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The role of shame and humiliation in relation to the technical difficulties in providing psychotherapy to a six-year old boy in care
No full textThis thesis is a single-case post facto research study designed to better understand the intensive psychotherapy treatment of a six-year old boy in foster care, who I refer to as Freddy. There were considerable technical difficulties I wanted to examine, including how in-terpreting and other attempts to bring attention to the internal world and psychic real-ity stirred up shame and humiliation for a boy with a history of maltreatment. The literature review refers to work with looked-after children with childhood mal-treatment by child psychotherapists. Theories from adult psychoanalysis on narcis-sistic personality structures and object relatedness are also reviewed, and the link between shame, narcissism and the Ego Ideal is also explored. The growing body of knowledge that neuroscience offers our understanding of maltreatment is also re-viewed. The research methodology used Grounded Theory to analyze psychotherapy ses-sions, from which initial codes and categories were developed into over-arching themes. The findings indicated that, despite difficulty in understanding the therapy as it progressed, important processes took place, and shifts in psychic development were evident, particularly in the ability to gain a different view of relating. Changes in Freddy’s ability to communicate relational anxiety were also observed. The findings are discussed in terms the importance of the development of a mecha-nism for thinking about experience, and how early trauma and maltreatment can con-tribute to shame, humiliation and difficulties with psychic reality. Further discussion include the implications of maltreatment for child psychotherapy, clinical practice and future research
Getting Intimate: Using attachment theory to understand intimate relationships in our work with people with intellectual disabilities
No full textThe experience of close relationships is as important to people with an intellectual disability (ID) as it is to those without a disability. This chapter considers the intimate relationships of individuals with intellectual disability (ID), through the lens of attachment theory, and with reference to empirical research and the authors' own clinical experience working in the Learning and Complex Disabilities Service at The Tavistock Clinic, London. It describes how attachment theory has been helpful in understanding some of the difficulties our service users experience in their close and intimate relationships, in the context of other barriers which people with ID face in this area. The chapter also discusses how secure attachment promotes positive relationships, through which people with ID can live positive and fulfilling lives. People with ID desire the same range of close relationships as those without ID, but face many barriers to achieving these
A sea change for sick doctors - how do doctors fare after presenting to a specialist psychotherapy service?
No full textBackground: Little is known about doctors who present to services following an episode of psychological distress. MedNet is a psycho-dynamically informed confidential self-referral service for doctors.
Aims: To examine the health and work trajectory of MedNet clients between 2002 and 2007 followed up in 2010.
Method: We report and compare service-monitoring data for 124 doctors on engagement with health services, whether in work or not, sick leave utilised, and reported distress measured by CORE-OM at intake and at one follow-up time point.
Results: 95.6% of doctors continue to work and progress in their careers. 58.3% remained engaged with services. Sick leave had reduced significantly at follow-up. Distress was significantly reduced, but no differences were found with respect to social functioning and well-being. An interesting shift was observed in doctors' use of medication from treating somatic complaints towards treating mood symptoms.
Conclusions: Doctors show improvements and continue to progress in their careers after a psychotherapeutically orientated intervention. A shift in doctors' perception of their difficulties is indicated from more somatic to psychological concerns. Many doctor-patients continue with ongoing professional support
Worried about a child’s mental health? Here’s what you should do
No full textMany children suffer from severe emotional difficulties, a recent study has shown, but at least more of them are getting the specialist help they need
Nursing education interventions for managing acute pain in hospital settings: A systematic review of clinical outcomes and teaching methods
No full textThe objective of this review was to examine the effects of nursing education interventions on clinical outcomes for acute pain management in hospital settings, relating interventions to health care behavior change theory. Three databases were searched for nursing education interventions from 2002 to 2015 in acute hospital settings with clinical outcomes reported. Methodological quality was rated as strong, moderate, or weak using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies. The 12 eligible studies used varied didactic and interactive teaching methods. Several studies had weaknesses attributable to selection biases, uncontrolled confounders, and lack of blinding of outcome assessors. No studies made reference to behavior change theory in their design. Eight of the 12 studies investigated nursing documentation of pain assessment as the main outcome, with the majority reporting positive effects of education interventions on nursing pain assessment. Of the remaining studies, two reported mixed findings on patient self-report of pain scores as the key measure, one reported improvements in patient satisfaction with pain management after a nursing intervention, and one study found an increase in nurses’ delivery of a relaxation treatment following an intervention. Improvements in design and evaluation of nursing education interventions are suggested, drawing on behavior change theory and emphasizing the relational, contextual, and emotionally demanding nature of nursing pain management in hospital settings
What is the nature of the therapeutic encounter in an adolescent psychotherapy group?
Get PDFThis study takes as its subject the clinical work with 7 older adolescents who attended for once-weekly psychoanalytic group psychotherapy, and focuses retrospectively on the first 15 months of this intervention, in which the researcher was a co-therapist. The clinical process notes formed the data set. The starting point for this thesis is our conception of an inherent, developmental relationship to groups, and to the intersubjective relating that exists in human beings. It then moves on to the psychoanalytic thinking about groups and the emotional disturbance that emerged during World War II found in the work of WR Bion and SH Foulkes. It further examines literature on adolescence as a developmental process, adolescent breakdown, and the particular psychosocial risks and challenges of later adolescence. The intrinsic complexity in the data precipitated initial conceptualisations – for example, borrowing Foulkes’ notion of figure-ground - to help apprehend the material. Then, using a form of Grounded Theory, the data set was examined methodically. This evidenced how members brought complex, changing constellations of feeling, and mental and bodily states to the group. Analysis revealed relational and developmental predicaments which would interweave inter-relationally at both conscious and unconscious levels. Using both narrative and tabular forms of presentation, it is demonstrated how this shared, multi-dimensional matrix of iv relationship and communication created the bedrock of the group therapeutic encounter. Emotional and psychological growth developed in the context of members’ capacities to bear emotional knowledge, and hold emotional states over time as individual preoccupations became less pressing within a heuristic relational encounter within the group. This conferred to the group the qualities of Bollas’ ‘transformational object’, while the matrix itself linked with Stern’s primary inter subjective matrix. It is suggested that group psychotherapy has much to offer young people whose relational and psychosocial struggles can be explored in the safety and stability of the clinical group setting