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Early medical treatment of gender dysphoria: Baseline characteristics of a UK cohort beginning early intervention
No full textAims: To describe characteristics of patients referred early (<16 yrs) medical treatment for gender dysphoria (GD). GD is a rare condition in which individuals experience clinically significant distress due to incongruence between their psychological perception of, and their natally assigned, sex.
Methods: We collected data prospectively on all patients referred from May 2010––July 2014 for early pubertal suppression using gonadotropin – releasing hormone analogue (GnRHa) therapy.
Results: 61 young people (34 natal males; 55.7%) were referred for early intervention to the national GD service endocrine liaison clinic at mean age of 13.1 years (range 9.8–15.3). All patients had a karyotype consistent with their natal sex. More natal males were in early puberty (32.4% Tanner 1/2; n = 11) than natal females (11.1% Tanner 1/2; n = 3).
Baseline endocrinology and physical examination were normal for natal sex in all patients. All females who had standard synacthen tests to exclude adrenal dysfunction (77.8%; n = 21) had normal cortisol and 17OHP. 38.2% (n = 13) males had low bone mineral density compared with 11.1% of females (n = 3).
50 patients (81.9%) elected to receive GnRHa following full explanation and informed consent at Tanner stage 3, following international guidelines. GnRHa could not be commenced immediately if pre-pubertal (10/61), having very low bone mineral density (3/61) or low body mass index (BMI) (2/61). All who began GnRHa achieved full gonadatropin suppression. No young people withdrew from GnRHa treatment in the first 2 years.
Many GPs were unwilling to prescribe GnRHa (56.0%; n = 28/50) therefore local hospitals (8.0%; n = 4) or the tertiary centre (36.0%; n = 18) issued prescriptions.
Conclusion: Early medical intervention in GD with GnRH suppression of puberty is effective and well–tolerated. Assessment of growth, bone health and psychological outcomes will be important to assess the medium-and long-term safety and effectiveness of early intervention for GD
Teaching, learning and Bion's model of digestion
No full textIn this paper the author is using Bion's model of the digestive process, among other models, in order to think about how teaching of theory can be approached as a task and undertaken in practice. Beginning with the ideas of Plato, she discusses how new ideas may be best conveyed, and how psychoanalytic theory teachers (using the teaching of Melanie Klein's ideas here to make her points) may make what they teach acceptable and ‘digestible’ to students. She uses some material from a theory group as well as a baby observation group, and concludes that in group teaching the responsibility for the taking on and elaboration of ideas – a process of digestion – is shared by the teacher and by the group. As psychoanalytic workers need to be able to ‘manage uncertainty’ in daily practice, this state of mind can usefully also be held by the theory teacher. The process of digestion will vary according to the composition of any group, drawing out different facets of understanding in both ‘teachers’ and ‘learners’, and may well draw on other vertices beyond that of psychoanalysis. These links will aid the process of digesting ideas, and will also be evident in the author style, structure and content of this paper
Psychoanalysis in times of technoculture: Some reflections on the fate of the body in virtual space
No full textThis article discusses psychoanalysis in times of technoculture. We cannot escape that this generation is growing up in a network culture where communication is mediated and digital connectivity along with different strands of virtuality are now an integral part of our quotidian practices. Global networks impact on identity formation: groups of individuals now organize and validate their experience as a community virtually. Cyberspace is not a homogenous space. We need to consider the contingent relations that exist between this space and what it affords in terms of representation and interaction. And as we do so we need to keep firmly in mind that what transcends the online and offline spaces is the individual. In thinking about the world of cyberspace as a potential space for experimentation that may facilitate psychic elaboration we need to consider not whether this is right or wrong, good or bad, but whether psychically the individual can cope with what is being presented or enacted within a given virtual space. This is why generalities are of limited value. This is why we need a psychoanalytic lens to focus on how technology can interact for better or for worse with particular psychic economies
Understanding the experience of parents of pre-pubescent children with gender identity issues
No full textWhilst in recent times there has been an increasing interest in the popular media in families with gender variant children, there is still a paucity of academic research into the experience of parenting a pre-pubescent child with gender identity issues. Gender dysphoria in young children engenders emotive reactions in adults meaning that social workers need to be aware of the various discourses surrounding gender identity in order to work sensitively with families affected. This research explores highly sensitive and intimate aspects of family life, requiring parents to talk and think about difficult issues and explores how it might feel for families to parent a child with gender identity issues. The psychosocial research method of Free Association Narrative Interviews was used in order to gather the data which was then coded and analysed drawing on a constructivist version of grounded theory. Five key themes relating to the process of mourning emerged from the data: loss, uncertainty, ambivalence, being unable to think and acceptance. Recommendations for both social work and clinical practice are also offere
Race, identity and the transference / countertransference: A mixed-race patient and a mixed-race therapist - a single case study
Get PDFThis thesis is a single case-study of a child and adolescent psychotherapist working with a fourteen year old female adolescent patient of similar mixed ethnic background. The thesis presents the completed two year therapeutic work which included periods of intensive therapy (3-4 times-a-week work) following less intensive work.
The patient’s early life was marked by witnessing parental domestic violence and parents who divorced. She subsequently struggled with maintaining relationships and presented race and gender identity ambiguity. She had consistently self-harmed and overdosed since the age of thirteen. The psychotherapist relied heavily on his countertransference in order to better understand and make sense of the patient’s inner world, particularly regarding issues of identity, race, gender and attachment.
The primary research method used to analyse processed clinical session notes was Grounded Theory Method
The contemporary dynamics of caring – A qualitative study of the relationship between mental health professionals and carers of people with long term mental health conditions
No full textAt the heart of this study is the experience of caring for someone with a long term mental health condition and the relationship between mental health professionals and carers, who
are largely family, partners or friends. The study has been
conducted at a time when there is increasing awareness of carers but at the same time limited understanding of the day-to-day lives of people caring for someone with a mental health condition.
Using a psychoanalytically informed psychosocial approach seven carers and eight mental health professionals were interviewed using a free association narrative interviewing approach, which provided a framework for participants to share their experiences. In the next phase a combined focus group of 16 participants was held, comprising nine carers and seven mental health professionals and vignettes were utilised to facilitate discussion. Data from both methods was analysed using a reflexive and psychoanalytical approach which encouraged the emotional response of the researcher to be taken into account. Alongside, a thematic analysis was undertaken to enable cross-referencing. The study found that the disturbing nature of mental health conditions directly affects carers and mental health professionals, and within this environment carers place high value on support that is built on a meaningful relationship with a mental health professional. However this is not always available as professionals seek to defend themselves from the distress that is bound up in the caring experience, and therefore
they idealise carers and maintain professional distance, with the result that carers’ anxiety is not dealt with effectively. Three implications are drawn from the research: firstly, that relational based support is developed based on the principles of ‘being alongside’ which includes: discerning those issues that need immediate response, and those that need time for a period of reflection, honesty about the nature of mental illness and what is realistic, agreeing respective expectations at the beginning of the work, and valuing seemingly mundane and everyday achievements that are often overlooked. Secondly, that there is no such thing as a service user, only a service user in relation to their carer, and the two are a unit that must be worked with together by the professional. Finally, that the framework of care in the community should adopt a different model in which the structures of an institution are utilised. Therefore each service user, carer and mental health professional form a mini community institution in which they all become members of the institution, and have a role in developing it
Graham Music on All in the Mind. Internet use and compulsive sexual behaviour. 24 November 2015, BBC Radio 4 [Starts at 22:20]
No full textLonely voices: A grounded theory study into the experiences of family members and mental health staff after suicide
Get PDFThe way in which family members are supported by staff from the mental services after the suicide of a relative is an important, though not well researched area. This research aims to explore two main areas; firstly to explore from the family members perspectives how they were supported by staff after the suicide of their relative and whether this was what they would have wanted as a means of support. Secondly mental health staff were asked about what and how they provided support to families after the suicide of a relative and how they felt about what was provided by them and the service. This research project presents a qualitative study using grounded theory analysis of data collected from family members and mental health staff members about their experiences after the death from suicide of a family member or patient receiving care from the mental health services. The study sample comprised six staff and five family members who were interviewed face to face about what they experienced. The interviews were audiotaped and transcribed verbatim, then analysed in keeping with grounded theory, by using constant comparison of data, paying particular attention to reflexivity and researcher influence upon the data and on-going analysis. The core categories arising out of the analysis from the staff interviews showed that staff feel ill equipped to inform family members or provide support after their relative has died by suicide. More specifically the core categories presented the following key areas for staff as follows; 1. Training and awareness raising about suicide, including broadening understanding about the context within which suicide occurs. 2. The emotions involved with and related to the impact of suicide. 3. Skills and competence in breaking bad news to others including family members after suicide. 4. Including families in the care of people receiving mental health services. 5. Awareness and support with the formal processes that ensue following suicide. 6. Staff support after suicide, including managers, colleagues as well as staff in general in the organisation. The core categories from the analysis of family members interviews showed, that; 1. Family members felt excluded and unheard by staff following the suicide of a relative. 2. Family members spoke about their fear for the future and the legacy of suicide. 3. The formal processes that take place after suicide were unclear and inconsistent for family members. 4. The emotional aftermath of suicide was significant however as core category 5 indicated, the family members experienced a mismatch between what they wanted and what they received from mental health staff and the organisation. Consequently core category 6. Showed how their experience motivated the family members to speak out and join the research into this subject. Conclusions are therefore set out with recommendations that promote guidance and training to mental health staff and services about ways to work with patients and families, incorporating current NHS policy, to improve staff skills and confidence; to ‘attune’ with patients and families, by including families in mental health care and afterwards if suicide happens, to which Family Therapy/systemic psychotherapy theory and practice could contribute in a variety of ways