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Observation as a therapeutic intervention for infants and young children in care
No full textMore than half of all children entering care in the UK are infants and children under five. The emotional and mental health needs of this population tend to be overlooked. Research described in this paper aimed to find out about the experience of an infant or young child in care and to inform training and support for health and social care professionals. The study found that therapeutic observation with a looked-after infant was feasible and provided an in-depth perspective on the experiences of the baby and his foster carers. The paper outlines the clinical context, defines therapeutic observation, describes stages in the first year of life of the observed infant and his transition to adoption, discusses functions of the therapeutic observer, describes applications of the research and makes suggestions for further research
Psychoanalytic psychotherapy with depressed older adults. A qualitative research study
No full textThis thesis is a qualitative investigation of once-weekly psychoanalytic psychotherapy practised by the researcher over a period of one year with a sample of six patients, all of whom were over 65 at the beginning of their
treatment and had been previously diagnosed by clinical referrers as depressed. The purpose of the study was to explore whether psychotherapy could alleviate their distress and enhance the quality of their later life. It was
also to investigate if there were other reasons for depression in later life than the failure to mourn early losses.
In an earlier study I had applied the method of psychoanalytic infant observationto the study of aged adults suffering from dementia, both to learn about their
states of mind and to study their responses to this kind of close observational attention. This new study brings my training and experience as a child and adult psychotherapist to bear on the experience of older adults.
I adopted a qualitative method of research, applying a form of Grounded Theory to the analysis of clinical data which I wrote up in detail after each clinical session. I sought to identify themes which explained the origins of depression in
later life in otherwise well-functioning adults both from thematic analysis of the separate case studies and by comparing them, In a follow-up review meeting three months after the completion of treatment research patients completed a questionnaire which enabled me to assess the changes which had taken place as a consequence of clinical treatment. These results and the outcomes of the CORE measures, an independent assessment, indicated significant
improvements in the states of mind of all the patients since the beginning of their psychotherapy.
The context for this qualitative clinical study is provided by a chapter which reviews the literature on the psychology and especially the psychoanalytic study of old age, identifying earlier theoretical contributions beginning with the work of Freud which were formative to my work. A central finding of my study was that losses, sometimes from childhood, remained the significant unrecognized sources of depression, and that enabling patients to reflect on aspirations which were no longer attainable could bring them relief from depression and a renewed interest in life. Most previous psychoanalytic writing in this field is
based on single clinical cases. My study is original both in its systematic comparison of six cases of depression in old age and in its adoption of an explicitly qualitative research method adapted to clinical data.
A further context for my investigation is provided by a chapter in which my research methodology is described. A chapter on the social context of old age is included, which takes note of the growing proportion of aged people in the population and the demands placed on social provision to meet their physical needs as well as their mental well being. The final chapter draws some further conclusions and recommendations from the study
A clinical investigation of impairment in the development of healthy aggression with reference to the work of Henri Parens
No full textThis thesis investigates how impailments and arrests in the development of ordinary healthy aggression interfere with development in general. I review the literature on aggression, particularly in relation to Henri Parens' concept of a spectrum of aggression. I describe two cases seen in a general CAMH service. The clinical material from the first year of therapy for each case is subjected to Grounded Theory coding to ensure that aggression has not been prejudiced over other significant factors. I describe the two cases using Anna Freud's Diagnostic Profile and
Developmental Lines to trace the development of aggression within the broader context of more general development. I compare their respective progress with reference to Parens' work, using his spectrum to hypothesise that in some children there is a confusion of ordinary healthy aggresssion(or developmental assertiveness) with destructiveness. I suggest that this confusion inhibits
development across several areas. Finally I discuss some possible implications for clinical practice
Observation, containment, countertransference: The contribution of psychoanalytic thinking to contemporary relationship-based social work practice
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Consultancy on deregistration to a care home for the long-stay mentally ill: You can take Stig out of the Dump, but Can you take the Dump out of Stig?
No full textWith the Olympic Games coming to London at the time of writing, summer 2012, and the country in economic crisis, the government is attempting to clean up the streets at the same time as cutting services by instructing mental illness to behave itself and meet mad targets. This leaves the mentally ill at most risk of being dumped. Following the dismantling over two decades ago of out-of-sight asylums, most care of the chronically mentally ill has been in registered care homes in the community. The legal definition of a care home is an establishment that provides accommodation with personal care, including assistance with bodily functions where required.
‘Registration is a legal requirement under the Health and Social Care Act 2008 for all health and adult social care providers to register with the Care Quality Commission.’ (forum.ukqcs.co.uk/home/forum/topic/36/8/1/17/)
However, in an attempt at reducing budgets, under the guise of cutting red tape and enhancing empowerment and independence, there is a proposal to deregister these housing associations by insisting that their customers become independent of the following needs: personal care, having their medication supervised, and having limited access to and responsibility for money. If a care home is deregistered then, in agreement with residents, the provision of residential accommodation, together with nursing or personal care, is discontinued, and instead these two elements are provided separately and tenancy agreements are put in place in the form of ‘supported housing’. It is expected that the primary task of support workers will adapt to empowering the charges in ‘their care’ so that self-responsibility on the part of the mentally ill will increase. The difficulty is that the nature of mental illness would seem to make this impossible, which makes the demands themselves mad