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Can we better understand the experience and outcome of complex neurodevelopmental assessment by considering the perspectives of both parents and clinicians?
Full text linkThis study aims to examine the lived experiences of four parents accompanying their child in a complex neurodevelopmental assessment. It attempts to understand what the parents experienced in the assessment particularly in relation to the clinicians and why, and how this might contribute to the outcome of the assessment. Free Association Narrative Interview (FANI) method and Interpretative Phenomenological Analysis (IPA) was used. FANI is designed to work with defended subjects, and IPA aids the researcher to identify themes that may not be apparent at first. As well as interviewing parents, the staff group of assessing clinicians were interviewed within a focus group. This aimed at understanding their counter-transferential responses to the parents in the assessment situation. This had the goal of understanding the parents' unconscious communications and motivations within assessment to further inform on the parent’s experience. It is hoped that this additional data will inform on the outcome and feedback aspects of the assessment by enlightening why clinicians might make decisions or process the assessment in particular ways. The following themes are described, with the first three belonging to the parents and a further three belonging to the clinicians: 1. Parental trauma and the role in the child’s difficulties. 2. Difficulty, uncertainty and the development of epistemic trust. 3. A persecuted state of mind: how assessment effects parental sense of self and clinician. 1. The clinicians’ experience of knowledge and power. 2. The presence and management of parental trauma in the assessment framework. 3. The need for time in processing conflict and coming to a conclusion. These themes are examined in relation to current research as well as psychoanalytic literature of internal processes. There are conclusive remarks around the presence of defensive states in parents as well as in clinicians which hinder the understanding of the child’s difficulties and there is discussion around why this may be. Recommendations for coping with the increasing demand for neurodevelopmental assessment are made by way of linking what parents want to what it appears they might need
“I can’t just sit and feel sorry for myself”: Norwegian men’s construction of masculinity after cancer treatment.
Full text linkThis research is a small-scale, qualitative research study conducted with 24 participants, to understand what peer support can provide for Norwegian men who are undergoing cancer treatment. A triangulation of research methods has been used. With the help of the Norwegian Cancer Association, action research was done with three groups of men in Bergen, Trondheim and Oslo. An ethnographic study was conducted with the first group in Bergen, and semi-structured interviews were done with each group after each cycle had ended. Areas of literature that are relevant to my research, concerning men’s experiences of peer support, gender in health care and family therapy with families experiencing physical illness have been reviewed. Systematic text condensation was chosen as the method of analysis. The findings showed how the men in this research construct their lives, post-cancer treatment, in line with their preconceptions of Norwegian masculine values. The men felt alone in their illness, and the group contributed to cohesion, increased coping and improved psychological well-being. It was found that the participants were concerned that women in the group would make it difficult to use masculine approaches in the conversations. The research suggests professionals need more knowledge of how gender influences the experiences of illness, and of how peer support can supplement cancer care. The knowledge arrived at in this research adds to professional understanding of men's needs in rehabilitative work, and to how professionals may be able to support families after cancer treatment
‘A missed session is still a session': How Child and Adolescent Psychotherapists understand the meaning of non-attended sessions with patients aged 18-25
Full text linkThis research project aimed to explore the individual experiences of Child and Adolescent Psychotherapists (CAPTs) working with patients aged 18-25 who, at times, do not attend - or ‘DNA’ - their sessions (as distinct from cancelling in advance). Current discourse around non-attendance largely focuses on its financial and emotional cost to services and patients; the aim of this project was to explore the deeper meaning behind non-attendance and the way it is understood in the context of psychoanalytic psychotherapy. Semi-structured interviews were conducted with qualified CAPTs and analysed using Interpretative Phenomenological Analysis (IPA). Findings revealed the feelings stirred up in CAPTs by their patients’ unexplained absences, ranging from rejection to relief, with notable anxiety in response to an absent patient who is at risk of self-harm or suicide. These responses were often understood in the context of unconscious communication and projection. Clinicians emphasised the need for a certain degree of tolerance of no-shows with this age group, sharing the view that non-attendance does not necessarily equate to non-engagement. They highlighted the importance of the patient’s communication being received and understood, which can in turn lead to progress in therapy. However, clinicians described the importance of limits and boundaries around non-attendance; this was in acknowledgement of limited resources, and also to encourage the patient to take responsibility for their therapy in order to aid development. Evident overall was the conflict felt by clinicians between the importance of working therapeutically with absence, and the pressure to discharge patients who aren’t attending. The importance of making decisions on a case-by-case basis was highlighted. An understanding of the potential therapeutic significance behind young people missing sessions could hopefully contribute towards developing a more informed and tailored approach to thinking about non-attendance in psychotherapy and policy development, particularly given current pressures on services. It may also help to shape the way we think about how young adults engage with mental health treatment
An exploration of the process and emotional experiences of young people transitioning between child mental health services (CAMHS) and adult mental health services (AMHS)
Full text linkThis study explores the process and emotional experience of transition from child mental health services (CAMHS) to adult mental health services (AMHS). Following a review of the literature on relevant studies, including those on service-level preparation and planning and psychoanalytic literature, the researcher notes that there are few studies in relation to how YP describe the emotional experience of transition. Therefore, a core aim of this study is to explore the emotional experience of transition for YP within the developmental period of late adolescence. To fulfil the aims of this mixed-method study, it is separated into two parts. In Study One, an audit that describes the population of YP in CAMHS requiring mental health care transition is given. This also includes which service YP are routinely referred to and by whom. Study Two explores the emotional aspects of transition for three YP. Here, the researcher focuses on the internal worldviews of YP, as demonstrated in their readiness or retreat from transition. Interpretative phenomenological analysis (IPA) is used to analyse the data along with countertransference reflections. Three overarching superordinate themes and six subordinate themes are selected for detailed exploration. The study found that each participant’s own personal disposition, the way they used their minds, including psychological defences, and their capacity for emotional development, is a significantly important factor in affecting transition success. In the conclusion, the researcher’s identity and position as a child and adolescent psychotherapist is explored. Strengths and limitations of the study are discussed and potential areas for further research are given
Parenting in the “extreme”: An exploration into the psychological well‐being of long‐term adoptive mothers
Full text linkObjective: The objective of this study was to increase understanding of factors that influence adoptive mothers' psychological and emotional well‐being. The aims were to compare mothers' self‐reported emotional state 12 months after child placement to the time of the interview and to identify factors that challenge and support maternal mental health. Background: Mothers who adopt children face unique challenges that put them at a heightened risk of negative mental health. There is a need for better understanding of the influences on their psychological and emotional well‐being. Method: This qualitative study involved nine in‐depth semistructured interviews. Transcripts were analyzed using reflexive thematic analysis. Results: The themes offered broad insights, including the consistency of negative mental health across time associated with demands of 'extreme parenting,' strains within and across relationships, and deprioritizing self‐care. Factors associated with positive mental health included development of love; attachment and sense of family identity; learning, competence, and 'therapeutic parenting,' and the ability to 'offload.' Conclusion: The emotional and psychological well‐being of mothers who adopt children should be validated and recognized as important to the overall adjustment of adoptive families. Implications: Adoption agencies should take a proactive approach to addressing the mental health needs of adoptive mothers, providing comprehensive information, ongoing support, and regular assessments
Finding a way to the child: Selected clinical papers 1983-2021; edited by Kate Stratton and Simon Cregeen
No full textMargaret Rustin’s writing is characterised not only by its subject matter, which is diverse, but by her imaginative sensitivity to the emotional lives of children and young people, the depth of her understanding, and her original insights into the complexities of child and adolescent psychotherapy.
Here a selection of her work, edited by Kate Stratton and Simon Cregeen, is brought together in a collection which focuses mainly on clinical issues and concerns: the dynamics of the interaction between patient and therapist in the consulting room; the task of assessment; the particular needs of children and young people whose early development has been distorted by trauma, loss or neglect; and the framework and skills required for effective psychoanalytic work with parents. Illustrated by vivid narratives detailing the strains and possibilities of the therapeutic encounter, this book is a record of clinical work and thinking over 50 years of psychoanalytic practice.
It will prove essential reading for psychoanalysts and child analysts, child psychotherapists, all those training as mental health professionals in work with children and parents, and anyone with an interest in deepening their understanding of the emotional lives of children and young people
Klein, Kleinians, and post-Kleinians: Deeper layers of the mind and projective identification
No full textKleinian psychoanalysis is rooted in the ideas of Sigmund Freud and Karl Abraham that paved the way for object relations theory as a school of thought and a therapeutic technique. In this chapter, the author focuses on the British developments in Kleinian and post-Kleinian psychoanalysis. Kleinian psychoanalysis exemplifies a close relationship between developmental theory, the focus on transference situation, and the clinical technique. The shift from libido to anxiety led to the notions of psychic positions, paranoid-schizoid and depressive, linking particular anxieties with relevant psychic defenses. Emphasis on the primitive processes of splitting, projection, and introjection, and the unconscious phantasy opened the way to recognition of manifestations of pre-verbal infantile experience represented in the session as memories in feelings. Melanie Klein firmly believed in early forms of object relations from birth, demonstrating the infant's capacity to momentary contact with external reality and primary objects even if in a primitive part-object form. This allowed her to see children's play as an expression of the unconscious narratives and interpret the transference situation to her young patients. Further understanding of those deeper layers of the mind, governed by processes of splitting and projection, led to her own model of early development and opened the way to a psychoanalytic approach to psychiatric disorders
The Question of Psychoanalytic Psychotherapy and Institutional Racism
No full textDiscussion following the Panel at the PPNOW Conference November 202
Personalised interventions for subgroups of children with conduct problems
No full textBackground: Conduct problems are a range of disruptive behaviours in childhood that are associated with long-term adverse outcomes in adolescence and adulthood, including antisocial behaviour, substance misuse, and poor academic achievement. Children with conduct problems can vary according to age of onset, comorbidities, and environmental factors, and it has been suggested that certain groups of children may have different treatment outcomes. Therefore, it is important to assess the extent to which personalised interventions for different groups of children with conduct problems may affect outcomes. To our knowledge, this is the first review to systematically identify and appraise the effectiveness of personalised interventions, adapted, or developed, for prespecified subgroups of children with conduct problems.
Objectives: To assess whether personalised interventions, adapted or developed for subgroups of children with conduct problems are effective in improving outcomes.
Search Methods: We used standard, extensive Cochrane search methods. The latest search was 1 February 2022.
Selection Criteria: We included randomised controlled trials (RCTs), in any setting, in children (aged two to 12 years) with conduct problems and within a prespecified subgroup, comparing a personalised intervention with a non-personalised intervention, waitlist control, or treatment as usual. Personalised interventions included adaptations to standard practice, such as parent-training programmes; other recommended interventions for children with conduct problems; or interventions developed specifically to target subgroups of children with conduct problems. We excluded non-personalised and non-psychological interventions (e.g. pharmacological or dietary intervention). Prespecified subgroups of children with conduct problems, however defined, were eligible for inclusion.
Data Collection and Analysis: We used standard Cochrane methods. Our primary outcomes were 1. child conduct problems or disruptive behaviour and 2.
Adverse Events: Our secondary outcomes were 3. personalised treatment outcomes relevant to each subgroup, 4. parenting skills and knowledge, 5. family functioning, engagement and decreased dropout, and 6. educational outcomes. We used GRADE to assess the certainty of the evidence.
Main Results: We identified 13 RCTs (858 participants). Seven studies were conducted in the USA, five in Australia, and one in Germany. Eleven studies reported their source of funding, with five studies receiving grants from the National Institute of Mental Health. In total, 15 different funders supported the studies included in the review. We separated subgroups of children with conduct problems into three broad categories: children with co-occurring conditions (e.g. emotional difficulties), parent characteristics (e.g. conflict between parents), or familial/environmental circumstances (e.g. rural families). All studies delivered a personalised intervention that was adapted or developed for a prespecified subgroup of children with conduct problems. We rated all trials at unclear or high risk of bias in most domains. Below, we report the results of improvement in child conduct problems and disruptive behaviour, personalised treatment outcomes, and parenting skills and knowledge for our main comparison: personalised versus non-personalised interventions. Improvement in child conduct problems and disruptive behaviour Compared with a non-personalised intervention, a personalised intervention may result in a slight improvement in child conduct problems or disruptive behaviour measured using the Eyberg Child Behavior Inventory (ECBI) Problem subscale in the short term (mean difference (MD) -3.04, 95% confidence interval (CI) -6.06 to -0.02; 6 studies, 278 participants; P = 0.05), but may have little to no effect on improving child conduct problems or disruptive behaviour measured by the ECBI Intensity subscale (MD -6.25, 95% CI -16.66 to 4.15; 6 studies, 278 participants; P = 0.24), or the Externalising subscale of the Child Behaviour Checklist (CBCL) (MD -2.19, 95% CI -6.97 to 2.59; 3 studies, 189 participants, P = 0.37) in the short term. We graded the certainty of evidence as very low for all three outcomes, meaning any estimate of effect is very uncertain. Personalised treatment outcomes, relevant to each subgroup Although six studies reported personalised treatment outcomes, relevant to each subgroup, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive. Parenting skills and knowledge Although seven studies reported parenting skills and knowledge, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive. Adverse events None of the trials reported monitoring adverse events. Summary of results In summary, there is limited evidence that personalised intervention improves child conduct problems, personalised treatment outcomes, relevant to each subgroup, or parenting skills and knowledge compared with a non-personalised intervention.
Authors' Conclusions: There is limited evidence for the effectiveness of personalised interventions for subgroups of children with conduct problems. The certainty of evidence for all outcomes was very low, meaning that we have very little confidence in the estimated effects and the true effects may be different to our findings, which will limit the relevance of our findings to clinical decisions. To overcome the limitations of the evidence, large-scale RCTs are needed to determine whether personalised interventions, adapted or developed, for subgroups of children with conduct problems are effective in improving outcomes. Consensus on the most appropriate measures to use in these studies is needed in order to facilitate cross-study comparisons. Persistent conduct problems predict a range of adverse long-term outcomes, so future research should investigate the medium- and long-term effects of personalised treatments. Studies are needed in low- and middle-income countries as well as studies recruiting children aged between nine and 12 years, as they were under-represented in the studies
"The ticking clock thing": a systems psychodynamic study of UK organisations that engage the public on climate change
No full textSystems psychodynamic scholars have paid limited attention to organisational dynamics in organisations whose task includes addressing climate change, but the experience of working in such organisations is increasingly significant as the climate crisis intensifies. The doctoral study described here identified seven themes and related social defences characterising the experience of working in such organisations: exclusion, shame, sexualised excitement and threat, splitting, a sense of fragility, an uncertain relationship with authority, and difficulties with grieving. The emotional flavour of these social defences resonates with the climate emotions proposed by the existing body of climate psychology literature. A tentative proposal is made that working in this field constitutes a traumatic epistemological, social, and emotional experience; and that the fact of the traumatic experience is the "unthought known" in this work. Organisations that engage the public on climate change, it is proposed, may experience a trauma-influenced basic assumption mentality and may unconsciously activate a version of the "internal establishment" that exists to defend against the unthought known, with the establishment unleashing perverse dynamics and other defensive mechanisms such as shame, with a particular focus on maintaining the split polarities and thereby preventing genuine connection with others who are different