‘Who decided this?’: Negotiating epistemic and deontic authority in systemic family therapy training

In this article we illustrate how trainers and trainees negotiate epistemic and deontic authority within systemic family therapy training. Adult education principles and postmodern imperatives have challenged trainers’ and trainees’ asymmetries regarding knowledge (epistemics) and power (deontics), normatively implicated by the institutional training setting. Up-to-date, we lack insight into how trainers and trainees negotiate epistemic and deontic rights in naturally occurring dialog within training. Drawing from discursive psychology and conversation analysis, we present an analysis of eight transcribed, videotaped training seminars from a systemic family therapy training program, featuring three trainers and eleven trainees. Our analysis highlights the dilemmatic ways in which participants resist and affirm the normatively implicated trainers’ deontic and epistemic authority. Trainers are shown as mitigating directives and trainees as resisting them, with both displaying (not)knowing, while attending to concerns about (a)symmetry. We discuss our findings’ implications for systemic family therapy training.

Quality of life of ostomates at a teaching and referral hospital in Kenya

Background: Ostomy surgery is performed to maintain gastrointestinal function. However, there is a lack of knowledge and experience about ostomies among patients and clinicians in public hospitals in Kenya. The issue is compounded by the social isolation and stigma ostomates face in the wards and in the community after discharge. Although it is not easy to identify the exact number of ostomates in Kenya and other African countries, there is need to shift the focus from curing symptoms in ostomates to maximising patients’ quality of life (QoL) and integrating services for ostomates in mainstream public hospitals. Aim: To understand the effects of ostomies on patients’ QoL, with a focus on nutrition, psychosocial aspects and challenges around sexuality after ostomy creation. Method: A descriptive study was undertaken using an interviewer-administered QoL questionnaire with 81 patients. Results: Most patients were male (54%); the largest age group was 35–44 years (24.7%). Colorectal carcinoma, intestinal obstruction and traumatic injuries were the main indications for ostomy. Ostomates resumed sexual activity, but did not find it fulfilling (P=0.002). Most reported feeling depressed, with suicidal attempts that negatively correlated with QoL. Ostomates adjusted their diets regardless of whether their level of QoL was poor, fair, good or excellent after ostomy creation (P=0.564). Conclusion: Ostomates experience low QoL. Patients’ lives can be improved by focusing on providing individualised ostomy care services after discharge. Enhancing stoma therapy training for nurses and running ostomy clinics alongside mainstream services, as well as support for ostomates towards enrolment into the country’s National Hospital Insurance Fund, will also improve patients’ QoL.

Learning to be Mindful: An Exploratory Study into the Perceived Benefits of Mindfulness-Based Stress Reduction Training for a Music Therapy Student

<p>Mindfulness training has become very popular in recent years and has proven successful for reducing anxiety and depression and enhancing coping skills (amongst other benefits). This research project explores the perceived benefits of mindfulness-based stress reduction (MBSR) training on a music therapy student working with young people with complex needs in special education. Secondary analysis of clinical records (session notes and a reflexive journal) was employed and included the use of both inductive and deductive methods of analysis. Five themes were developed (framed as themes of learning) including: Presence, Non-striving, Beginner’s Mind, Acceptance, and Patience with a final key finding being the effect of modelling to the students. Findings showed these benefits emerging through a journey from early data (before MBSR training) to later data (after MBSR training) and suggest that mindfulness training can be beneficial for both music therapy students and (indirectly) to those they work with. The themes and perceived benefits proved very interconnected with each relating to several others and ‘Being Present’ emerging as an over-arching theme. Similarities between benefits discovered and certain principles of music therapy were discussed and whether the benefits found may have occurred naturally through the course of music therapy training amongst other factors of change and natural growth.</p>

Learning to be Mindful: An Exploratory Study into the Perceived Benefits of Mindfulness-Based Stress Reduction Training for a Music Therapy Student

<p>Mindfulness training has become very popular in recent years and has proven successful for reducing anxiety and depression and enhancing coping skills (amongst other benefits). This research project explores the perceived benefits of mindfulness-based stress reduction (MBSR) training on a music therapy student working with young people with complex needs in special education. Secondary analysis of clinical records (session notes and a reflexive journal) was employed and included the use of both inductive and deductive methods of analysis. Five themes were developed (framed as themes of learning) including: Presence, Non-striving, Beginner’s Mind, Acceptance, and Patience with a final key finding being the effect of modelling to the students. Findings showed these benefits emerging through a journey from early data (before MBSR training) to later data (after MBSR training) and suggest that mindfulness training can be beneficial for both music therapy students and (indirectly) to those they work with. The themes and perceived benefits proved very interconnected with each relating to several others and ‘Being Present’ emerging as an over-arching theme. Similarities between benefits discovered and certain principles of music therapy were discussed and whether the benefits found may have occurred naturally through the course of music therapy training amongst other factors of change and natural growth.</p>

Enabling the curious practitioner: perceptions on the integration of research and practice in the education of music therapy students at masters' level.

<p>This PhD research explored perceptions about the integration of research and practice in the Masters’ training of music therapists. Using constructivist case study methodology, the study analysed viewpoints of international educators, researchers and students about how research could helpfully be integrated into the practical and conceptual learning of music therapy trainees. The synthesis of research and practice in the professional music therapy field has regularly been advocated but recent studies and reviews suggest there is significant need for development of pedagogical theory and guidance for educators and students in the interface between placements and university-based learning in key areas, including research. Participants included a purposeful sample of 19 music therapy practitioners, researchers, educators and students in the wider international profession of music therapy and at music therapy training programmes in Europe and Australasia. Data sources included focus groups of professionals, two site visits to training programmes (comprising interviews, observations, field notes and concluding improvisation session) and a researcher reflective journal. Core themes identified in the thematic analysis concentrated on cherishing students’ fire and curiosity; facilitating the acknowledgement and management of change; and helping students embrace complexity in their music therapy education. Evidence from this study indicates that moving beyond ‘research competency’ and the development of individual academic skills towards collaborative, engaged learning with peers and supervisors, has potential to nurture sustainable, practice-based researchers of the future. Devising integrative strategies for learning and assessment, undertaken in diverse ways and to suit varied contexts for training, was perceived to be inspiring for students and educators and rehearsed significant professional tasks. These strategies - despite tensions experienced in their development - had potential to deepen personal learning, develop creative and critical skills that characterise graduate attributes of University Masters’ courses, and prepare graduates for evidence-based practice in health and education workplaces. An integrative model for a more holistic approach to learning, combining individual and collaborative approaches and using opportunities inside and outside the programme was developed, allowing for differences in culture and approach of the institutions which host music therapy training. The challenges and solutions explored in this research, while being particular to this qualitative music therapy study, have potential relevance to other applied areas of professional practice and research, such as arts therapies, allied health disciplines, education and nursing.</p>

Enabling the curious practitioner: perceptions on the integration of research and practice in the education of music therapy students at masters' level.

<p>This PhD research explored perceptions about the integration of research and practice in the Masters’ training of music therapists. Using constructivist case study methodology, the study analysed viewpoints of international educators, researchers and students about how research could helpfully be integrated into the practical and conceptual learning of music therapy trainees. The synthesis of research and practice in the professional music therapy field has regularly been advocated but recent studies and reviews suggest there is significant need for development of pedagogical theory and guidance for educators and students in the interface between placements and university-based learning in key areas, including research. Participants included a purposeful sample of 19 music therapy practitioners, researchers, educators and students in the wider international profession of music therapy and at music therapy training programmes in Europe and Australasia. Data sources included focus groups of professionals, two site visits to training programmes (comprising interviews, observations, field notes and concluding improvisation session) and a researcher reflective journal. Core themes identified in the thematic analysis concentrated on cherishing students’ fire and curiosity; facilitating the acknowledgement and management of change; and helping students embrace complexity in their music therapy education. Evidence from this study indicates that moving beyond ‘research competency’ and the development of individual academic skills towards collaborative, engaged learning with peers and supervisors, has potential to nurture sustainable, practice-based researchers of the future. Devising integrative strategies for learning and assessment, undertaken in diverse ways and to suit varied contexts for training, was perceived to be inspiring for students and educators and rehearsed significant professional tasks. These strategies - despite tensions experienced in their development - had potential to deepen personal learning, develop creative and critical skills that characterise graduate attributes of University Masters’ courses, and prepare graduates for evidence-based practice in health and education workplaces. An integrative model for a more holistic approach to learning, combining individual and collaborative approaches and using opportunities inside and outside the programme was developed, allowing for differences in culture and approach of the institutions which host music therapy training. The challenges and solutions explored in this research, while being particular to this qualitative music therapy study, have potential relevance to other applied areas of professional practice and research, such as arts therapies, allied health disciplines, education and nursing.</p>

Mental Health Nurses' Knowledge and Views on Talking Therapies in Clinical Practice

<p>Nurses consider that their training, knowledge and skills in evidence-based talking therapy models are essential for competent mental health nursing practice. Using a qualitative descriptive research design this study explored nurses' knowledge and views on their talking therapy training and skills in practice. The study examined the use of talking therapies, or specialised interpersonal processes, embodied within the Te Ao Maramatanga: New Zealand College of Mental Health Nurses Inc (2004) Standards of Practice for Mental Health Nurses in New Zealand. A survey questionnaire was sent to 227 registered nurses from a District Health Board (DHB) Mental Health Service and a sample of eight nurses participated in a semi-structured interview. Content analysis based on the headings " knowledge views, skill acquisition and skill transfer" established the major themes from the data collection processes. The findings of this study confirmed that nurses believe their knowledge and skills in evidence-based talking therapies to be vitally important in mental health nursing practice. Nurses identified that talking therapy training courses needed to be clinically relevant and that some learning strategies were advantageous. The identification of some knowledge gaps for, nurses with limited post graduate experience, and for nurses who currently work in inpatient areas suggests that further consideration must be given to ensure that a cohesive, sustainable approach is ensured for progression of workforce development projects relevant to training in talking therapies for mental health nurses in New Zealand.</p>