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Managing patients with complex needs: Evaluation of the City and Hackney Primary Care Psychotherapy Consultation Service
No full textEvery day, across England, people are seeking help for
distressing and painful conditions with which their family doctors are unable to help and for which no specialist service is available. Many visit their GPs, hospitals and other health services many times, yet their problems remain unresolved, at a high cost to them, to their families and to the NHS.
People with medically unexplained symptoms, people with personality disorders and those with complex mental health problems frequently get‘bounced’ around the NHS, passed from one service to another, none able(or willing) to offer them the flexible, personalised and sometimes time-
consuming support they require.
A group of GPs in the City of London & Hackney decided to tackle this by setting up a new service for those with mental health problems they could not manage through existing primary care services who fell outside the scope of other local mental health services. The ground-breaking Primary Care Psychotherapy Consultation Service (PCPCS), implemented and run by the Tavistock and Portman
NHS Foundation Trust, is the result of that innovation. It offers help for a range of needs, close to home, often in people’s own GP surgeries, rather than in remote clinics. This includes a range of psychological therapies, joint consultations with GPs, and training for primary care staff to enhance their capacity to help. As this report demonstrates, it can change people’s lives and dramatically
improve their health and wellbeing
Minding the body: The body in psychoanalysis and beyond
No full textMinding the Body: The Body in Psychoanalysis and Beyond outlines the value of a psychoanalytic approach to understanding the body and its vicissitudes and for addressing these in the context of psychoanalytic psychotherapy and psychoanalysis. The chapters cover a broad but esoteric range of subjects that are not often discussed within psychoanalysis such as the function of breast augmentation surgery, the psychic origins of hair, the use made of the analyst's toilet, transsexuality and the connection between dermatological conditions and necrophilic fantasies. The book also reaches 'beyond the couch' to consider the nature of reality television makeover shows.
The book is based on the Alessandra Lemma's extensive clinical experience as a psychoanalyst and psychologist working in a range of public and private health care settings with patients for whom the body is the primary presenting problem or who have made unconscious use of the body to communicate their psychic pain. Minding the Body draws on detailed clinical examples that vividly illustrate how the author approaches these clinical presentations in the consulting room and, as such, provides insights to the practicing clinician that will support their attempts at formulating patients' difficulties psychoanalytically and for how to helps such patients.
It will be essential reading for psychoanalysts, psychologists, psychiatrists, mental health workers, academics and literary readers interested in the body, sexuality and gender
Psychotherapy with severely deprived children
No full textOriginally published in 1983, this study describes the experience of severely deprived children referred for individual psychoanalytic psychotherapy at the Tavistock Clinic in London, and at other clinics and schools. Most were living in children’s homes, all came from chaotic and disrupted families, and many had been abused or neglected. Children from such backgrounds have previously been considered unsuitable for psychotherapy, and the theoretical and technical issues arising from their treatment are discussed here, and detailed case material is presented.
There is a high rate of emotional and behavioural disturbance among children in community care. The experience of the therapists struggling, often painfully, to establish contact and communication with these young people, who have been hurt and disillusioned by life, provide illuminating material on the children’s perceptions of their lives. This book clearly demonstrates the need for and the capacity to respond to treatment, and it provides insights which are of relevance to all who are in close contact with such childre
Social defences against anxiety: Explorations in a paradigm
No full textThis book revisits the theory of social systems as a defence against anxiety first set out by Elliott Jaques and Isabel Menzies Lyth in papers which they published in 1955 and 1960, and which have been influential points of reference ever since. Menzies Lyth’s study of the nursing system of a general hospital, with its roots in both psychoanalysis and socio-technical systems thinking, has remained one of the most convincing demonstrations of the influence of unconscious anxieties on social behaviour, and of their effects in inducing dysfunctional defensive systems in organisations. The theory of ‘social defences against anxiety’ remains one of the most significant contributions of the ‘Tavistock school’ to the study of human relations
A Study of patients referred following an episode of self-harm, a suicide attempt, or in a suicidal crisis using routinely collected data
No full textSelf-harm and suicide prevention remain a priority of public health policy in the UK. Clinicians conducting psychosocial assessments in Accident and Emergency Departments are confronted with a complex and demanding task. There is a paucity of research into the content of psychosocial assessments and the experiences of clinicians conducting psychosocial assessments in Accident and Emergency Departments. This study examines the experiences of people who presented in an Accident and Emergency Department following self-harm or with suicidal ideation, as those are documented in the psychosocial assessments. Furthermore, the study explores the attitudes, feelings and experiences of clinicians working in a Psychiatric Liaison Team, as well as the process of making decisions about aftercare plans. In order to achieve this, qualitative methods were employed. A sample of sixty-one psychosocial assessments was collected and analysed using thematic analysis. The coding of the data was done inductively and deductively with the use of the categories of the Orbach and Mikulincer Mental Pain Scale. Two focus groups with clinicians were conducted and analysed with a grounded theory oriented approach. Stevens’ framework was applied in order to analyse the interactional data in the focus groups. Key themes emerging from the focus groups were shared with serviceusers who offered their own interpretation of the data and findings. The study draws on psychodynamic theories to explore the experiences of clinicians assessing and treating patients with self-harm and suicidal ideation in an Accident and Emergency Department and to make sense of the needs of the patients. The findings are that suicidal ideation and self-harm were assessed and treated in similar ways. Difficulties in relationships and experiences of loss or trauma in childhood and/or adulthood were the two most common themes emerging in the psychosocial assessments. Decisions about aftercare plans were guided by patients’ presentation and needs in conjunction with available resources. Clinicians were found to have various emotional responses to patients’ painful experiences with limited space to reflect upon these at work. Clinicians and service-users commented upon the therapeutic aspect of psychosocial assessments, which in light of the painful experiences reported in the psychosocial assessments could be used to generate more sensitive and meaningful approaches to the care of this population. Providing support and a space for clinicians to be able to think of their task and their responses seems important
Don’t shoot the messenger: An exploration of how professional networks struggle to receive, contain and process painful communications from and about adolescents in the care system
No full textI aim to explore the conditions that either facilitate or disable effective networking within the complex, transitory professional networks that support ‘looked after’ adolescents. Drawing on my experience of undertaking specialist mental health assessments, I identify dynamics within multiagency, inter-disciplinary systems that influence the extent to which these assessments contribute positively to the care planning process. I discuss how the intra-psychic and psychosocial difficulties of many ‘looked after’ adolescents are mirrored in their professional support networks. I use a grounded theory approach, underpinned by psychoanalytic theory, to analyse two reflective case studies of ‘looked after’ adolescents and two focus group interviews with residential care workers and CAMHS clinicians. Through my analysis I identify six interlinked themes with associated sub-themes. Two relate to the challenging ‘external worlds’ of many children who enter care and also of those professionals who support them. Two relate to the intense emotional pain and turmoil of the ‘internal worlds’ of these young people and their workers. The final two relate to various ways in which adolescents who have been neglected and abused attempt to numb or distract themselves from their emotional pain; and to defensive barriers erected by professionals to ward off their young clients’ unbearable projections. I argue that defences erected by individual workers against the significant emotional disturbance generated through close contact with these troubled and troubling young people may become rigidly entrenched at an organisational level. The intense anxiety generated by the work can trigger requests for specialist assessments in which the needs of adolescents take second place to those of workers. Conversely, when professionals are in less anxious states of mind they may, in order to enhance the quality of the care planning process, seek an expert opinion in recognition of the value of skills differentiation, alternative viewpoints and collaborative working practices
‘I’m no more your mother or father...’ Parents’ experiences of having a child hospitalised for an eating disorder
Get PDFThis thesis explores parents’ experiences of having a child hospitalised for an
eating disorder. It is a qualitative study based on clinical parent work sessions,
undertaken by a child psychotherapist in an inpatient unit treating young people
aged 8 – 17. There is a review of the relevant literature, which outlines themes
that have arisen in similar studies, as well as defines the terms used in this
study. The methodology section explains how the research was carried out and
provides details about the sample group of the eight parents who were recruited
to the study. Parents were asked about their experiences in an open and
unstructured way and explored with the child psychotherapist. These sessions
were written up and analysed, using Interpretive Phenomenological Analysis.
The main preoccupations of the parents were around transitions, their states’ of
mind and their relationships, both inside the unit and outside of it. Each of these
themes is explored in detail in the findings section. Of particular interest was
that some parents seemed to have developed what were termed ‘eating
disorder states’ of mind’, which are states of mind that have been written about
previously in patients with eating disorders. Furthermore, it was found that
previous parental experiences played a significant role in all three areas of
parental preoccupations. The thesis then draws together the main conclusions
from this study. The limitations of this study are discussed as well as reflecting
on the process of undertaking the research. Recommendations for practice are
made, as well as considering the role of the child psychotherapist supporting
parents in this context
An order of pure decision: Growing up in a virtual world and the adolescent’s experience of the body
No full textPsychoanalysis in the technoculture era
No full textBy now the internet and other forms of virtual communication have been in place for at least twenty years. However, surprisingly little has been written about the use of new technologies in the psychoanalytical literature. As such, Psychoanalysis in the Technoculture Era is a timely exposition on the subject of both virtual and analytic space.
Bringing together the work of several psychoanalysts, the Editors Alessandra Lemma and Luigi Caparrotta illustrate how new technologies have become an integral part of our everyday lives and how they have silently and subtly permeated the psychoanalytic setting. The contributors explore how new technologies have affected psychoanalytic practice and discuss the advantages and disadvantages of its use.
Psychoanalysis in the Technoculture Era unravels some of the meanings of virtual world terms, and opens this field to greater scrutiny, stimulating and promoting discussion about new technologies in psychoanalytic practice. This book will be of interest to the psychoanalytic community including psychotherapy professionals, psychoanalysts, post graduate, graduate and undergraduate students