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Tavistock Adult Depression Study (TADS): A randomised controlled trial of psychoanalytic psychotherapy for treatment-resistant/treatment-refractory forms of depression
No full textABSTRACT: BACKGROUND:
Long-term forms of depression represent a significant mental health problem for which there is a lack of effective evidence-based treatment. This study aims to produce findings about the effectiveness of psychoanalytic psychotherapy in patients with treatment-resistant/treatment-refractory depression and to deepen the understanding of this complex form of depression.
METHODS:
INDEX GROUP: Patients with treatment resistant/treatment refractory depression.
DEFINITION & INCLUSION CRITERIA: Current major depressive disorder, 2 years history of depression, a minimum of two failed treatment attempts, [greater than or equal to]14 on the HRSD or [greater than or equal to]21 on the BDI, plus complex personality and/or psycho-social difficulties. EXCLUSION CRITERIA: Moderate or severe learning disability, psychotic illness, bipolar disorder, substance dependency or receipt of test intervention in the previous two years. DESIGN: Pragmatic, randomised controlled trial with qualitative and clinical components.
TEST INTERVENTION: 18 months of weekly psychoanalytic psychotherapy, manualised and fidelity-assessed using the Psychotherapy Process Q-Sort.
CONTROL CONDITION: Treatment as usual, managed by the referring practitioner.
RECRUITMENT: GP referrals from primary care.
RCT MAIN OUTCOME: HRSD (with [less than or equal to]14 as remission). SECONDARY OUTCOMES: depression severity (BDI-II), degree of co-morbid disorders Axis-I and Axis-II (SCID-I and SCID-II-PQ), quality of life and functioning (GAF, CORE, Q-les-Q), object relations (PROQ2a), Cost-effectiveness analysis (CSRI and GP medical records). FOLLOW-UP: 2 years. Plus: a). Qualitative study of participants' and therapists' problem formulation, experience of treatment and of participation in trial. (b) Narrative data from semi-structured pre/post psychodynamic interviews to produce prototypes of responders and non-responders. (c) Clinical case-studies of sub-types of TRD and of change.
DISCUSSION: TRD needs complex, long-term intervention and extended research follow-up for the proper evaluation of treatment outcome. This pushes at the limits of the design of randomised therapeutic trials,. We discuss some of the consequent problems and suggest how they may be mitigated. Trial registration Current Controlled Trials ISRCTN40586372
Neither here nor there, not one thing or another: The use of a reflective practice group to understand the distortion of a boundary
No full textGuests experiences of Maytree during and after their stay
No full textIn 2012, researchers from the University of East London and the Tavistock Clinic published the results of a project aimed at assessing how guests experienced their stay at Maytree and how it impacted on them after leaving. The study found that a large majority of guests felt less suicidal during their stay and for months afterwards. Furthermore, many guests felt their stay was 'transformational', indicating that Maytree had a significant and powerful impact which led them to reappraise their lives
Les nombreux visages du Syndrome d’Asperger [The many faces of Asperger’s Syndrome]
No full textCe livre a pour objectif de présenter un récit pluridisciplinaire d’une approche psychodynamique du syndrome d’Asperger. Il propose une revue des théories psychiatriques et psychanalytiques utiles à sa compréhension, puis des études de cas détaillées illustrant l’expérience émotionnelle des patients, le processus thérapeutique et la grande variété de cas individuels qu’englobe ce syndrome. Il s’adresse aussi bien aux professionnels de la santé qu’aux enseignants et à quiconque s’intéresse à ce sujet
An investigation into the interactions between a child psychotherapist as a consultant/researcher and three primary school SENCOs.
Get PDFThis thesis examines the work of the author, a Child and Adolescent Psychoanalytic
Psychotherapist who is a former Special Educational Needs Co-ordinator (SENCo),
taking the role of a consultant to three SENCos, each of whom are attached to three
separate primary schools. Its method is participation observation in so far as it is the
practice of the consultant herself that is the subject of the research. Two kinds of
uncertainty are central topics of study: the continuing uncertainties surrounding the role
of SENCos in schools, and the uncertainties surrounding the role of a Child and
Adolescent Psychoanalytic Psychotherapist taking on a consultancy role in a school.
The research demonstrates the emotional complexities of SENCos’ work in schools, and
of the situations of the children with whom they work. A particular perspective brought
to this work by a Child and Adolescent Psychoanalytic Psychotherapist includes the
understanding of the place of ‘the baby in the child’ (as one respondent put it), and of
the importance of transference and countertransference processes, which the thesis
examines in detail.
The author traces the interactions that take place during the consulting work with the
three SENCos over the course of an academic year. There are ten sessions in the first
school (Barnswood School), eleven in the next (Valley School) and fourteen in the last
school (Ashurst School). Each session is summarised. Three sessions from each of the
three schools are presented and analysed in detail, using an adaptation of the methods of
Grounded Theory. Main themes emerging from the coding outcomes of all three
schools can be summarised as: consultant containing difficult feelings; the conflicts of
the SENCo Role. These two themes are thought about within a framework of
psychoanalytic knowledge. The author makes references to her countertransference
responses in her analysis of the sessions and she uses these responses to gain more
insight into the themes that emerge from the coding outcomes. She charts the
countertransference responses and links them to projections from children and their
families into the SENCos.
The thesis draws some conclusions both about the development of the SENCo role in
schools, and about the role of Child and Adolescent Psychoanalytic Psychotherapists as
consultants offering support to this work. What emerges strongly is the extremity of the
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feelings that are projected into the SENCos, and the importance of the SENCos being
able to access consulting work that can help them not only to endure the projections, but
also to understand them
Core psychiatry
No full textA new edition of a highly successful, award winning textbook for trainee psychiatrists, covering in one volume all the subjects required for the new MRCPsych and similar exams. Written in a highly engaging manner, it will also prove invaluable to qualified psychiatrists who need to keep up-to-date with the latest developments, as well as clinical psychologists, general practitioners, psychiatric nurses and senior medical students
Concise yet comprehensive, Core Psychiatry reflects the latest developments in the curriculum plus all that is new and essential in clinical practice and the sciences that underpin it. It includes new information on the new Mental Capacity Act and Mental Health Act as well as enhanced sections on psychopharmacology, old age psychiatry, child and adolescent psychiatry, forensic psychiatry and rehabilitation. The book also makes reference to the latest NICE guidelines and includes new sections on sleep medicine and trauma psychiatry
On being involved in a major incident abroad: An exploratory study of an international service
No full textYouth justice and social work. 2nd edition
No full textIt is vital for social work students and practitioners to understand the complexities of the youth justice system. This fully revised second edition analyses and puts into context several pieces of new legislation such as the Criminal Justice and Immigration Act 2008, the Youth Rehabilitation Order 2009 and the new Youth Conditional Caution. Carefully selected case studies and summaries of contemporary research help to underpin this accessible and essential resource. Ideal for students on placement, this new edition enables the reader to follow complex and often difficult legislation and law
Culture and reflexivity in systemic psychotherapy: Mutual perspectives
No full textThe therapeutic relationship is increasingly becoming a central topic in systemic psychotherapy and cross-cultural thinking. Here, experienced systemic psychotherapists offer their reflections and thoughts on the issues of race, culture, and ethnicity in the therapeutic relationship. The aim is to develop this area of systemic practice, to place culture squarely at the centre of all systemic psychotherapy practice as a model for all psychotherapy practice, to encourage both trainees and experienced systemic psychotherapists to pay attention to race, culture, and ethnicity as central issues in their own and their clients' identities, and to inform researchers who use qualitative research techniques such as ethnography. This book moves the issues of culture, race and equity into the centre of psychotherapeutic practice, including that which involves therapeutic encounters across culture, racial and ethnic divides. It develops an approach to cultural transference and demonstrates that thinking about culture, race and ethnicity does not belong at the margin