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Representation, place and equivalent realities: An exploration of relational perspectives on representation and meaning
No full textEspecially relevant in the continuing complexities of the UK Referendum, this timely paper from Karen Izod focuses on the nature of representation as both an authorised function of governance, and as a negotiation with one’s inner world, sense of identity, and sense of place. It opens up ideas about intentions and consequence of representational acts as they are expressed in unconscious and symbolic ways.
Karen brings together ideas from a number of workshops that she has run in the UK and in Sweden, which explore the centrality of place as a formative aspect of how we develop our patterns of attachment, and its significance in thinking about the here in working in the here and now. She proposes that place as a contributing factor in the way that we take up roles in particular those representing our organisations and communities. Contexts in which Karen has developed and applied this work include: integrated city planning, working in globally dispersed organisations, and brand creation through acts of representation
How evolution can help us understand child development and behaviour
No full textThe traditional disease model, still dominant in psychiatry, is less than ideal for making sense of psychological issues such as the effects of early childhood experiences on development. We argue that a model based on evolutionary thinking can deepen understanding and aid clinical practice by showing how behaviours, bodily responses and psychological beliefs tend to develop for ‘adaptive’ reasons, even when these ways of being might on first appearance seem pathological. Such understanding has implications for treatment. It also challenges the genetic determinist model, by showing that developmental pathways have evolved to be responsive to the physical and social environment in which the individual matures. Thought can now be given to how biological or psychological treatments – and changing a child’s environment – can foster well-being. Evolutionary thinking has major implications for how we think about psychopathology and for targeting the optimum sites, levels and timings for intervention
Dimensionality,identity and security: Finding a home through psychoanalysis
No full textThis paper suggests that Meltzer’s understanding of the development of inner space can be thought about in relation to how a state of ‘being at home’ can be impaired through early trauma and developmental failure. It shows how a very young child developed a greater capacity for recognising inner and outer experience and consequently a greater awareness of inner space through intensive psychotherapy. Clinical material is presented in which this two-year-old boy moves from profound disorientation and disconnection, through physical containment and moments of communication, to some shared expression and symbolisation of his preoccupations. The author uses episodes from the psychotherapy to illustrate links between Meltzer’s thoughts on impaired interior dimensionality and a resulting terror of the ‘breaking of surfaces’ with Winnicott’s understanding of the necessary ‘gravitational pull’ of a good internal object and the negative retreat which may be caused by overwhelming anxiety. The paper suggests that a developmental approach to psychotherapy with young children has some technical ramifications which might include physical containment, emphasised attunement, simple observational commentary and developmental interpretation. The relationship between interior and exterior spatial awareness is discussed and brief reference is made to a study of psychotherapy with homeless adults regarding their capacity to make use of a physical home. Finally, Bion’s encouragement to abandon memory and desire is discussed in relation to the need traumatised children may have for environmental hope and hopefulness in the person of their therapist
'Graphic Medicine’ as a mental health information resource: Insights from comics producers
No full textRecent literature suggests that a growing number of comics are being published on health-related topics, including aspects of mental health and social care (Williams 2012; Czerwiec et al 2015) and that comics are increasingly being used in higher education settings as information resources.
This article offers insights from comics creators and disseminators and explores the wider context of comics production and distribution (with a focus on 'Graphic Medicine' or health-related comics) as part of a larger examination of the interface between these documents and potential academic audiences. Original data was gathered through semi-structured interviews with 15 participants actively involved in comics creation and production. Elements of domain analysis (Hjørland 2002) were used to obtain insights into attitudes to the creation, dissemination and use of mental health-related comics.
Though potentially useful comics material is being produced in the mental health domain, significant challenges remain for producers in enabling their work to be accessed within higher education settings. This paper suggests that comics producers need to make a concerted effort to reach academia, and academia - including information professionals - need to embrace new types of material to enhance teaching
The role of paediatric mental health liaison teams
No full textI would like to thank the authors for producing the most significant (and accessible) paper that I have enjoyed since beginning my higher training in Child and Adolescent Psychiatry.
This is an essential ethnographic account of the inner mental states, characteristically undisclosed, of young people presenting in crisis to acute medical settings. I plan to share the paper widely amoungst colleagues in Emergency Medicine and Paediatrics, but it also makes for vital reading for other health professionals (paramedics, social workers and police) who will come into contact with this patient group in their respective, essential, lines of work.
The paper hints that the patients it describes are merely the tip of the iceberg. Most under 18s who deliberately self-harm do so in isolation and do not seek medical attention, precisely because of the degree of stigma and misunderstanding to which they can be exposed when they present to hospital.
Although deliberate self-harm is often impulsive, invariably there are significant and longstanding problems in the young person and his or her family. The instinctive “flight to health” under the circumstances described in this paper can be powerful, and young people may hide or minimise their distress in an attempt (conscious or otherwise) to leave the hospital. Some presentations (eg boxer’s fractures in boys) are easily missed as self-harm events, because the young person in question will choose not to volunteer the context of the presentation.
What the paper does not directly address is the strategic means through which we can improve the experience of care for these young people.
Some argue that the acute hospital is not an appropriate setting to care for young people in psychological distress, but often they will need medical attention (bloods, stitches, scans etc) and they should be considered as much “Paediatric” as “Psychiatric” patients – their needs are no less deserving.
Admission to a paediatric ward (recommended by NICE guidelines but often not followed) is an entirely appropriate intervention, irrespective of immediate “medical” need. This demonstrates that the act is being taken seriously, that professionals recognise the severity of the symptoms and that the patient is being thought about, rather than ‘disposed’ of. Frequently, it is only the next day, in the safety of the paediatric environment (following consultations with family members and any already involved professionals) when the full social circumstances are made apparent, and disclosures are commonly made.
Dedicated Paediatric Mental Health Liaison (PMHL) teams, co-located with paediatrics in the acute setting, are sadly few and far between. Where they exist, they can provide a gold standard in integrated physical and mental healthcare, with rapid response times to A&E, including out-of-hours, when most such patients present. Assessments can be afforded sufficient time, and aside from quantifying risk, can be therapeutic events, making the child’s prospective contact with community CAMHS a more approachable idea.
With the input of PMHL teams, admission to Tier 4 inpatient psychiatric services is rarely needed. Many patients are successfully assessed and managed on the paediatric ward for 24-48 hours, avoiding the need for a higher level of psychiatric care. These are therefore early intervention and cost saving interventions for the wider healthcare system.
In addition to the assessment and management of deliberate self-harm, PMHL teams perform a range of diverse roles in children of all ages from the neonate to older teens, including management of the psychological sequelae of chronic illness in children, medically unexplained symptoms, life-limiting illnesses, bereavement and perinatal mental health. The bulk of work in PMHL is in fact with such non-emergency cases. Liaison teams also help staff from allied disciplines to develop a more sophisticated understanding of such complex cases, by assisting in systemic reflection – often known as “work discussion”, or “psychosocial meetings”. The presence of a PMHL team is psychologically containing for paediatric colleagues as well as the patients. Such teams build confidence as well as resilience.
Too often, children and adolescents presenting with self-harm to hospitals without PMHL teams are left to wait for many hours to be assessed (a torturous and emotionally compounding experience, given the cognitive state they are often in as described so vividly in the paper). They may be reviewed by general adult psychiatrists who will perhaps lack the clinical acumen and confidence of a specialist in the field.
The rates of child and adolescent self-harm presentations to hospital are increasing year upon year. As promised new funding finds its way to the frontline of CAMHS services, it is to be hoped that a good amount of it is invested in Paediatric Mental Health Liaison Services which are a key intervention for this group of distressed and desperate young people
Clients’ experiences of dynamic interpersonal therapy (DIT): Opportunities and challenges for brief, manualised psychodynamic therapy in the NHS
No full textDynamic interpersonal therapy (DIT) is a brief manualised psychodynamic intervention for depression. This is a first study exploring clients’ experiences of DIT specifically and brief, manualised psychodynamic psychotherapy (PP) in general. Interpretative phenomenological analysis was the methodology employed. Five participants completed a semi-structured interview, three weeks to ten months after completing DIT. The scores of pre- and post-therapy outcome measures of depression and anxiety were also available. Two emerging superordinate themes are presented here: (1) ‘The Distinct Features of DIT’, referring to how its therapeutic style and time limitations were experienced and (2) the ‘Impact of Therapy’, referring to perceived outcomes. While previous findings showed that therapist’s perceived limited activity in long-term PP was experienced as hindering/unhelpful, the perceived sense of direction in DIT appeared adequate to most participants. Secondly, the time limitations provoked complex responses. Reactions to the distinct elements of DIT are to be treated both as therapeutic opportunities and as challenges. Further, in line with psychoanalytic theory, most participants described relational changes that went beyond symptom relief and remained in progress after therapy ended. Intriguingly, there was no consistency between participants’ qualitative accounts of change and the scores of the outcome measures
An exploration of trainee educational psychologists' experience of attending a group relations conference using Interpretative Phenomenological Analysis
No full textAim: The aim of this research has been to explore trainee educational psychologists’ experience of attending a group relations conference and their perception of any influence on their behaviour. Design: Four participants were recruited through purposive sampling and interviewed on two occasions. Interview data was analysed using interpretive phenomenological analysis. Findings: Themes that emerged through analysis indicated that participants’ described their experience, of attending a group relations conference, as involving chaos, confusion, conflict and coping. Participants also indicated that they gained an enhanced awareness of behaviours within groups and engaged in significant levels of self-reflection, exploring concepts of identity and the self in role. These findings were related to the literature and it is proposed that psychosocial theory can help in offering a coherent understanding of the intersubjectivity influencing the interrelated internal and external experiences. The influence of anxiety, defences and splitting in particular are discussed. Limitations of the research are considered. Impact: It is argued that group relations conferences can support the development of knowledge and understanding of groups, relationships and interpersonal skills, which are included in the requirements of professional training in educational psychology. More broadly, it is argued that attending a group relations conference can support self-reflection and exploring issues of identity and the self in role. It is suggested that this learning can support trainees in understanding the complex contexts in which they work. It is also suggested that this approach to experiential learning may be of interest to more experienced professionals and to trainees and practitioners from a range of professions. This research may also be of interest to those designing and delivering group relations conferences in terms of theory and practice. A range of possible future directions for research are considered
Psicoterapia con una nina psicótica
Get PDFEsta presentación dilucidará la puesta en práctica de la supervisión del Dr. Meltzer y en particular sus pensamientos descritos en el Proceso Psicoanalítico (Meltzer, 1967). El trabajo clínico describirá aspectos de la esperanza, el concepto de tiempo y la emergencia gradual de capacidades reparatorias y creativas en una niña psicótica de 6 años de edad. Se mostrará la emergencia de capacidades de simbolización a través del curso de la terapia