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'No entry', an invitation to intrude, or both? Reflections on a group of anorexic patients
No full textThis paper describes the twice-weekly psychoanalytic psychotherapy of a young woman who had undergone major bowel surgery in her early 20s, with no clear medical indication for the surgery. Whilst the concept of ‘No Entry’ described by Williams (1997a, b) aptly describes many features of more ‘typical’ anorexic patients, this paper describes a particular group of anorexic patients, referred by their physicians for multiple medical procedures; and proposes there is a group of anorexic patients, repeatedly referred for medical investigations, into whom particular types of entries occur. These are entries into the body ‘legitimized’ as medical, with a trajectory towards multiple procedures, examinations and surgical operations. Other entries (outside the medical setting) may occur in a state of altered consciousness, under the influence of alcohol or drugs, such that any wish for intrusion is disowned and denied. In both sets of events, intrusion is both invited, and consciously denied.
The case example illuminates some of these features, and aspects of the countertransference are also described. Attention is drawn to relevant research focusing on surgical intrusion. Finally, there is an exploration as to how such patients may invite intrusions into the body through surgery and medical procedures
How I became a therapist
No full textTaiwo Afuape’s decision to train as a therapist has its roots in her Nigerian heritage and her passion to challenge oppressio
Continuity of care for carers of people with severe mental illness: Results of a longitudinal study
No full textBackground:
Continuity of care is considered by patients and clinicians an essential feature of good
quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasise it and encourage systems to promote it. Despite this there is no accepted definition or measure against which to test policies or interventions designed to improve continuity. We aimed to operationalise a multi-axial model of continuity of care and to use factor analysis to determine its validity for severe mental illness.
Methods: A multi-axial model of continuity of care comprising eight facets was operationalised for quantitative data collection from mental health service users using 32 variables. Of these variables, 22 were subsequently entered into a factor analysis as independent components, using data from a clinical population considered to require long-term consistent care.
Results:
Factor analysis produced seven independent continuity factors accounting for 62.5% of the
Total variance. These factors, Experience & Relationship, Regularity, Meeting Needs, Consolidation,
Managed Transitions, Care Coordination and Supported Living, were close though not identical to the original theoretical model.
Conclusions:
We confirmed that continuity of care is multi-factorial. Our even factors are intuitively
meaningful and appear to work in mental health. These factors should be used as a starting-point
in research into the determinants and outcomes of continuity of care in long-term disorders
Drawing below the surface – Eliciting tacit knowledge in social science research
No full textThe use of drawing in research has been limited to studies of visual representations produced by the culture observed or illustrations made by the ethnographer recording objects or scenes witnessed, akin to the use of photography. The paper first considers the model provided by the discipline of Infant Observation as developed in the Tavistock tradition and applied to observations in organizational settings. It then considers the production of drawings by the observer/researcher as a mean to access tacit knowledge and unconscious perceptions of which s/he has
not been aware due to the work of internal censorship. Findings concerning the approach made in different settings are examined,and the hypothesis advanced by the paper is that drawings of an observation may function as a dream ‘shared’ by observed and observer. The records can then be explored by the observer with a peer group of researchers producing free associations to the (verbal, written
and) drawn accounts produced by the researcher of and about the culture described, thus resulting in richer data
Experiencing endings and beginnings
No full textThroughout life we undergo many changes in our circumstances, beginnings and endings of relationships, gains and losses. This book highlights the emotional turmoil which, to a greater or lesser extent, accompanies these changes. It considers the nature of the anxieties aroused by a new situation and the ending of a previous state at various stages in life. Endings and beginnings are shown to be closely related, for every new situation entered into, more often than not, involves having to let go of some of the advantages of the previous one as well as losing what is familiar and facing fear of the unknown.
The author shows how all these aspects of change evoke primitive anxieties, stemming from our earliest experiences of coming into this world. While beginning life outside holds the promise of a wider, more enriching existence it involves the loss of the known, relative safety of life inside mother's body. Moreover, the human newborn is at first utterly helpless, totally dependent on others to keep him alive. It leaves him terrified of being abandoned and left to die. The loss of what is familiar, the fear of the unknown as well as the fear of being unable to manage on our own remain in the depth of our psyche throughout life and are re-evoked at times of life-changing events and to some extent by any ending and beginning. The book stresses the importance of examining the way these anxieties are dealt with by different individuals and those who look after them and what promotes or undermines mental, emotional and spiritual growth.
Freud, as well as stressing the importance of the "work of mourning" when someone we love and/or depend on dies, drew attention to the fact that mourning occurs in other situations, such as losing one's country, or an ideal. The author describes how bereavement affects young children, adolescents, young and old people. She also looks at all the ordinary endings in life such as the separation from mother when the child begins to go to nursery, leaving home to go to college, losing one's place of work at retirement, losing one's youth. She stresses how important it is to prepare and work through these and other losses for it is only if we continue to value and internalise the good aspects of the experiences we have had - rather than remain angry about what we have lost - that we are able to internalise and carry them within our heart and mind to sustain us through life, and remain open to appreciate the preciousness of living in the present
The experience of parents of a premature baby
No full textTo have an idea of the experience of parents having a premature baby it might be helpful to think about the impact and atmosphere of a neonatal intensive care unit, since almost all babies born more than eight weeks early are likely to spend some time in such a unit. A multiplicity of equipment surrounds the baby, and tubes and leads are fixed to him, so that it is hard to focus on the baby in the middle. In the intensive care unit the babies have tubes, which can be heavy, taped to their arms and legs. The babies have come too early, their capacities are not fully developed. Their skin is still very thin; sometimes there are fears that it may break down, with primitive and nightmare terrors of what that might mean. Many women seem to find it useful to talk over their experience with the child psychotherapist and they may use this opportunity in many different ways
