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Resource-oriented therapeutic models in psychiatry: conceptual review

  • Stefan Priebe (a1), Serif Omer (a1), Domenico Giacco (a1) and Mike Slade (a2)
Abstract
Background

Like other medical specialties, psychiatry has traditionally sought to develop treatments targeted at ameliorating a deficit of the patient. However, there are different therapeutic models that focus on utilising patients' personal and social resources instead of ameliorating presumed deficits. A synopsis of such models might help to guide further research and improve therapeutic interventions.

Aims

To conduct a conceptual review of resource-oriented therapeutic models in psychiatry, in order to identify their shared characteristics.

Method

The literature was searched to identify a range of resource-oriented therapeutic models, particularly for patients with severe mental illness. Key texts for each model were analysed using a narrative approach to synthesise the concepts and their characteristics.

Results

Ten models were included: befriending, client-centred therapy, creative music therapy, open dialogue, peer support workers, positive psychotherapy, self-help groups, solution-focused therapy, systemic family therapy and therapeutic communities. Six types of resources were utilised: social relationships, patients' decision-making ability, experiential knowledge, patients' individual strengths, recreational activities and self-actualising tendencies. Social relationships are a key resource in all the models, including relationships with professionals, peers, friends and family. Two relationship dimensions – reciprocity and expertise – differed across the models.

Conclusions

The review suggests that a range of different therapeutic models in psychiatry address resources rather than deficits. In various ways, they all utilise social relationships to induce therapeutic change. A better understanding of how social relationships affect mental health may inform the development and application of resource-oriented approaches.

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Copyright
Corresponding author
Professor Stefan Priebe, Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK. Email: s.priebe@qmul.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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Resource-oriented therapeutic models in psychiatry: conceptual review

  • Stefan Priebe (a1), Serif Omer (a1), Domenico Giacco (a1) and Mike Slade (a2)
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eLetters

Nidotherapy is a resource-orientated therapy too

Peter Tyrer, Professor of Community Psychiatry
16 May 2014

The article by Priebe et al 1 is a welcome addition to the literatureon developing strengths in psychiatric patients rather than just correcting deficits. They identify ten models that satisfy their requirements for a resource orientated perspective. We wish to suggest that nidotherapy, the collaborative systematic evaluation and manipulationof the environment to make a better fit for the patient2, is also eligiblefor inclusion in this group. Nidotherapy includes the resource-orientatedthemes of social relationships and adjustment3-4, promotes decision-makingby patients and experiential knowledge3, and fosters individual strengths5. It also uses recreational activities to deliver aspects of thetherapy (www.nidotherapy.com). It also focuses strongly on individual relationships and reciprocity5. Although nidotherapy is a relatively new form of management and is concerned with changing the environment only it still should be included in this group as it is particularly helpful for disorders that currently have little evidence for effective interventions4and also engenders hope and optimism in patient groups in whom these feelings are in short supply.

Yours etc

Peter TyreraMike CrawfordaHelen TyreraMaja RangerbAnna MaratosbKatarina Miloseska-ReidbSandra O'SullivanbRachel Everedb

a Centre for Mental Health, Imperial College, London W6 8RPb Central North West London Mental Health NHS Foundation Trust, London W9 Declaration of interest: Peter Tyrer, Helen Tyrer, Maja Ranger and SandraO'Sullivan are Trustees of a registered charity, NIDUS-UK, which supports the development of nidotherapy internationally.References:1.Priebe S, Omer S, Giacco D, Slade M. Resource-oriented therapeutic models in psychiatry: conceptual review. Br J Psychiatry 2014; 204:256-61.

2.Tyrer P (2009). Nidotherapy: harmonising the environment with the patient. London: RCPsych Press, 2009.3.Tyrer, P., Sensky, T., & Mitchard S (2003). The principles of nidotherapy in the treatment of persistent mental and personality disorders. Psychotherapy and Psychosomatics, 72, 350-356.4.Tyrer P, Miloseska K, Whittington C, Ranger M, Khaleel I, Crawford M,North B & Barrett B (2011). Nidotherapy in the treatment of substance misuse, psychosis and personality disorder: secondary analysis of a controlled trial. The Psychiatrist, 35, 9 - 14.

5.Spencer S-J, Rutter D & Tyrer P (2010). Integration of nidotherapy into the management of mental illness and antisocial personality: a qualitative study. International Journal of Social Psychiatry, 56, 50-59.

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Conflict of interest: Declaration of interest: Peter Tyrer, Helen Tyrer, Maja Ranger and Sandra O'Sullivan are Trustees of a registered charity, NIDUS-UK, which supports the development of nidotherapy internationally.

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