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Current understanding of narcissism and narcissistic personality disorder
No full textThis article reviews historical contributions to the conceptualisation of narcissism and narcissistic personality disorder (NPD), including its evolution as a clinical diagnosis within the DSM classification of mental disorders. It discusses the epidemiology and aetiology of NPD, noting that empirical studies of both are limited. The challenges of managing patients with prominent narcissistic traits are presented, and the psychological therapies specifically designed for the treatment of patients with NPD are summarised
Risk assessment practice within primary mental health care: A logics perspective
Get PDFFrom the 1980s onwards, discourses of risk have continued to grow, almost in ubiquity. Ideas and practices of risk and risk aversion have extended to UK mental health care where services are expected to assess and manage risks, and high-quality clinical assessment has been revised to incorporate risk assessment. This article problematises practices of risk assessment in mental health provision, focussing on the base-rate problem. It presents an analysis of audio recordings of risk assessments completed within a primary care mental health service. The analysis is informed by a critical logics approach which, using ideas from discourse theory as well as Lacanian psychoanalysis, involves developing a set of logics to describe, analyse and explain social phenomena. We characterise the assessments as functioning according to social logics of well-oiled administration and preservation, whereby bureaucratic processes are prioritised, contingency ironed out or ignored, and a need to manage potential risks to the service are the dominant operational frames. These logics are considered in terms of their beatific and horrific fantasmatic dimensions, whereby risk assessment is enacted as infallible (beatific) until clients become threats (horrific), creating a range of potential false negatives, false positives and so forth. These processes function to obscure or background problems with risk assessment, by generating practices that favour and offer protection to assessors, at the expense of those being assessed, thus presenting a challenge to the stated aim of risk assessment practice
Psychoanalytic perspectives on paraphilias and perversions
No full textSince Freud’s exposition of the nature of perversion in his seminal work, Three Essays on the Theory of Sexuality there has been a multitude of rich and varied explorations of human sexual fantasies and behaviours that are considered as perversions within the psychoanalytic literature. However, with more recent societal shifts towards the acceptance of sexual orientations and practices which would previously been categorized as deviant, perversion has become a pejorative term seen as stigmatizing and debasing those whose sexual preferences do not conform to the traditional norm. In this paper I argue that certain psychoanalytic concepts of perversion retain utility in how we might think about and help individuals whose sexual desires and practices cause distress to themselves and/or others, particularly in the realm of intimate relationships. Historical and contemporary theories about the nature and origins of perverse fantasies and behaviour are presented and explored, focusing on how perversion may be conceptualized as a defence against early anxieties and disturbances in the mother–infant relationship. Such ideas inform a psychoanalytic approach to the treatment of perversions, particularly in consideration of transference and countertransference dynamics. The ideas in this paper are based on my work at the Portman Clinic in London, UK
Assessment and support of children and adolescents with gender dysphoria
No full textThere has been a large increase in the
number of children and adolescents who
question conventional gender expectations
and seek recognition and acceptance
of their gender diversity, wishing
to develop a body that is congruent with
their gender feelings.Professionals may
be unsure how best to provide supportive
care, how to access the national Gender
Identity Development Service (GIDS)
for children and adolescents, or how to
deal with a transgender young person
presenting with another clinical problem
unrelated to their gender transition. Faced
with very distressed young people, they
may feel under pressure to initiate physical
intervention without consultation with
psychosocial colleagues. It is important
that all professionals are aware of the care
pathway for transgender children that
may be of relevance in a range of paediatric
settings. The purpose of this practice
review is to present an up-to-date perspective
on the care of transgender children
and adolescents to guide management
and to enable the provision of a practical,
evidence-based approach to their support
Trans and Sexuality: An existentially-informed enquiry with implications for counselling psychology
No full textGrounded in cutting-edge qualitative research, Trans and Sexuality explores the sexuality of people who do not identify with the gender that they were assigned at birth. Arguing that whilst splitting members of the trans community into distinct groups might seem like a reasonable theoretical procedure, the pervasive assumption that group membership impacts on the sexuality of trans people has unduly biased opinions in this highly contested, yet dramatically under-researched area. Moreover, whilst existing literature has taken a purely positivistic standpoint, or relies on methodology that could be seen as exploitative towards trans people, Richards is careful to place the real-life experiences of trans research participants at the heart of the work.
Showing that sexuality extends beyond the bedroom, this forward-thinking book touches on topics such as identity, sexuality and the intersections between the two. Richards takes a cross-disciplinary approach and considers the sexuality of trans people within the contexts of psychiatric and psychological settings, including Gender Identity Clinics, as well as in the broader contexts of cultural and community settings. The implications of the research at hand are also explored with respect to counselling psychology and existentialist philosophy.
Trans and Sexuality will appeal to academics, researchers and postgraduate students in the fields of gender and sexuality, counselling, sociology, psychotherapy, psychology and psychiatry. It will be of particular interest to those seeking an in-depth and up-to-date overview of ethics and methodologies with people from marginalised sexualities and genders