A Socially Sensitive CBT-Based Model For Working at the

Intersections of Gender, (Past) Interpersonal Violence and Abuse

and Mental Health/Illness

Tracey Sloan, Women’s Health Statewide

Zhila Javidi, Centre for Anxiety and Related Disorders

Service Reorientation

> Mental health effects of violence and abuse

Anxiety Depression Complex post traumatic stress disorder Eating disorders Substance misuse Self harming

> Incorporation of cognitive behaviour therapy framework

> Established evidence base for • Anxiety and depression• Range of other mental health conditions.

Feminism and Primary Health Care

> The importance of the quality of the therapeutic relationship

> A social view of mental health and illness• Contextualise development and maintenance

of problems• Gender is a key health determinant (WHO

2000)• Race, education, access to technology, ability,

socioeconomic status, sexuality

> Violence and abuse • Gender-based nature of violence• Detrimental effects of violence and abuse on

health• Experiences of violence are common for

women

> Politico-social forces impact on thinking, feeling, behaviour and physiology

Weakness of our framework:> Inadequate frameworks and tools for

responding to psychological, physiological effects of social forces

> Society doesn’t necessarily care• Slow and reluctant to change as it involves

renegotiation of relationships of privilege and power

> Current clients need an effective intervention right now!

Practice Framework

> Establishing and maintaining a positive therapeutic relationship• Trust, physical & psychological safety• Needs to be experienced by client

> Understanding the person and the problem in their social-political context• The problem is the problem, not the person

> Assessment/ problem identification

> Individualised intervention plan

> Ongoing feedback and review

Cognitive Behavioural Core

> Motivational interviewing• Establishing readiness for change

> Pyschoeducation• Gender and mental health• Effects of violence and abuse on mental health• Anxiety, depression, complex PTSD• Treatment methods

> Distinguishing between normal and problem anxiety

> Cognitive interventions• Negative automatic thoughts, thinking biases• Core beliefs

> Graded exposure therapy for anxiety-related avoidances

> Behaviour activation for depression related inactivity

> Mindfulness• Negative automatic thoughts, thinking biases• Maintaining overall mental health and wellbeing

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Women’s Health Emphasis

> Maintaining overall mental health and wellbeing and preventing relapse

• Understanding the impact of gender in this

• Self care

> Linking individual service provision to broader therapeutic, policy and social change initiatives

Model has been developed and documented

Training coming from the model

½ day training components

> Values and skills in establishing an enabling therapeutic relationship

> Gender and mental health> Impact of violence and abuse on mental health and

the development of mental illness> Recognising and responding to disclosures of abuse

when working with mental health problems> Working with complex post traumatic stress disorder

and substance use> Establishing safety when using exposure therapy for

traumatic memory > Worker mental health, wellbeing and self care

THANKS!