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Current programme leads for UK qualifying level courses reflect on contemporary issues in family therapy training
No full textAn invitation was sent to all programme leads for qualifying level courses in family and systemic psychotherapy to contribute to this issue of Context and a small group of us
accepted the invitation, and considered how we might respond.
With one of AFT's core tasks being the accreditation of training programmes, it seemed fitting for us to reflect on contemporary issues in systemic training. In deciding the focus of the article, we pulled together some initial ideas that centred around the training legacies and traditions passed on from our training elders, our thoughts on what we might keep and how we might do things differently. We acknowledged that the crafting of a training programme is never a one-person show; rather, it is the continuous weaving of a tapestry with the threads, textures and colours of influences of others from the past, present and future: a work always in progress. We also acknowledged the fact that any effective systemic training programme will undoubtedly reflect and be responsive to the societal zeitgeist
Digital transformations: Exploring the human-technology constellation in our entangled organisations
No full textWork, organisations, and society have been transformed by digital technologies. Information and communication technologies are increasingly important to the management and delivery of human services. Significant sums are invested with the expectation that new technology will drive positive changes such as improving service user experience, efficiency, and outcomes. Sometimes the promises of technology are not fully realised. As researchers and practitioners in organisational and social dynamics it is important to understand how these technologies are affecting the ways in which we organise, communicate, and relate. In this article I explore one aspect of this dynamic, which is that technologies are entangled with the anxieties of human service organisations where the task is caring for people who are ill or in distress. This may lead to structures and processes that are not requisite to the primary task of these services and the technology implementation may fail to meet its aims. I draw on the work of Kurt Lewin, Isabel Menzies Lyth, sociotechnical systems theory, and my own research to explore the entangled nature of contemporary organisations. I suggest ways in which we might develop our concepts and practices to fully account for the role of technologies in organisational process and therefore our ability to consult to those processes
‘It’s a tough gig’: Can reflective practice groups support senior leaders in child welfare manage anxiety and provide containment for others?
No full textSenior leaders are responsible for providing containment for practitioners navigating the emotional challenges of complex safeguarding work with children and families. This requires attention to the defences, uncertainties, and anxieties that such leadership responsibilities provoke. However, little is written about the stress and anxieties experienced by leaders or the supportive mechanisms they need. Creating containment across an organization with limited reflective space is a difficult task. This article explores whether psycho-socially informed Reflective Practice Groups (RPGs) provide emotional containment for leaders in child safeguarding. RPGs are a facilitated, structured group-based method of reflection designed to contain anxiety generated by health and social care practice. While RPGs have been successful for frontline practitioners, their potential for senior leaders has been unexplored. RPGs were held monthly with fifty participants across five organizations over a six-month period. Focus groups were conducted before and after the RPGs ended to assess the impact from the participants’ perspectives. Findings suggest that RPGs help contain anxiety by offering a space for collective reflection on the complexity of leadership. By promoting professional connectedness, participants reported reduced isolation and reliance on unhelpful defences mechanisms, potentially contributing to more emotionally containing conditions for both leaders and those that they lead
Learning and unlearning through the clinical encounter: On becoming a psychoanalytic psychotherapist
No full textThis book examines the learning process involved in becoming a psychoanalytic practitioner and presents training experiences at the Tavistock and Portman NHS Foundation Trust through the lens of both teachers and trainees.
The book describes the relevant history at the Tavistock and how psychoanalytic knowledge is acquired through a process of learning from experience and the fostering of a culture of enquiry. The contributors also present their interpretations of what is meant by analytic learning and how this is acquired for a psychoanalytic attitude to become possible. The book includes a mix of chapters by more experienced clinicians setting out what can be useful in training, balanced by other chapters from more recent trainees who reflect on their development and experience of that training. Other important sections focus on the experience and importance of supervision and on how to respond to clinical challenges in training and practice, specifically public-sector-based trainings.
With rich clinical vignettes and personal reflections on training experiences, this book is key reading for all psychoanalysts and psychotherapists involved or interested in training
Paraphilias, problematic sexual behaviours and personality disorder-To what extent are they linked?
No full textBackground: Since DSM-III, mental disorders have been classified based on overt symptoms and behaviours rather than underlying psychological and personality processes.
Aims: This study examines the occurrence of personality dysfunction in individuals with paraphilic disorders and problematic sexual behaviours.
Method: The Shedler-Westen Assessment Procedure (SWAP-200), a clinician-rated assessment measure of personality disorders, was administered in a sample of 303 patients referred to a specialist forensic psychotherapy clinic. Sixty-six percent (N = 200) of the sample were diagnosable with traits of one or more DSM-5 personality disorders, and 35% (N = 106) were diagnosable with categorical DSM-5 personality disorders. When an alternative set of empirically derived personality diagnoses was examined, 94% (N = 285) had significant traits of the personality syndromes, and 62% (N = 188) of the sample met criteria for categorical diagnoses.
Conclusions: Paraphilic fantasies and behaviours may be linked to underlying personality pathology, suggesting implications for assessment and treatment
Subtyping Service Receipt in Personality Disorder Services in South London: Observational Validation Study Using Latent Profile Analysis
No full textBackground:
Personality disorders (PDs) are typically associated with higher mental health service use; however, individual patterns of engagement among patients with complex needs are poorly understood.
Objective:
The study aimed to identify subgroups of individuals based on patterns of service receipt in secondary mental health services and examine how routinely collected information is associated with these subgroups.
Methods:
A sample of 3941 patients diagnosed with a personality disorder and receiving care from secondary services in South London was identified using health care records covering an 11-year period from 2007 to 2018. Basic demographic information, service use, and treatment data were included in the analysis. Service use measures included the number of contacts with clinical teams and instances of did-not-attend.
Results:
Using a large sample of 3941 patients with a diagnosis of PD, latent profile analysis identified 2 subgroups characterized by low and high service receipt, denoted as profile 1 (n=2879, 73.05%) and profile 2 (n=1062, 26.95%), respectively. A 2-profile solution (P<.01) was preferred over a 3-profile solution, which was nonsignificant. In unconditional (t3941,3939=19.53; P<.001; B=7.27; 95% CI 6.54-8) and conditional (t3941,3937=−3.31; P<.001; B=−74.94; 95% CI −119.34 to −30.56) models, cluster membership was significantly related to receipt of nursing contacts, over and above other team contacts.
Conclusions:
These results suggest that routinely collected data may be used to classify likely engagement subtypes among patients with complex needs. The algorithm identified factors associated with service use and has the potential to inform clinical decision-making to improve treatment for individuals with complex needs
Contemporary developments in supportive therapy: Principles and practice
No full textThis book explores Open-Ended Supportive Therapy, a psychoanalytically informed approach designed to offer a compassionate and flexible alternative to more rigid therapeutic methods. Supportive therapy is particularly valuable for individuals who find traditional therapeutic models either too directive or insufficiently supportive, as it prioritizes the therapeutic relationship over specific goal-oriented techniques. The book presents consistent research indicating that early termination of treatment, when patients abruptly leave the therapeutic process, is often linked to therapists offering interventions that patients are not ready for. Supportive Therapy assigns a specific role to the therapist in the use of transference, leveraging this understanding to create a supportive environment through a strong therapeutic alliance. This framework guides the therapist in navigating the complexities of providing support without colluding with the patient’s pathology
Exploring psychoanalytic concepts through culture, the arts and contemporary life: Learning from observation and experience
No full textThis book explores how psychoanalytic ideas and thinking enhance our understanding and engagement with the creative arts and contemporary life. Many of us love to read poetry and novels and enjoy the performing arts. All of us take part in contemporary life. But how might a psychoanalytic perspective deepen our understanding or enhance our experience in these areas? What might we discover when we explore the unconscious dimensions of particular cultural artefacts and activities. Based on the work of the longstanding Psychoanalytic Studies Course at the Tavistock Clinic, contributing authors draw on their experience of infant observation and psychoanalytic theory and apply them to explorations of culturally diverse and wide ranging topics such as social work, literature, the act of littering, a Palestinian poem, and even a chart-topping Korean pop song. Blending a deep understanding of clinical work and a broad range of artistic endeavours, this book will be key reading for psychoanalysts, psychotherapists, and any interested in understanding how psychoanalysis can inform art and life
Explaining and reducing the poor physical health of individuals who engage in criminal behavior
No full textLearning and Unlearning through the Clinical Encounter: Becoming a Psychoanalytic Psychotherapist
No full textThis book examines the learning process involved in becoming a psychoanalytic practitioner and presents training experiences at the Tavistock and Portman NHS Foundation Trust through the lens of both teachers and trainees.
The book describes the relevant history at the Tavistock and how psychoanalytic knowledge is acquired through a process of learning from experience and the fostering of a culture of enquiry. The contributors also present their interpretations of what is meant by analytic learning and how this is acquired for a psychoanalytic attitude to become possible. The book includes a mix of chapters by more experienced clinicians setting out what can be useful in training, balanced by other chapters from more recent trainees who reflect on their development and experience of that training. Other important sections focus on the experience and importance of supervision and on how to respond to clinical challenges in training and practice, specifically public-sector-based trainings.
With rich clinical vignettes and personal reflections on training experiences, this book is key reading for all psychoanalysts and psychotherapists involved or interested in training