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Infant observation in Britain: A Tavistock approach
No full textThe author draws attention to something distinctive in the psychoanalytic ‘air’ from the early 1960s onwards: the strong emphasis upon the very early psychological, emotional and cognitive view of infants and young children. She focuses on the work of two analysts in particular, Esther Bick and Wilfred Bion, and the comparable, though differently expressed, centrality of the observational method in their work. Each explored not only the pathological picture but also the nature and integrative function of psychic containment in earliest mental life. Each also shared a preoccupation with what constituted a psychoanalytic attitude and with the process of becoming a psychoanalyst and, in Bick's case, a child analyst or psychotherapist. The author provides an historical background to the idea of observation, followed by an account, with detailed examples, of the nature of infant observation and the observational method as taught and practised at the Tavistock Clinic, London since the late 1940s, and subsequently in many other training institutions. Here the themes of Bick and Bion are constantly interrelated such that the prototype or model for the creation of emotional meaning and thought can be appreciated and learning from experience can take place
Supported employment: Cost effectiveness across six European sites
No full textA high proportion of people with severe mental health problems are unemployed but would like to work. Individual Placement and Support(IPS) offers a promising approach to establishing people in paid employment. In a randomized controlled trial across six European countries, we investigated the economic case for IPS for people with severe mental health problems compared to standard vocational rehabilitation. Individuals (n5312) were randomized to receive either IPS or standard vocational services and followed for 18 months. Service use and outcome data were collected. Cost-effectiveness analysis was conducted with two primary outcomes: additional days worked in competitive settings and additional percentage of individuals who worked at least 1 day. Analyses distinguished country effects. A partial cost-benefit analysis was also conducted. IPS produced better outcomes than alternative vocational services at lower cost overall to the health and social care systems. This pattern also held in disaggregated analyses for five of the six European sites. The inclusion of imputed values for missing cost data supported these findings. IPS would be viewed as more cost-effective than standard vocational services. Further analysis demonstrated cost-benefit arguments for IPS. Compared to standard vocational rehabilitation services, IPS is, therefore, probably cost-saving and almost certainly more cost-effective as a way to help people with severe mental health problems into competitive employment
Continuity of care for people with psychotic illness: Its relationship to clinical and social functioning
No full textBackground:
The relationship between continuity of care and user characteristics or outcomes has rarely been explored. The ECHO study operationalized and tested a multi-axial definition of continuity of care, producing a seven-factor model used here.
Aims:
To assess the relationship between user characteristics and established components of continuity of care, and the impact of continuity on clinical and social functioning.
Methods:
The sample comprised 180 community mental health team users with psychotic disorders who were interviewed at three annual time-points, to assess their experiences of continuity of care and clinical and social functioning. Scores on seven continuity factors were tested for association with user-level variables.
Results:
Improvement in quality of life was associated with better Experience & Relationship continuity scores (better user-rated continuity and therapeutic relationship) and with lower Meeting Needs continuity factor scores. Higher Meeting Needs scores were associated with a decrease in symptoms.
Conclusion:
Continuity is a dynamic process, influenced significantly by care structures and organizational chang
The influence of different forms of early childcare on children's emotional and behavioural development at school entry
No full textBackground:
Over the past few decades there has been a dramatic increase in maternal employment and, as a result, an increase in the use of non-maternal childcare in the early years. The purpose of this longitudinal study was to examine, in a large representative English sample, the influence of different forms of childcare on children's behavioural and emotional development around the age of school entry.
Methods:
A sample of 991 families, originally recruited when the children were 3 months old, was assessed around school entry age at 51 months. The main outcome variable was the children's emotional and behavioural functioning, measured by questionnaire completed by both mothers and teachers. A range of repeated assessments were carried out at different time points, including direct observation of the quality of maternal caregiving and observations of the quality of non-parental care, and amount of time spent in different forms of care. Results: The strongest and most consistent influences on behaviour and emotional problems were derived from the home, including lower socio-demographic status, poorer maternal caregiving, parental stress/maternal mental health problems, as well as child gender (being a boy). Non-parental childcare had small effects on child outcome. One finding that did emerge was that children who spent more time in group care, mainly nursery care, were more likely to have behavioural problems, particularly hyperactivity. Conclusions: These findings suggest that interventions to enhance children's emotional and behavioural development might best focus on supporting families and augmenting the quality of care in the home.
Results:
The strongest and most consistent influences on behaviour and emotional problems were derived from the home, including lower socio-demographic status, poorer maternal caregiving, parental stress/maternal mental health problems, as well as child gender (being a boy). Non-parental childcare had small effects on child outcome. One finding that did emerge was that children who spent more time in group care, mainly nursery care, were more likely to have behavioural problems, particularly hyperactivity.
Conclusions:
These findings suggest that interventions to enhance children's emotional and behavioural development might best focus on supporting families and augmenting the quality of care in the home
Living on the border: Psychotic processes in the individual, the couple, and the group
No full textThis book centres on the problem of psychosis, understood from a psychoanalytic perspective, as it manifests itself in different contexts and different levels of organisation: from the individual psychoanalytic session, through work with couples, groups and institutions and wider levels of social organisation. Beginning with a discussion of the psychoanalytic apporach to psychosis centring on the work of Freud, Klein and the Post-Kleinians, it goes on to cover individual, couple and group therapy with psychotic patients. It draws on clinical material and theoretical discussion to explore the links between psychotic processes on different levels. This work is aimed at different professionals working within the psychodynamic frame of reference: individual psychotherapists, couple and family and group psychotherapists; organisational consultants and trainees in different therapies. As well as this it will be a useful resource to nurses, doctors and social workers who work with very disturbed patients and wish to learn about psychotic processes
Vulnerability for Functional Somatic Disorders: A Contemporary Psychodynamic Approach.
No full textPatients with functional somatic disorders (FSD) are markedly heterogeneous with regard to the factors contributing to their illness, their symptoms, and treatment response. In this article, we present a contemporary psychodynamic approach to the conceptualization and treatment of these patients based on attachment and mentalization theory. Extant research is reviewed that suggests a key role for attachment history and mentalization in determining stress and affect regulation, and immune and pain-regulating systems. We focus more specifically on the high interpersonal and metabolic costs associated with the excessive use of insecure secondary attachment strategies in response to stress, and the associated impairments in (embodied) mentalization in patients, both as a cause and consequence of FSD. Finally, a new brief psychodynamic intervention for patients with functional somatic complaints is discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved
Feasibility study of a psychodynamic online group intervention for depression
No full textDynamic Interpersonal Therapy (DIT) was originally developed as a brief psychodynamic intervention for the treatment of depression and anxiety. More recently it has become the psychodynamic protocol for depression specifically within Improving Access to Psychological Therapies services across the U.K.
The aim of the present study was to pilot and evaluate the feasibility of a group online version of DIT—Online Group Dynamic Interpersonal Therapy—and the perceived helpfulness of psychodynamically informed self-help materials. Twenty-four participants were randomly assigned to three groups. Participants in Condition A (n = 8) took part in an online DIT group, with self-help materials, facilitated by a therapist. Participants in Condition B (n = 8) were given access to a closed virtual group space where they could interact with each other and were supplied with the same self-help materials used by participants in Condition A, but without online therapist facilitation. Participants in Condition C (n = 8) received no instructions or facilitation, but had access to an online mental well-being site where they could meet virtually in a large, open, moderated virtual group space to discuss their psychological difficulties.
This feasibility study was underpowered to detect significant differences in rates of change between facilitated and unfacilitated provision of material, but decline in symptoms appeared to be superior to control only for the facilitated group when the groups were considered separately. The response of the combined treated groups against control suggests that the DIT self-help materials may be helpful and appear to support the process of change. Further work is required
