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How DNA helped to go deeper: A Puerto Rican therapist’s reflections of his exploration of ethnicity
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NHS mental health staff: securely attached or under attack?
No full textThe author discusses the need for more compassionate and emotionally secure settings for patients and mental health providers of the National Health Service (NHS). He recaps key concepts in attachment theory and suggests applicable and helpful areas to work contexts of the NHS mental health initiative. The author explains the factors such as costs to workplace cultures, high pressure workloads, and highly competitive environments
Observation in health and social care: Applications for learning, research and practice with children and adults
No full textDer diagnostisch-therapeutische Dialog mit dem elektiv mutistischen Kind (Diagnostic-therapeutic dialogue with a child with elective mutism)
No full textIndividuals communicate in a variety of ways. In the course of development, non-verbal, gestural and mimic signs and gestures are gradually replaced by verbal language and narrative. In the case of a child suffering from extreme elective mutism, how is a diagnostic-therapeutic dialogue to be established that would indicate whether or not a course of psychoanalytic psychotherapy would be beneficial? The author investigates this question with reference to four psychoanalytically oriented interviews with a boy in latency, discussing it against the background of theoretical ideas and psychoanalytic concepts
Sex now, talk later
No full textSex matters. It is a crucial part of whom we are and what to do. So why do we police what is ‘normal’ and what is ‘bizarre’? As Estela Welldon argues in this insightful book, whenever we disapprove of others or ourselves in this way, we close our eyes to a deeper understanding of human nature.
Dr Welldon is an internationally recognized expert on sexual diversity. As a psychiatrist, she has also worked inside prisons with sex offenders, so she is familiar with the extremes of ‘oddity’. Here, she uses a psychoanalytic framework with humour, insight and clarity to explore why we disapprove, and what we lose when we do. She presents us with a series of interwoven vignettes, drawn from clinical work and life experiences, which have led her to these conclusions.
Dr Welldon argues in this book that as human beings we have a responsibility to develop a much more enquiring and open mind, and to feel privileged rather than disgusted when we have access to primitive fantasies that shine light into the dark corners of minds not considered ‘normal’.
Be ready to live dangerously as you read these pages. The pursuit of understanding will take you deep inside the primitive and archaic origins of our present attitudes.
All artworks by Ricardo Cinalli. Photographs by Ferdinando Maria Carabot
Too close for comfort: The challenges of engaging with sexuality in work with adolescents
No full textThis paper explores some of the ways in which sexuality can intrude into the psychotherapeutic relationship and present both opportunities and risks to our work with adolescents. It highlights some of the complexities of this area of the clinical encounter, exploring the particular difficulties encountered by both patient and therapist when sexuality emerges in the transference and countertransference. While we are well aware of the centrality of sexual development during adolescence, far less has been written about the way in which sexuality and the erotic transference emerges and impacts on both patient and therapist. Given the profoundly unsettling nature of this area of work and its capacity to disrupt our thinking and psychic equilibrium, it is easy to underestimate how much we are drawn to avoid, negate and defend ourselves against registering such experiences. Through the discussion of clinical material with two adolescent patients, this paper explores some of these dynamics, addressing some of the technical dilemmas that frequently challenge us in this area of work. These include questions about whether and when it is therapeutically important and effective to take up and interpret the emergence of sexuality more directly in the transference and some of the risks to our patients when we ‘play safe’ and fail to do so. Most importantly, this paper aims to facilitate further thinking and discussion about an important but uncomfortable and easily neglected area of our work
General practice, mental health and stress. Part 2: Organisational model and commentary on the post modern context
No full textThinking together: a pilot scheme linking paediatric and CAMHS trainees to improve collaboration and address training gaps
No full textBackground: Mental health presentations are an increasing part of the paediatric caseload and there is growing evidence that paediatric trainees feel ill-equipped to manage these patients. Only 33% of trainees we surveyed felt that their current training programme enabled them to achieve their curriculum requirements in paediatrics or mental health respectively. CAMHS services are increasingly stretched, raising referral thresholds and making the need for closer working together across disciplines paramount.
Aim: A working group of paediatric and psychiatry trainees developed the concept of Thinking Together, to tackle this training gap. The scheme involves pairing paediatric and CAMHS trainees to share in each other’s clinical encounters to foster a joint way of learning and working together, while fulfilling curriculum competencies that are otherwise difficult to achieve.
Method: A pilot was launched in March 2016 where trainees from both specialties were paired for a period of 6 months, attending at least two clinical encounters in each setting. Curriculum competencies for both specialties were outlined in a resource pack. Trainees were encouraged to explore a variety of learning possibilities, including clinics, referral meetings and signposting their partner to other relevant clinical opportunities.
Results: 30 trainees were surveyed and 16 of these completed pre and post pilot evaluation. Prior to participating in Thinking Together, 70% stated they had no experience of working in a jointly delivered paediatric/mental health clinic. 93% of participants felt that their patients benefitted from access to the jointly delivered paediatric and mental health clinics. Confidence in achieving curriculum competencies in paediatrics and mental health respectively, increased to 93% following involvement in the project.
Conclusion: Our results highlighted that trainees felt they had achieved curriculum competencies in their linked specialty, while improving their capabilities in collaborative, patient-centred practice. Trainees felt the scheme benefited both their patients and themselves, thinking together through cases and developing a greater appreciation of different professionals’ roles and responsibilities. As the burden of mental health grows, with it’s irrefutable link to physical well being, we feel schemes such as ours will improve understanding for future trainees between the cross over of mind and body