Embed Size (px)
Citation preview
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..
Our mission?
• Our work within psychiatry can be like solving a puzzel that we must workout together with the patient in order to acertain what works and doesentwork according to their lives as an individual.
• To understand this means that choicescan be made = the process of changecan begin
• When we meet at the clinic wediscuss the problem, on the otherhand in the stable we see the problem.
• Many patients need to be in a physical/practical situation in order to understand theirbehavior in certain situations.
First assessmentDoes the patient has the resources to deal
with a intervention? Or do we offer support first?
Support •High anxiety•Addiction•Social situation•Neuropsyciatri
Intervention•Ability to reflect•Motivation & right timing•Soc. situation
Support contact InterventionKbt, psycotherapy, jagstrukturerande
Clear goalsTake a new approach
”If you do what you always do then you will get what you
always get…..”
” Anxiety ”
Psycological Cognitiv Physical Social
IsolationAvoidanceDepression
Neg. thought
MemoryConcentration
Big picturePunctuality
BalansStiffness
PainBody Awearness
NetworkSocial competens
SocialSelf confidence
PsykoeducationHomework
Group
VisitationProgram
Flexibility
Body awearnessRelaxationPhysicalBalance
Practicaltheoretcalinteraction
Our mission?Summary:
• Make a realisticjudgement as to which treatment suitsthe patient best .
• Set up measureablegoals
• Evaluate- ”are wedone” or are therenew goals to achieve?
How do we doit?
Referral
Study-visit
Mixed groupEx.Anxietygroup
Verbal
assessment
• 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.
1. Stresszon, film, 2. The Brain3. Cognitiv aids4. Anxiety5. Symtom Anxiety6. Depression7. Symtom depression8. Motivation9. Summery10. Trip, ”the end”
1. Presentation 2. What is anxiety?3. Physical symtoms4. Mental symtom 5. My symtoms6. How is my anxiety?7. What are my
strategies?8. New strategies9. New strategies10. ”The end”
MIXED GROUP (support) ANXIETYGROUP (intervention)
Mix theoretical information and practical exercises
• Talking is not the onlymeans of understandingourselfs, ourbehaviours 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 learningzone. If you cross over to the panic zoneyou’ll be thrashingrather than learning. Noel Tichyhttp://www.noeltichy.comhttp://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- activechoice
• 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 ageand theirbye setting reasonable demands uponthe horses.
• We can take a ”shortcut” around ourrelationship 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 wemiss.
•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 compensationfor grief and sadness beforeyou 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 howthat would be for you?
Avoidence..
Or….
5. Individual information is seenearly on.
Physical
MentalSocial
Cognitiv
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 increasedfeelings 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 behaviourtherapy
•Learning
•Challange
•”Learning by doing”
The horsebecomes a catalyst
Relationship building process
•To dare• Trust•Hope
Focus on the horse- takea shortcut
Try – fail
Closeness
Metaphor
Mindfulness
•Here & now•Not value
Help through the body
Metaphor- horses cantvalue
They feel instead of think.
Summary:
• Horse reinforcecurrent treatmentmethods.
• ”No need to reinventthe wheel..”
Evaluation
• We use SF36• Had• PHQ9• Own material
Patient
ThearpistThe horse
•Environment
•Assistant
•Otherparticipants
•Etc, etc
Whatworks…?
What we have seen along the way..
• Many areas are affected- which makes it effectivbut 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 destuctivepatterns within yourself.
• Differences at individual and group level.• Difficult to know how to put together in the most
effecive way?
EvaluationSummary:
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.
BostonBostonArdenner Ardenner bornborn 2002, 2002,
Lina Tinkersto, född 2001,.
OboyTinkervalack, född 2000,
•They are outside and live “like horses” year around.
•We vary there work/tasks-ridning, driving, from the ground, grooming etc.
They must enjoy there work = and that’s our job!
Trained to live in strangesurroundings for a horse..
A unique relationship – predator and prey…
For the horse we are ”second best”....
..wich means responsabilityfor us..
WorkWith horses
GruppAnxietyKikiHedberg
WorkWith horses
Mixed Group
GroupKKBC youngadults.Depr.
Mixed Group
WorkWith horses
GroupSkogsBackenMBT
Workwith horses
FridayThursdayWednesday
TuesdayMonday
Thomas Lindbäck moosehunting with Lantz
Lars- Olov Lundberg loading timber
The horsessummary:
• 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, nothingelse matters
Noel Tichy
”Even if you are on the right road, you can still get run over if you just sits there..” Povel Ramel
