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Napięcie na granicy, wolność emocjonalna i proces twórczy [Tension at the border, emotional freedom and the creative process]
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‘Which aspects of social GGRRAAACCEEESSS grab you most?’ The social GGRRAAACCEEESSS exercise for a supervision group to promote therapists' self‐reflexivity
No full textPromoting supervisees' self‐reflexivity is an integral component of systemic family therapy supervision. This includes facilitating thinking about the influences of social differences. The article describes an exercise designed to facilitate exploration of participants' relationships with different aspects of social GGRRAAACCEEESSS (SG). The exercise consists of mapping the influences of different aspects of SG and ascertaining how some of them come to be more privileged than others. It is proposed that the exercise is used in the context of a supervision group, where the supervisees and supervisor share their personal and family of origin stories related to SG. Team members' reflection offers a further opportunity for learning. Feedback from supervisees has been sought on how this exercise impacted on their practice. The potential benefits and caveats are discussed.
Practitioner points:
Promote self‐reflexivity on issues of differences.
Explore supervisees' relationships with aspects of social GGRRAAACCEEESS
Predictors of natural and unnatural mortality among patients with personality disorder: Evidence from a large UK case register
No full textBackground:
People with personality disorder have reduced life expectancy, yet, within this population, little is known about the clinical predictors of natural and unnatural deaths. We set out to investigate this, using a large cohort of secondary mental health patients with personality disorder.
Methods:
We identified patients with an ICD-10 diagnosis of personality disorder, aged ≥15 years in a large secondary mental healthcare case register. The case register was linked to national mortality tracing. Using Cox regression, we modelled the effect of a number of pre-specified clinical variables on all-cause, natural cause and unnatural cause mortality.
Findings:
2,440 patients were identified. Eighty-five deaths (3.5% of cohort) occurred over a 5-year observation period, of which over 50% were from natural causes. All-cause mortality was associated with alcohol or drug use (adjusted Hazard Ratio [aHR] 2.3; 95% CI 1.3–4.1), physical illness (aHR 1.9; 95% CI 1.0–3.6), and functional impairment (aHR 1.9; 95% CI 1.0–3.6). Natural cause mortality was associated with mild problems of alcohol or drug use (aHR 3.4; 95% CI 1.5–7.4), and physical illness (aHR 2.4; 95% CI 1.0–5.6). Unnatural cause mortality was associated only with severe alcohol or drug use (aHR 3.1; 95% CI 1.3–7.3).
Interpretation:
Alcohol and drug use, physical illness, and functional impairment are predictors of mortality in individuals with personality disorder. Clinicians should be aware of the existence of problems in these domains, even at mild levels, when assessing the needs of patients with personality disorders
Art and analysis: An Adrian Stokes reader
No full textThis edition is an introductory selection from the writings of Adrian Stokes (1902-1972), the Kleinian aesthete who created a unique vision of the relation between psychoanalysis, art, and aesthetic experience in general. His approach was founded initially on his travels in Italy which then acquired a more formal theoretical foundation during his analysis with Melanie Klein. Stokes was a close friend of leading figures in both psychoanalytic and artistic-literary circles, including Richard Wollheim who organised a previous edition of extracts, The Image in Form. The present edition concentrates specifically on the writing that demonstrates the parallels between art and psychoanalysis
Thrive: The AFC-Tavistock Model for CAMHS
No full textAll ideas in this paper and related to this model are independent of any organisational affiliations,
committee membership or other official capacities of any of the authors, other than their roles
within the Anna Freud Centre and The Tavistock and Portman NHS Foundation Trust. ..
Understanding hard to reach adolescents: A bio-psycho-social model of aetiology, presentation and intervention
No full textThis thesis examines hard to reach adolescents in respect of; the link between historical, contextual and familial factors, the young people’s inner working model and the manner of intervention with such young people and how one might understand what is most helpful. Psycho-social case work with seven Black and Minority Ethnic (BME) adolescent boys in an area of high social deprivation and ethnographic study of the direct and wider environment was undertaken. This environment of trauma organised systems, within a community dominated by gang violence was impactful on the whole project. The data was analysed by means of a case study approach using psychodynamic, attachment and neurodevelopmental paradigms. The findings suggest that early and ongoing adverse relational and attachment experiences impacts on four aspects of ‘hard to reachness’: Biological, Unconscious, Relational and Environmental. This includes neurochemical disregulation, excessive use of projective processes, emotional immaturity, difficulties with reciprocity and taking responsibility. The four aspects of ‘hard to reachness’ correspond to four domains of intervention: Management and Safety, Therapeutic, Relationship and Social/External. The relationship is seen as central to successful intervention and the worker needs to be able to move between domains as required. Three groupings of presentations were identified; Chameleons, Reactors and Fragmentors based on neurodevelopmental arousal states, types of projective process and attachment styles. Reactors were seen to be typical of the hard to reach group. It is argued that the Reactors continue to rely on very early teleological or concrete behavioural defences which are interactive rather than interpsychic. Thus their behaviour is seen as immature, annoying and deliberate rather than archaic defences against anxiety where neither workers nor young people understand the powerful unconscious forces underlying their acting out