Participation-engagement: a philosophically based heuristic for prioritizing clinical interventions in the treatment of comorbid, complex, and chronic psychiatric conditions.
We propose Participation-Engagement (PAR-EN) as a philosophically based heuristic for prioritizing interventions in comorbid, complex, and chronic psychiatric conditions. Drawing from 1) the sociologist Talcott Parsons, 2) the continental-philosophical tradition, and 3) our own previous work (Davidson & Shahar, 2009; Shahar, 2004, 2006), we argue that participation in personally meaningful life goals represents a hallmark of mental health. Symptoms and vulnerabilities that impede such participation should therefore be targeted vigorously, whereas others which do not pose such imminent threats should assume a secondary focus, if at all. Winnicott's (1987) notion of the spontaneous gesture, the importance of daily activities as reflecting patients' participation, and the dialectics of interpersonal relatedness and self-definition, are introduced as guidelines for implementing PAR-EN. Implications for clinical assessment and the therapeutic relationship are discussed.
Shahar
Golan
G
Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel. shaharg@bgu.ac.il
Davidson
Larry
L
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D001294:Attitude to Health; D002908:Chronic Disease; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005868:Gestures; D017408:Guidelines as Topic; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008960:Models, Psychological; D009042:Motivation; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D010684:Philosophy; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D012649:Self Concept; D012931:Social Environment; D011795:Surveys and Questionnaires