Missionary Outreach Support Services MOSS: A Model for Online Mental Health Consultation

1
Missionary Outreach Support Services (MOSS) A
Model for Online Mental Health Consultation

• Glen Moriarty, Psy.D.
• Joanne R. Schwandt
• December 6, 2005

2
Missionary Outreach Support Services

• Goal To provide support and resources to
  Christian families throughout the world engaged
  in ministry through online, private, secure,
  mental health consultation.

3
Benefits and Challenges

• Benefits
• Cost Effective
• Efficacious
• Disinhibition effect freedom to express
  thoughts openly due to anonymity, invisibility
• Transcends geographical distance
• Challenges
• Difference in cultures and customs for text-based
  relationships
• Technological difficulties
• Crossing National Boundaries
• Suler, 2003

4
Ethical Considerations

• Suitability
• client poses a danger to himself
• history of suicidal, violent, or abusive behavior
• clients experiencing delusions, hallucinations,
  life-threatening situations or is abusing alcohol
  or drugs (Kraus, 2003)
• Informed consent (APA Ethics code)
• Limits of confidentiality (APA Ethics code)
• Liability of Technology (Rosik and Brown, 2001)
• Transmission, Therapist end, Client end, Legal
  Subpoena (Manhal-Baugus, 2001)
• Competency
• Training in Text-Based Communication
  (Manhal-Baugus, 2001).

5
Outcome Research

• Therapeutic alliance can be established through
  text communication (Cook and Doyle, 2002)
• Other studies show that it is comparable to f2f
  treatment Magaletta, Fagan, and Ax, 1998 Cohen
  and Kerr, 1998
• Barak, 2001 compiles list of case studies that
  use text based therapy to treat anxiety, eating
  disorders, PTSD, panic, recurrent headaches,
  weight loss
• Studies also show internet use can both increase
  and decrease depression (LaRose, Eastin and
  Gregg, 2001)

6
Missionary Mental Health

• Missionary
• Any person who works full-time for a
  religious organization outside the borders of the
  home country and whose primary purpose is to
  communicate the gospel as revealed in the Bible
  (Jones and Jones, 2000)
• Many articles are theoretical and descriptive
• Characteristics
• - Missionary population tends to worry more than
  norm population (Dillon, 1983)
• - High mobility and a variety of intercultural
  influences (Pollock, 1997)
• - Lack of Self-disclosure and a Denial of the
  existence of Stress (Chester, 1983)

7
Missionary Mental Health

• Missionary Women
• Difficulty in balancing familial responsibilities
  and their ministerial roles (Skelton, 1986)
• Failure to recognize these roles may lead to low
  self-image and depression (Bowers, 1985)
• Increase in women applicants experiencing
  homosexual encounters (Gardner, Barer, and
  Kellogg, 1993)
• Missionary Children
• Educational Needs
• Delayed psychosocial development (Wrobbel,1990)
• Importance of Family Relationship (Wrobbel and
  Ludeddemann,1990)
• Reentry Issues

8
Missionary Mental Health

• Dorothy Plackett - William Careys first wife who
  suffered from jealous delusions (Beck, 1993)
• Well-being of missionaries
• Interpersonal Relationships
• Forgetting effects of physical illness
• Fatigue
• Professional inferiority
• Inadequate job descriptions
• Conflict between professional and spiritual
  obligations (Foyle, 1985)
• Spirituality Related to Family Life
  Satisfaction (Andrews, 1999)
• Assessment of spirituality amongst missionaries
  shows significant problems such as identity,
  depression, and sexual orientation (Parshall,
  1987)
• Occupational Satisfaction
• Attrition - political crises, death in service,
  retirement, marital or familial difficulties,
  personal difficulties or in the sending body,
  adaptation to culture or occupation, lack of
  support, inappropriate training, lack of calling,
  commitment or immaturity (Limpic, 1997
  Adiwardana, 1997)

9
Missionary Mental Health

• Stress
• The average cross-cultural worker has
  approximately 600 points of stress per year
  (Carter, 1999)
• Five major sources of stress
• Confrontation, cross-cultural communication,
  support maintenance, work overload, work
  priorities (Gish, 1983)
• Additional sources of stress
• Culture shock, loneliness, depression, familial
  difficulties (education of children), lack of
  privacy
• Indirect hostility as expression of anger incited
  by stress (Taylor and Malony, 1983)
• Overall hostility scores lower than the norm
  population indicating a lack of self-disclosure
  or the lack of acceptance to express negative
  emotions (Taylor and Malony, 1983)

10
Missionary Mental Health

• Culture Shock
• Accumulated stresses and strains which stem from
  being forced to meet ones everyday needs . . .
  In unfamiliar ways (Whitecotton, 1996)
• Culture fatigue eventually become worn down by
  constant adjustments (Allen, 1986)
• Precursor to anxiety and depression
• Specific Mental Health Disorders
• Separation anxiety (Bullock, 1973)
• Post-traumatic Stress
• Crises that incite trauma (Carr, 1994 Carr,
  1997)
• Elective Mutism (Beck and Hubbard, 1987)
• Child Molestation and Sexual Abuse (Kellogg and
  Hunter, 1993)
• Dissociative Identity Disorder (Rosick and
  Kilbourne-Young, 1999)
• Personality Disorders (Schubert, 1993)
• Traumatic Experiences
• Missionaries are often in parts of the world
  where socioeconomic conditions expose the
  missionary to poverty, crime and disease (Carr,
  1984)

11
Member Care Services

• Ongoing investment of resources by mission
  agencies, churches, and other mission
  organizations for the nurture and development of
  missionary personnel (ODonnell, 1997)
• Current Services
• Candidate Selection
• Crisis intervention
• Treatment consultations
• Counseling on furlough and on location (Hall and
  Barber, 1996)
• Missionaries serving in East Africa reported a
  desire for member care services and a
  dissatisfaction of the services currently offered
  (Rosik, Richards, and Fannon, 2005)
• While member care services are growing, dual role
  conflicts and difficulty offering timely services
  to missionaries continue to be a problem.

12
Missionary Outreach Support Services

• Missionary Outreach Support Services
• An Educational consultation website for mental
  health services
• Uses Asynchronous communications
• Utilizes Email as form of online service provision

13
Four Email Exchange

• Based on principles of motivational interviewing,
  brief solution-focused therapy and narrative
  approaches.
• Four Emails
• Build rapport and normalize the problem
• - Connect, Convey safety, reframe problem as
  something to be overcome
• Address the consultation question
• - Client has choices, provide self-help
  techniques
• - Revisit maintaining factors and circumstances
• Planning
• Validate positive changes
• Formulate plan for after treatment
• Summarizing
• Summarize and validate clients progress
• - Zelvin and Speyer, 2003

14
Four Email Exchange
Entry
Diagnosis
Implementation
Disengagement
15
Four Email Exchange

• Subject Heading
• Gains attention
• Engages client
• Build Rapport
• Introduction
• Introduces Topic
• Summarizes central issue
• Focused and Directive
• Addresses clients interpretation of problem
• Body
• Confrontation and Rapport
• Summarizing paragraph
• Encourage and Challenge
• Condense and Help Client Remember Main Principles

16
Consultation Process

• 1 . Missionary visits www.missionaryoutreach.net
• 2. Uses own email or hushmail to express interest
  in receiving consultation.
• Consultant receives email and sends missionary
  demographic form, research link, and informed
  consent.
• Missionary fills in relevant information and
  digitally signs the informed consent.
• Consultant constructs initial response and
  discusses response and consultant question with
  licensed psychologist.
• Consultant, under the supervision of a licensed
  psychologist, works with the missionary until the
  4-step model is completed or the issue is
  resolved.

17
Website

• Overview of Website
• Questions, Comments, Suggestions?
• Thank you very much for your time. Please contact
  me if you are interested in working or
  collaborating with us. God Bless.
• glenmor_at_regent.edu or
• [phone]

18
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