Shame and acute psychiatric in-patient care

Scandinavian Journal of Caring Sciences, 2019

Contradictory experiences of safety and shame in inpatient mental health practicea qualitative study This study explores the lived experience of hospitalisation from the perspective of people with a mental health disorder. This hermeneutic-phenomenological study, which forms part of a larger qualitative serial inquiry, uses a participatory research design, with analysis inspired by interpretative phenomenological analysis. Fourteen participants were interviewed twice: first during hospitalisation and then again 3 months following hospital discharge. Findings are reported from the entire interview data set. Our findings suggest that mental health hospitalisation is a contradictory experience for patients. On one hand, our study participants experienced the hospital as a place where it is alright to be vulnerable, while on the other hand participants experienced hospitalisation as a burden of everyday stigma and signs of depersonalisation. We conclude that it is important to recognise that patients in need of inpatient treatment for mental illnesses are, in fact, people first and foremost. More reflective practice can be developed by shifting the focus to recovery-oriented practices to and open dialogue-based approaches.

From January 2011 until December 2012, forty Family Group Conferences (FGCs) will be studied in the public mental health care (PMHC) setting in the province of Groningen, the Netherlands. Research should yield an answer to whether FGCs are valuable for clients in PMHC as a means to generate social support, to prevent coercion and to elevate the work of professionals. The present study reports on two case studies in which shame and fear of rejection are designated as main causes for clients to avoid contact with their social network, resulting in isolated and marginalised living circumstances. Shame, on the other hand, is also a powerful engine in preventing clients from relapse into marginalised circumstances for which one needs to feel ashamed again. An FGC offers a forum where clients are able to discuss their shameful feelings with their social network; it generates support and helps breaking through vicious circles of marginalisation and social isolation. Findings of these case studies confirm an assumption from a previous study that a limited or broken social network is not a contraindication, but a reason for organising FGCs.

2016

Shame is a powerful emotion and experience that impacts how individuals interpret a situation, and often their behavior. It correlates with a number of mental health conditions that are commonly treated by psychotherapists, and yet the explicit or implicit treatment of shame directly or simultaneous to the disorder is less common. A qualitative exploratory study was conducted in an attempt to gather insight regarding the conceptualization, observation, and treatment of shame in the context of psychotherapy by both generalists and specialists (those with and without explicit training in relation to shame and its treatment). Themes that emerged from the data included: the difference between guilt and shame, observations of shame, and the treatment of shame. Social workers can utilize this information to gain a better understanding of the importance of recognizing, understanding, and naming shame in a clinical context and to have more skills in addressing it with clients.

Psychology Applications & Developments VIII. InScience publications., 2023

Anthropological literature indicates that Malta, by virtue of its central position in the Mediterranean, is somewhat structured by codes of honour and shame (Bradford & Clark, 2012; O'Reilly Mizzi, 1994: Schneider, 1971). Despite the awareness of the potential negative effects of shame on the psychotherapeutic relationship (Gilbert & Procter, 2006; Rustomjee, 2009), shame in psychotherapy has been largely under-researched. The current study aimed to explore how Maltese psychotherapists understand and manage feelings of shame in a particular social context. A qualitative approach was taken to explore the individual perspectives of ten Maltese psychotherapists and data gathered from semi-structured interviews was analysed by means of Interpretative Phenomenological Analysis-IPA (Smith, Flowers, & Larkin, 2009, 2021). The findings indicated that feelings of shame and inadequacy were frequently experienced by Maltese psychotherapists in various professional contexts, including clinical supervision. The perceived impact of these dominant societal codes on therapists' sense of self and professional practice were considered. Supervisory needs of trainee psychotherapists, such as clinical supervisors' sensitivity to affect states and empathy for their shamed identity, were discussed. Suggestions as to how personal therapy and supervision can help psychotherapists deconstruct and normalise feelings of shame and inadequacy by linking them to social and cultural dynamics were put forth.

2019

Being aware of the way's stigma and shame effect individuals and groups of people could contribute to improving the quality of care provided to people using health services. This paper explores situations that might provoke stigma and shame in people receiving or providing health care. Background Internationally, there are concerns for aspects of health care available to people who use health services. There is literature, which suggests that treatment, care and hospital admission can be stigmatising and shame provoking and so non-therapeutic. Data-Sources The following data sources were explored; CINHAL, PSYCHOLOGICAL LITERATURE, MEDLINE and EMBASE Key words included stigma and shame. Inclusion criteria concerned English language texts. Review Methods This paper reviews literature concerning stigma, shame and health care provision and service use generally. The discussion provides a commentary concerning the potentially harmful effects of stigma and shame aroused became of health care provision and service use.

Psychological Applications and Trends

Anthropological literature indicates that Malta, by virtue of its central position in the Mediterranean, is somewhat structured by codes of honour and shame (Bradford & Clark, 2012; Schneider, 1971; O'Reilly Mizzi, 1994). Honour refers to claimed status by an individual and necessitates that the social group affirms that claim. It holds a positive social value. Shame may be understood in either positive or negative terms. When construed in a positive sense it indicates consideration of one's reputation and standing in the community's eyes. On the other hand, negatively, shame refers to loss of position and consequent mortification. Shame is also construed as an emotion involving an evaluation of the self as one that is inherently imperfect. Despite the awareness of the potential negative effects of shame on the psychotherapeutic relationship (Gilbert & Procter, 2006; Rustomjee, 2009), shame in psychotherapy has been largely under-researched. The current study is based on the results of a doctoral thesis which explored how Maltese psychotherapists understand and manage feelings of shame in a particular social context. A qualitative approach was taken to explore the individual perspectives of ten Maltese psychotherapists whose years of professional experience ranged between 6 and 28. Semi-structured interviews were conducted and the data gathered from the interviews was analysed by means of Interpretative Phenomenological Analysis (IPA). Four super-ordinate themes emerged: The Therapist's World of Shame, Beholding Patients' Shame; A Shared Experience and The Island of Shame. Participants described themselves as having a high propensity for feelings of shame and inadequacy, and referred to their cultural context as "a breeding ground for shame". Multiple roles in the Maltese professional arena were perceived to augment these difficulties. The findings indicate that feelings of shame and inadequacy were frequently experienced by Maltese psychotherapists in various professional contexts, including clinical supervision. They also emphasise the importance of helping psychotherapists deconstruct and normalise feelings of shame and inadequacy by linking them to social and cultural dynamics. The lived experiences of shame emanating from these contexts are examined and the perceived impact of these dominant societal codes on the therapist's self and professional practice are considered. Implications for training and supervisory needs of trainee psychotherapists are discussed.

From January 2011 until December 2012, forty Family Group Conferences (FGCs) will be studied in the public mental health care (PMHC) setting in the province of Groningen, the Netherlands. Research should yield an answer to whether FGCs are valuable for clients in PMHC as a means to generate social support, to prevent coercion and to elevate the work of professionals. The present study reports on two case studies in which shame and fear of rejection are designated as main causes for clients to avoid contact with their social network, resulting in isolated and marginalised living circumstances. Shame, on the other hand, is also a powerful engine in preventing clients from relapse into marginalised circumstances for which one needs to feel ashamed again. An FGC offers a forum where clients are able to discuss their shameful feelings with their social network; it generates support and helps breaking through vicious circles of marginalisation and social isolation. Findings of these case studies confirm an assumption from a previous study that a limited or broken social network is not a contraindication, but a reason for organising FGCs.

Aim: The aim of this research was to investigate the area of shame in counsellors/psychotherapists whether in practice or during training following their own experiences of psychological and/or emotional difficulty. Method: This was a qualitative project, and data was collected via semi-structured interviews and a questionnaire about 'self conscious emotions' (Tangney, Dearing, Wagner & Granzow 2000) prior to interview. The questionnaires were scored prior to interview, and the interviews interviews analysed using thematic analysis. Results and Conclusions: The participants scored highly on shame -based responses in the questionnaire, potentially indicating a predisposition to experiencing shame in the psychotherapy field during/following a period of psychological and/or emotional difficulty. The analysis of the interview transcripts revealed a strong correlation between shame, survival and self-protection regardless of the environment, whether it was family of origin or the psychotherapy field, and is a response to and regulator of the 'field'/environment and has correlations with relationship for survival.

Iranian Journal of Psychiatry and Behavioral Sciences, 2017

Background: According to the World Health Organization, one in four people experience a psychiatric disorder throughout his/her life. For centuries, psychiatric patients have been sent to psychiatric hospitals that often stigmatized and located out of the community. Moreover, these patients are stigmatized by the hospital staff because they are not aware of patients' experiences in this domain. This humiliating attitude leads to low self-esteem, isolation, and frustration, and prevents patients from seeking treatment. Aim: This study aimed to explain the lived experiences of patients with psychiatric disorders on the consequences of stigma in mental health centers. Methods: This hermeneutic phenomenological study is a part of a larger study undertaken for partial fulfillment of the requirement for PhD dissertation in nursing. The main study was conducted on 12 psychiatric patients during 2014-2015. They were selected based on purposeful sampling method. Data were collected using unstructured interviews and analyzed by an interpretative method. Results: Psychiatric hospital as an unsafe place is one of the main themes of the phenomenon under study in the original project. It consists of two sub-themes (i.e., an egregious hospital and cold-hearted white collars) each of which is supported by a number of common meanings. Implications for Practice: The results of this study can shape the interventions and policies to combat and prevent the spread of stigma through health centers about people with psychiatric disorders.

2019

Background: According to the World Health Organization, one in four people experience a psychiatric disorder throughout his/her life. For centuries, psychiatric patients have been sent to psychiatric hospitals that often stigmatized and located out of the community. Moreover, these patients are stigmatized by the hospital staff because they are not aware of patients� experiences in this domain. This humiliating attitude leads to low self-esteem, isolation, and frustration, and prevents patients from seeking treatment. Aim: This study aimed to explain the lived experiences of patients with psychiatric disorders on the consequences of stigma in mental health centers. Methods: This hermeneutic phenomenological study is a part of a larger study undertaken for partial fulfillment of the requirement for PhD dissertation in nursing. The main study was conducted on 12 psychiatric patients during 2014-2015. They were selected based on purposeful sampling method. Data were collected using u...