By: Hadas-Lidor, N., Weiss, P., & Redlich, D
Noami Hadas-Lidor, PhD, OT, is Senior Lecturer, Occupational Therapy Department, Tel Aviv University, Tel Aviv Israel
Dorit Redlich, MSc, OTR, is National program coordinator of Keshet.
Corresponding author: Penina Weiss MSc, OTR, CDRS, Doctoral Student, Haifa University, Haifa, Israel. Address: 20 Hainbal St., Petach Tikva, Israel, 49733 Tel 972-544-933580, Fax 972-3-9335802, penina.weiss@gmail.com
Family interventions in mental health focus primarily on consumer outcomes, with family wellbeing viewed only as an intermediate outcome. Since families are usually the most stable entity in the lives of those with mental illness, they can benefit from exposure and instruction to intervention strategies, techniques and methods that are typically used by professionals as part of their therapeutic practices. One such area is a deeper understanding of cognition, how it is affected in mental health illnesses, how to identify cognitive strengths and weaknesses and how cognitive communication skills based on mediation can enhance learning, adaptability, participation and recovery.
"Keshet" (rainbow in Hebrew) is a course designed for family caregivers seeking support within academic settings. It is a standardized cognitive educational course that helps family caregivers appreciate and develop skills for empowering communication. The "Keshet" course focuses on teaching parents about cognition and mediation, considered a basis for the concepts of brain plasticity, cognitive modifiability, and the turning of experiences into a source of learning. Mediating interaction is a specific human intervention which is different from just exposure to stimuli. The mediator – a parent, caregiver, teacher and therapist – interposes himself/herself between the world of stimuli and the consumer/ child/ student, in order that the he/she will assimilate the stimuli into internalized cognitive structures that can lead to change. An interaction becomes a mediating interaction when there is at least an explicit intentionality on the part of the mediator, with the child reciprocating that intention; an attempt to ‘‘transcend’’ the here-and-now, relate to other situations, add meaning to the stimulus, regulate behavior, boost feelings of competence and share experiences. Emphasis is placed on relationships between cognition and emotion and their impact on effective communication. One of the central aspects of "Keshet" is Knowledge Translation—providing caregivers with practical tools traditionally used by therapists, to help them translate components proven to be effective in research, to actual practice. One of the central methods used in "Keshet" to meet this need is the use of Meaningful Interactional Life Episodes (MILEs), a written description of actual life interactions involving a dialogue between at least two people, handed in by participants. For example:
I picked up the phone to call my daughter. I asked her: "How are you?"
She replied: "The same, not well. Nothing helps me to get over this depression, I don't have any strength and I don't want to go on living".
I replied: " You're not making enough of an effort to get out of it, you're not occupying yourself with things you enjoy that'll help you overcome the depression.
My daughter answered: " Okay, you don't understand" and she slammed down the phone".
After the episode I felt guilty that I had hurt her, not being able to understand that she's incapable of leaving her house and doing things that she enjoys.
We analyze these MILEs, according to the themes introduced as the course progresses. The above MILE for example was used to demonstrate and teach the significance of different perspectives. Other areas of focus include emotions, cognition and actions; mediation parameters; clear and masked intentions, and more.
Since initiated by Hadas-Lidor in 2001, over 300 parents have participated in the 45-hour bi-weekly three hour program with one to two participants from every group becoming moderators of future "Keshet" groups. We developed a moderator manual and structured outline of theoretical content using uniform presentations and assignments. Moderators undergo uniform training and there is ongoing supervision and instruction. The course consists of lectures, workshops, home assignments and exercises, reading of material, viewing and analyzing documentary films on recovery concepts, and writing and analysis of Meaningful Interactional Life Episodes (MILEs).
Participants have reported a higher level of knowledge and confidence and an improvement in their interactions after the completion of the course. A quasi-experimental study (n=49) found that "Keshet" significantly increased the hope of families concerning the ill person, while decreasing the gap between hope of family members regarding themselves and the affected person. A study of five "Keshet" courses (N=88) focusing on the perceived value of participating caregivers found that “Keshet” courses change the ways participants perceive and think about diverse life situations with which they have to cope. Participants reported that analysis of MILEs was beneficial and useful in applying links between theory and practice. Among the changes experienced by participants were feelings of improved communication with the family member suffering from mental illness, improved marital relationships, improved caregiver organizational skills, and more time invested in personal goals and interests.
