kelley-Hardison, along with members of the AR SJM Family, hired and privately paid independent contractors and freelancers, also Ms. Hardison and several of her family members working as volunteers using their own money, and collaborating with a group of qualified contracted experts from across the world that had acquired degrees, held additional credentials and had significant work experience in their own respective fields.
The Definition of “Peer Recovery”
The term peer recovery can be first defined through PARfessionals as “the process of giving and receiving encouragement and assistance to achieve long-term recovery. Peers offer emotional support, share knowledge, teaches skills, provide practical assistance, and connect people with resources, opportunities, communities of support, and other people”.
The Association for Addiction Professionals provides a different definition of recovery. According to William White, MA, “recovery is the experience… through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life”.
The International Certification & Reciprocity Consortium states that “peer recovery is experiencing rapid growth, whether it is provided by a peer recovery coach, peer recovery support specialist, peer navigator, patient navigators, public health learning navigators, behavioural health navigator or peer recovery mentor. Peer support services – advocating, mentoring, educating, and navigating systems – are becoming an important component in recovery oriented systems of care”.
IC&RC credentials and examinations, including Peer Recovery are administered exclusively by various certification and licensing boards in the United States and the world.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the US Department of Health and Human Services that leads public health efforts to advance the behavioural health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
SAMHSA states that:
Peer support services are delivered by individuals who have common life experiences with the people they are serving. People with mental and/or substance use disorders have a unique capacity to help each other based on a shared affiliation and a deep understanding of this experience. In self-help and mutual support, people offer this support, strength, and hope to their peers, which allows for personal growth, wellness promotion, and recovery.
Research has shown that peer support facilitates recovery and reduces health care costs. Peers also provide assistance that promotes a sense of belonging within the community. The ability to contribute to and enjoy one’s community is key to recovery and well-being. Another critical component that peers provide is the development of self-efficacy through role modeling and assisting peers with ongoing recovery through mastery of experiences and finding meaning, purpose, and social connections in their lives.”
Peer Recovery Navigator Academics Programme and (Micro-Certification) Registry
In 2012, PARfessionals developed the first globally recognised online training programme for peer recovery professionals. As of September 2015, PARfessionals offers an online distance learning pre-certification training course, a home study correspondence course and an inmate correspondence course for student-candidates to study at their own pace for global certification in peer recovery. The curriculum is based on proven research in order to make it the most specialised and comprehensive training programme for a new generation of Peer Recovery Professionals for a variety of settings.
Students worldwide have completed the training and shared their satisfaction with PARfessionals training programme.
PARfessionals developed its own exam and credential, NCPRP, which stands for “National Certified Peer Recovery Professional”.
The NCPRP credential and exam primarily emphasize the concept of peer recovery, with the main purpose of providing guidance, knowledge or assistance, especially among those with similar experiences who can meet as equals. The certification was integrated into the academic programme and renamed the PARfessionals’ Peer Recovery Workforce Development Certification Programme.
In Fall 2016, PARfessionals’ founder worked with qualified and licensed clinicians to create and sponsor the world’s first college level peer recovery training course and lifetime credential for the behavioural healthcare workforce, which was submitted and reviewed through the Connecticut Credit Assessment Programme and The Consortium for the Assessment of College Equivalence of Charter State College in Fall 2016.
Global Health Impact
Deloitte provides an annual look at the topics, trends, and issues impacting the global health care sector. According to its 2017 Global Healthcare Sector Outlook Infographic, “Peer support, self-management education, health coaching, and group activities, along with workforce training, and investments in the right technology” are “potential enablers of patient activation and engagement” and “key ingredients for productive health care operations”.
Behavioural Health Educational Mobile Apps
In February 2016, PARfessionals’ founder, Ms. Kelley Hardison started to partner with several independent app developers to develop Behavioural Health educational apps and games for the Addiction Peer Workforce.
Mobile Library Garden and Pocket Park Commemoration
In the fall of 2016, the AR SJM Family distributed two college preparatory guides, PARfessionals’ Peer Recovery/Cultural Intelligence in Addictions and PARfessionals’ Peer Recovery Navigator Practicum Guide to 240,000+ digital libraries and 2,000 digital publishers across the world. In 2017, the successful worldwide distribution was commemorated with a plaque in a mobile library garden and pocket park in Centennial, Texas.
Approvals
PARfessionals is an approved behavioural health training provider recognised by many states, national and international professional associations and state boards.
Traumatic experiences of conditional refugee children and adolescents and predictors of post-traumatic stress disorder: data from Turkey.
Background
The researchers aimed to determine traumatic events, mental health problems and predictors of PTSD in a sample of conditional refugee children.
Methods
The sociodemographic features, chief complaints, traumatic experiences and psychiatric diagnoses according to DSM-5 were evaluated retrospectively.
Results
20.7% (n = 70) of children experienced the armed conflict or exposed to firefights at their country of origin. Most common diagnoses were anxiety disorders (n = 82, 24.3%), major depressive disorder (n = 52, 15.4%) and PTSD (n = 43, 12.7%). Age, number of traumatic experiences, explosion and sexual violence are the most important predictors for PTSD.
Conclusions
The results suggest that the number of traumas exposed as well as their nature predicted PTSD diagnosis. Refugee children have increased risk for psychiatric problems after migration and resettlement underlining the importance of an adequate follow-up for mental health and ensuring social support networks.
Reference
Yektas, C., Erman, H. & Tufan, A.E. (2021) Traumatic experiences of conditional refugee children and adolescents and predictors of post-traumatic stress disorder: data from Turkey. doi: 10.1080/08039488.2021.1880634. Online ahead of print.
Mental Health Matters 
You must be logged in to post a comment.