Mental Health and Public Policy
A more elaborate and explicit therapeutic framework, especially regarding time intervals between sessions and how session series are completed in the best way, is another area of development. An initial evaluation to get an overview of the complexity of the client’s problems might provide a basis for contacting, or referring, the client to a more appropriate support resource.
Limitations of the study
There is reason to reflect on the outcome measures chosen and the instruments developed for our study, and on their ability to capture and make visible the change processes and the personal benefits that they had for clients who received crisis counseling at Samtalsakuten (Hill, Chui, & Baumann, 2013). We chose the self-assessment scales we deemed appropriate for capturing changes in symptoms typical for persons in crisis. Information from the open-ended questions of the completion form, such as what participants considered helpful, was limited in comparison to interviews. Qualitative studies of psychotherapy outcome have shown that clients’ perceptions and experiences of psychotherapy differ for different kinds of therapies and processes (Hill, et al., 2013). Hence, we cannot draw any in-depth and detailed conclusions concerning the personal benefits that our participants had of the counseling at Samtalsakuten.
Furthermore, our study lacked information about the therapists that might have contributed to the understanding of what was helpful and why. Data on the therapists’ skills, theoretical orientation, and practice, would have been useful for increasing the understanding of the counseling treatment. We also tried to circumscribe the working model of Samtalsakuten by describing the context in which it operates, but it was not enough: We were not able to say anything about the specific factors of the working model (APA, 2006; Duncan, Miller, Wampold, & Hubble, 2010; Oscarsson, 2009). However, we define the working model of Samtalsakuten as eclectic and assume that the positive effect that we were able to demonstrate stem from the so-called common factors (ibid.), i.e., therapists’ empathy, sensitivity, and willingness to understand their clients’ situation; therapists’ warm and accepting attitude; and therapists’ ability to handle their own reactions and not act on them in relation to the patient (Norcross, 2010). These factors correspond well with what the study participants highlighted as helpful.
We would like to state the obvious: Persons who are 18 and older, live in the municipalities of Forshaga, Hammarö, Karlstad, and Kil, and contact Samtalsakuten, do so because they can. Samtalsakuten exists. It is an available resource, at a structural level, which is there for people who need it. Existence, availability, and acquaintance are crucial for people in a crisis situation to get the support and help they need—when they need it.
Reavley and Jorm (2013) pointed out that people who suffer from depression and anxiety may have to wait for years to get the support and assistance they need. This is very problematic since it could delay or hinder recovery considerably. The Swedish national psychiatry coordination campaign (SOU, 2006:100) pointed out that mental illness should be treated as early as possible. In some aspects, Samtalsakuten makes this possible by being easily accessible and conducting important interventions for a limited time—with a good outcome at a relatively low cost. The results of our study illustrate that the local crisis center defends its position very well: It even fills a gap in the support and help supply of the welfare state since centers like Samtalsakuten still are very rare on a national level—despite the wording of the final report from the national psychiatry coordination campaign.
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