Brief Article
Copyright ©2014 Baishideng Publishing Group Co.
World J Psychiatr. Mar 22, 2014; 4(1): 13-29
Published online Mar 22, 2014. doi: 10.5498/wjp.v4.i1.13
Table 1 Assimilation of problematic experiences scale
0Warded off/dissociated. Client seems unaware of the problem; the problematic voice is silent or dissociated. Affect may be minimal, reflecting successful avoidance. Alternatively, the problem appears as somatic symptoms, acting out, or state switches
1Unwanted thoughts/active avoidance. Client prefers not to think about the experience. Problematic voices emerge in response to therapist interventions or external circumstances and are suppressed or actively avoided. Affect involves unfocused negative feelings; their connection with the content may be unclear
2Vague awareness/emergence. Client is aware of the problem but cannot formulate it clearly-can express it but cannot reflect on it. Problematic voice emerges into sustained awareness. Affect includes intense psychological pain-fear, sadness, anger, disgust-associated with the problematic experience
3Problem statement/clarification. Content includes a clear statement of a problem-something that can be worked on. Opposing voices are differentiated and can talk about each other. Affect is negative but manageable, not panicky
4Understanding/insight. The problematic experience is formulated and understood in some way. Voices reach an understanding with each other (a meaning bridge). Affect may be mixed, with some unpleasant recognition but also some pleasant surprise
5Application/working through. The understanding is used to work on a problem. Voices work together to address problems of living. Affective tone is positive, optimistic
6Resourcefulness/problem solution. The formerly problematic experience has become a resource, used for solving problems. Voices can be used flexibly. Affect is positive, satisfied
7Integration/mastery. Client automatically generalizes solutions; voices are fully integrated, serving as resources in new situations. Affect is positive or neutral (i.e., this is no longer something to get excited about)
Table 2 Retrospective interview: Structured questions and domains of interest
QuestionsDomains of interest
In retrospect, what do you think were the key issues at the VAMC at the time of the NCOD intervention in 2002Events that lead to interventionOverall feelings about environment at the facilityManagement, union, employee, legal
In general, what do you feel the intervention accomplishedChanges in the overall feelings of employeesPolicies, plansLasting impacts on the VAMC, qualitative judgments of individuals who participated at a high level in the intervention
What do you think were the most helpful practicesNCOD events, management eventsManagement, union, employee, NCOD
What do you think were the least helpful practicesNCOD events, management eventsManagement, union, employee, NCOD
How do you think things could have been handled differentlyNumber and types of eventsParty responsible for interventionType of intervention, management responseIdeas for improved outcomes, responses to employee ideas
Do you feel there were overall improvements at the facilityChanges in overall employee attitudes and morale, community perceptionLong term evaluation, immediate improvement, sustainability
What do you feel were the causes of improvements or the lack thereofManagement, NCOD, and community eventsWillingness to change of management and employeesManagement, union, employee, NCODEffects of success or lack of success
Table 3 Main problematic experiences by informant type, and pre- to post-intervention changes
Type of informantProblematic experience rated on the APESAPES level at preAPES level at post
VAMC administrators (n = 2)Admin 1: Employee perceptions of discriminatory practices (the allegations)25, 6
Admin 2: Personal experience of the allegations25
Admin 2: Existing practices at the VAMC0, 16
Admin 1: Management-union relationship1.52.5
Admin 2: Management-union relationship1.5-23
Union representatives (n = 2)Union 1: Lack of communication (management and unions)22.5
Union 1: Lack of employee empowerment26
Union 1: Resenting interventionists “interfering”23
Union 2: Management “doing as they please” (discriminatory hiring and promotions, lack of accountability, resulting employee disempowerment)23
VAMC employees (n = 240)Existing practices (racism, favoritism, unfairness), caused by uncaring or weak leadership, result in negative workplace climate, low morale, disempowerment of employees1, 2, 35, 6
Intolerant, adversarial attitudes by supervisors of certain areas cause no cohesion between staff1, 24, 5
VAMC-wide lack of communication, training, and support for job-related tasks2, 33, 4, 5
Understaffing creates many problems which are not addressed by leadership2, 33
Bad public image of the VAMC is unfair and depressing0, 1, 23.5, 4