Passage - Nordanstig

Passage
”We want to see changes”
Psykiatriska kliniken Skellefteå
•Skellefteå/Norsjö: 76500
•Södra Lappland: 39000
•Our clinic has 300
employees
Today I’m going to talk about:
• Our mission
• How do we do it
• Why horses in
treatment
• What is “ridingtherapy”?
• Evaluation
• Our horses..
Hälsan trädgård kontakt:
karin.dahlgren@skelleftea.se
Our mission?
• Our work within psychiatry can be like
solving a puzzel that we must work
out together with the patient in order
to acertain what works and doesent
work according to their lives as an
individual.
• To understand this means that choices
can be made = the process of change
can begin
• When we meet at the clinic we
discuss the problem, on the other
hand in the stable we see the
problem.
• Many patients need to be in a
physical/practical situation in
order to understand their
behavior in certain situations.
First assessment
Does the patient has the resources to deal
with a intervention?
Or do we offer support first?
Support
•High anxiety
•Addiction
•Social situation
•Neuropsyciatri
Support contact
Intervention
•Ability to reflect
•Motivation & right timing
•Soc. situation
Intervention
Kbt, psycotherapy, jagstrukturerande
Clear goals
Take a new approach
”If you do what you
always do then you
will get what you
always get…..”
” Anxiety ”
Psycological
Cognitiv
Physical
Social
Isolation
Avoidance
Depression
Neg. thought
Memory
Concentration
Big picture
Punctuality
Balans
Stiffness
Pain
Body Awearness
Network
Social competens
Social
Self confidence
Psykoeducation
Homework
Group
Visitation
Program
Flexibility
Body awearness
Relaxation
Physical
Balance
Practical
theoretcal
interaction
Our mission?
Summary:
• Make a realistic
judgement as to
which treatment suits
the patient best .
• Set up measureable
goals
• Evaluate- ”are we
done” or are there
new goals to
achieve?
How do we do
it?
Referral
Studyvisit
Verbal
Mixed group
assessment
Ex.Anxiety
group
• A care plan is made the same way as in the
clinic.(Actual problem,Resource,Goal,Plan)
• We meet 10 times per term.
• 6-8 to a group
• Mix practical and theoretical exercises
around a subject
• We have five groups a week.
MIXED GROUP
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
(support)
Stresszon, film,
The Brain
Cognitiv aids
Anxiety
Symtom Anxiety
Depression
Symtom depression
Motivation
Summery
Trip, ”the end”
ANXIETYGROUP
1.
2.
3.
4.
5.
6.
7.
(intervention)
Presentation
What is anxiety?
Physical symtoms
Mental symtom
My symtoms
How is my anxiety?
What are my
strategies?
8. New strategies
9. New strategies
10. ”The end”
Mix theoretical information and
practical exercises
• Talking is not the only
means of
understanding
ourselfs, our
behaviours and the
world around us.
• Doing, seeing, feeling,
watching, trying etc. is
other means to
understanding and
coping.
If you want to learn,
you need to get out of
your comfort zone,
but just enough to
stay in the learning
zone. If you cross
over to the panic zone
you’ll be thrashing
rather than learning.
Noel Tichy
http://www.noeltichy.com
http://freekleemhuis.com/
Term evaluatuion
•
•
•
•
Clear finish, (had, PHQ. SF 36)
Summery
Individual verbal summery
Chose next step ..
How do we do it?
Summery:
• Study visit- active
choice
• Careplan
• Support/ intervention
treatment?
• Psycoeducation +
practical exercise
• Clear finish
• Chose next step.
Why horses in
treatment?
1. Speeds up the relation
building process
Through:
• Showing care towards the horses, taking into
account their personality, condition and age
and theirbye setting reasonable demands upon
the horses.
• We can take a ”shortcut” around our
relationship to horses and raise hope for the
patients that they can be treated whith the
same respect as the horse.
2. Horses only feel….they dont think..
•Horses can reflect emotions that we
miss.
•Through body aweaerness execises the
feeling can become clearer
•Horses are not ”magic”- it just feels like
it….
3.As a motivator
• ”One must have compensation
for grief and sadness before
you start to work with grief and
sadness”
//Sven Forsling
4. As a metaphor
• Horses work differently than we.
• – The more we learn about them – the
more we learn about us.
• Horses can only feel- try to imagine how
that would be for you?
Avoidence..
Or….
5. Individual information is seen
early on.
Social
Mental
Cognitiv
Physical
6.Horses are big and obvious…
Their feelings are easy to see- relaxed tensed,
curious etc.
7. New problems for a new
age..
Within psychiatri we see more of young adoults showing increased
feelings of being ”lost” or difficulty finding their way in life.
”Standard” answer has become – ” I don’t know”.
Horses and their environment provide plenty of opportunitys for
personal growth and coping strategies such as;
•
•
•
•
Boundry setting
Control
Closeness
Challanges etc.
Why horses in treatment?
Summary:
Horses speed
things up!
• Faster information.
• Affect many areas.
• Limitless possibilitys.
What is “ridingtherapy” ?
• Thera are many definitions today. If we
cant define what we do – then how can
anyone else understand..?
• AAT, EAT, EASEL,HUT, HUB, Ridterapi,
Hippoterapi, etc etc.
This is our view …
• Therapist profession
+
• Patients needs and resuorces
+
• Horses characteristics and training
=
Reinforce current methods…
Cognitiv therapy/cognitiv behaviour
therapy
•Learning
•Challange
•”Learning by doing”
The horse
becomes a
catalyst
Relationship building process
•To dare
• Trust
•Hope
Focus on the horse- take
a shortcut
Try – fail
Closeness
Metaphor
Mindfulness
Help through the body
•Here & now
•Not value
Metaphor- horses cant
value
They feel instead of
think.
Summary:
• Horse reinforce
current treatment
methods.
• ”No need to reinvent
the wheel..”
Evaluation
•
•
•
•
We use SF36
Had
PHQ9
Own material
Patient
What
works…?
•Environment
•Assistant
•Other
participants
•Etc, etc
The
horse
Thearpist
What we have seen along the way..
• Many areas are affected- which makes it effectiv
but difficult to evaluate.
• Same diagnosis can can show different
symtoms
• Behaviour changes takes time and relapses are
natural.
• You can feel worse when you notice destuctive
patterns within yourself.
• Differences at individual and group level.
• Difficult to know how to put together in the most
effecive way?
Evaluation
Summary:
Our horses
•They work at most
two ours a day, four
days a week with
patients
•We have two days a
week where we train
or exercise our
horses.
Boston
Ardenner born 2002,
Lina
Tinkersto, född 2001,.
Oboy
Tinkervalack, född 2000,
•They are outside
and live “like
horses” year
around.
•We vary there
work/tasksridning, driving,
from the ground,
grooming etc.
They must enjoy there work =
and that’s our job!
Trained to live in strange
surroundings for a horse..
A unique relationship – predator and
prey…
For the horse we are
”second best”....
..wich means responsability
for us..
Monday
Work
with
horses
Group
KKBC
young
adults.
Depr.
Tuesday Wednes
day
Group
Work
Skogs
With
Backen horses
MBT
Mixed
Work
Group
With
horses
Thursday Friday
Mixed
Group
Grupp
Work
Anxiety With
horses
Kiki
Hedberg
Thomas Lindbäck moosehunting with Lantz
Lars- Olov Lundberg loading timber
The horses
summary:
•
•
•
•
•
You must know your horses
You must test your horses
You must learn continually
Safety can be seen in many ways..
Often our methods of handling our horses
are based on our thoughts rather than
facts and reresearch .
• There is a lot left to do in this area…
With good judgment,
little else matters.
Without it, nothing
else matters
Noel Tichy
”Even if you are on the
right road, you can still
get run over if you just
sits there..”
Povel Ramel
Thanks from
me !
Lena Stenvall
Lena.stenvall@vll.se