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Three years of infant observation with Esther Bick
No full textIn this chapter, the author examines areas of special difficulty in the beginning, middle and last phases of the three-year observation. She illustrates some of Mrs. Esther Bick's central ideas the child in relation to his family, the role of the observer in containing the mother–baby anxieties, the role of the tutor and seminar members in helping the observer. The author reviews a vivid account not only of the infant and of the infant observation experience but also the experience of being in close contact with Bick's thinking. she describes how Bick guided her observations to recall and reflect on what might emerge of the meaning of a tiny infant's behaviour and actions is brilliant and memorable, and as the observation continues, who can be seen to be a very sensitive observer, is contained by the seminar structure and settles. The author provides substantial contributions in integrating infant observation ideas with clinical practice
Thinking space: Promoting thinking about race, culture, and diversity in psychotherapy and beyond
No full text'Thinking Space' was set up to develop the capacity of staff and trainees at the Tavistock Clinic to think about racism, and other forms of hatred toward difference in ourselves and others. Drawing on Bion’s (1962) distinction between “knowing” and “knowing about”, the latter of which can be a defence against knowing a subject in a deeper and emotionally real way, Thinking Space sought to promote curiosity, exploration and learning about difference, by paying as much attention as to how we learn (process) as to what we learn (content).
This book is a celebration of ten years of Thinking Space at the Tavistock Clinic and a way of sharing the thinking, experience and learning gained over these years. Thinking Space functions, among other things, as a test-bed for ideas and many of the papers included here began as presentations, and were encouraged and developed by the experience. These papers do not seek to provide a coherent theory or set of views. On the contrary they are very diverse and decidedly so, as finding, expressing and developing one’s own personal idiom involves emotional truthfulness and is an important part of getting to know oneself: both of which are important prerequisites to getting to know the other
Clinical commentary
No full textComments on an article discussing the psychotherapeutic sessions and interaction taking place between the client, Rebecca and her therapist for selective mutism. This article presents a step-by-step discussion of the brief background and the sequential presentation of the psychotherapy session with Rebecca, aged seven, presenting with selective mutism. The author discusses the interaction paragraph by paragraph in order that the therapist can watch the evolving minute changes both in the child and in himself/herself. According to the author who is a child, adult and family psychotherapist, the task of a supervisor is twofold: in the first instance the supervisor is trying to assist in containing anxieties of the child in psychotherapy and to evolve a shared understanding of the child and the child and supervisee’s relationship; secondly, the supervisor has the task of furthering the supervisee’s capacities as a questioning, wondering, observing, effective and empathic psychotherapist. For this reason, the author considers overseeing the work of psychotherapist and child as promoting the beauty of a duet for two, a development of two people, child and psychotherapist
Envy, jealousy, love, and generosity in sibling relations: The impact of sibling relations on future family relations
No full textIn this chapter, I assume that, just as we have an external family and many other important relations, in our internal world we have an internalised family with relations existing between the self and the internalised family members and other important people in our lives. Such internalised family members might be different from external family members, for they "are always coloured by our phantasies and projections" . Bearing this in mind, I focus on both external and internalised sibling relations and their influence on family life. I look at the tricky question of when, how, and whether or not to intervene in a sibling relation to help the siblings develop a healthier future. I also look at what can happen when unhealthy sibling relations are internalised and later provide the impetus for re-enactment in adult life. In addition, I discuss how we can use dream analysis to observe and repair the internalised damaged sibling relations and, thus, promote the development of loving and more thoughtful intimate relations
The buzz trap: Speeded-up lives, distractedness, impulsiveness and decreasing empathy
No full textThis paper examines a set of traits and bodily reactions that are often seen in people who suffer stress and anxiety. These include speeded-up metabolisms and less ability to concentrate, regulate emotions as well as reduced empathy. The paper suggests that early trauma and stress give rise to a range of bodily and metabolic changes that affect the very speed of the life-course. It is also suggested that many factors in contemporary society, such as stress, increased reliance on screens and technology and a more consumerist and individualistic lifestyle, might be linked to an increase in such ‘buzzy’ character traits. More hopefully, such developments can be countered by positive experiences such as those provided in psychotherapy, secure attachment relationships, mindfulness and less-stressed social environments
Clinical commentary
No full textThe author expresses her opinion regarding the medical information presented concerning the child psychotherapy of Lizzie, a three-and-a-half-year-old diagnosed with autism. She discusses the development of Lizzie's ability to create and remember links to objects, remarks on the frequency of her therapy sessions, and notes the patients apparent fascination with senses
Standardization in patient safety: The WHO high 5s project
No full textQuality problem: Despite its success in other industries, process standardization in health care has been slow to gain traction or to demonstrate a positive impact on the safety of care. Intervention: The High 5s project is a global patient safety initiative of the World Health Organization (WHO) to facilitate the development, implementation and evaluation of Standard Operating Protocols (SOPs) within a global learning community to achieve measurable, significant and sustainable reductions in challenging patient safety problems. Goals: The project seeks to answer two questions: (i) Is it feasible to implement standardized health care processes in individual hospitals, among multiple hospitals within individual countries and across country boundaries? (ii) If so, what is the impact of standardization on the safety problems that the project is targeting? Method: The two key areas in which the High 5s project is innovative are its use of process standardization both in hospitals within a country and in multiple participating countries, and its carefully designed multi-pronged approach to evaluation. Status: Three SOPs—correct surgery, medication reconciliation, concentrated injectable medicines—have been developed and are being implemented and evaluated in multiple hospitals in seven participating countries. Nearly 5 years into the implementation, it is clear that this is just the beginning of what can be seen as an exercise in behavior management, asking whether health care workers can adapt their behaviors and environments to standardize care processes in widely varying hospital settings
Culture and madness: A training resource, film and commentary for mental health professionals
No full textCulture and Madness is a training resource that critically approaches the subject of culture by questioning commonly held professional and cultural assumptions and biases. It outlines how mental health professionals can develop the skills in observation, analysis and critical thinking which are central to good mental health practice.
The resource combines film, research and clinical scenarios to demonstrate how cultural influences pervade mental health thinking, practice and policy. At its heart is a 150-minute DVD, How Culture Matters, which explores how cultural communities in Britain consider mental health and illness. It shows conversations about culture and mental health taking place in different community contexts: interviews between local persons; between community members and mental health professionals; and between experts in cultural and clinical practice. The accompanying book explores the issues raised in the film further, featuring clinical examples and summarised research drawn across a range of disciplines. In articulating the subtle and textured place of 'culture' in the everyday lives of all communities, this resource will encourage mental health professionals to adopt a reflective approach to practice and to pursue a more flexible approach to cross-cultural mental health theory and practice.
Full of unique insights and learning points for clinical practice, this resource is required reading for managers and trainers in the field of mental health, and will be a valuable tool for lecturers and students on mental health courses
I know you can't see it but it hurts: A research study of the experiences of young people, their parents and healthcare professionals who live and work with medically unexplained physical symptoms
No full textIn this study I have explored first-person stories of young people, parents and
healthcare professionals about their experiences of living and working with
medically unexplained physical symptoms (MUPS). MUPS claims large
amounts of healthcare professionals’ time and technological resources in
primary and secondary healthcare. As a consequence there has been an
increasing amount of research interest in MUPS sufferers in recent years.
However, few studies have explored the experience of MUPS sufferers from a
social constructionist, dialogical and narrative epistemological standpoint.
A cross-disciplinary review of the literature on MUPS revealed the experiences
of young people and their families to be similar to those with a diagnosis of
chronic illness and their families. A dearth of qualitative studies have explored
the first-person accounts of young people, their parents, and healthcare
professionals who live and work with the condition. Research aims were
generated following the review of the literature:
To explore the meanings that young people, their parents and
healthcare professionals attach to their experience of MUPS in the
absence of a medical diagnosis.
To explore stories constructed from these experiences by young
people, their parents, and healthcare professionals about the impact of
MUPS upon identity and significant relationships.
To discover the discourses and narrative templates that inform
healthcare professionals’ practice with young people and their families
who live with MUPS.
To identify cultural and institutional discourses and narrative templates
from focus group members’ stories of experience; that position or
marginalise MUPS sufferers and their families.
The focus group method was chosen for data collection. Seven focus groups
were held in a Paediatric Liaison Department (PLS) in a Regional Hospital in
the East Midlands, U.K. Young people and parents were recruited to the focus
groups from historical casework of the PLS Department. Healthcare
professionals were recruited from the hospital paediatric and PLS teams. The
focus groups involved two groups for adolescents with MUPS and two groups of
parents of adolescents with MUPS. Three other focus groups involved
healthcare professionals who work with adolescents and their families with
MUPS.
The focus group discussions were videotaped and transcribed by the
researcher and two forms of analysis were employed: Thematic Analysis (TA)
and Dialogical Narrative Analysis (DNA).
The two forms of analysis produced multiple literal themes and implicit stories
abstracted from focus group members’ accounts. A major theme for young
people and parents was their feelings of anger and frustration following the
initial medical interview with their doctors. Young people and parents reported
they were not only disbelieved by the doctor about the existence and severity of
the symptoms, but the doctor attributed negative attributions about their
presentation such as ‘You’re lazy’, ‘It’s psychosomatic’, ‘All in your head’,
‘Fussy parent’. Without a diagnosis concerns of the young people and their
parents were not legitimised. Young people and parents lost confidence in
medical institutions. Young people responded by withdrawal and increasing
social isolation. Many parents took on the role of advocacy in an attempt to
restore their child’s credibility and the family’s integrity.
Some of the doctors interviewed spoke about the dearth of training in MUPS in
both paediatrics and psychiatry. They suggest that managing MUPS patients
can be very time-consuming for hard-pressed clinicians. Within the medical
encounter they sometimes feel pressured or ambivalent about whether to
continue to investigate despite previous negative results. Doctors also stated
that MUPS patients can generate anxiety and uncertainty in clinicians.
More main themes emerged including recognising MUPS as primarily ‘an idiom
of distress’ and the shortcomings of the biomedical paradigm in addressing the
problems and dilemmas of MUPS sufferers, their parents and healthcare
professionals.
In the Discussion Chapter I propose a model of training and CPD for healthcare
professionals. The model proposes introducing a hermeneutic approach and
open emotional postures to compliment the deductive role of the diagnosing
physician. It is proposed that by accessing concepts from both the scientific and
phenomenological paradigms healthcare professionals will reduce the
possibility of incongruence and potential for impasse within the physician-
patient relationship.
In the conclusion of the report a number of recommendations are given based
upon the outcomes of the study to introduce the benefits for professionals in
adding theoretical concepts from systemic family psychotherapy, dialogical and
narrative theory to inform and promote a hermeneutic discursive centred
practice with MUPS sufferers and their families