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Ethnic disparities as potential indicators of institutional racism in inpatient care within acute mental health wards: A rapid review
No full textPurpose: Previous reviews suggest minoritised ethnic patients face inequalities in aspects of inpatient care including involuntary admission and forced medication. This rapid review aimed to identify ethnic disparities in acute adult mental health care and explore to what extent these provide evidence of institutional racism, as defined by the Macpherson report. Methods: Ovid MEDLINE, Cochrane Library, Ovid PsycINFO, Web of Science and Ovid EMBASE were searched for studies published from January 2018 to August 2024. Quality of evidence was assessed using the Joanna Briggs Critical Appraisal Tools. A synthesis of the studies was performed. Results: Quantitative studies (n = 34) revealed ethnic disparities in involuntary admission, psychiatric diagnoses, forced medication, physical restraint, seclusion, length of stay and access to appropriate services/facilities. Qualitative data (n = 2) revealed experiences of disempowerment, confusion and loss of autonomy. Collectively these findings mapped onto components identified as underlying institutional racism as defined by the Macpherson report. Conclusion: Our current evidence can be used to understand the genesis and perpetuation of insitutional racism in health care settings. This will enable us to better target intervention or change management to address issues where they arise. Further research and analyses are needed however, in order to verify whether ethnic disparities in inpatient services and treatment reflect or are themselves exacerbated or contributed to by institutional racism
Understanding occupational histories and how they influence a psychoanalytic child psychotherapist’s experience of their work: An Interpretative Phenomenological Analysis.
Full text linkThis study explores how Child and Adolescent Psychoanalytic Psychotherapists (CAPPTs) experience the influence of their previous occupations on their current work. Using Interpretative Phenomenological Analysis (IPA), it investigates how diverse professional backgrounds shape their identity, skills and therapeutic approach. Addressing a gap in the literature, it highlights the significance of prior occupations—an overlooked topic in CAPPT training and practice. Participants were selected based on their former roles and current status as CAPPTs, with semi-structured interviews used to elicit personal narratives. The study focuses on the lived experiences of four CAPPTs, analysing how their earlier careers inform their practice and professional development. Analysis of interview transcripts and occupational histories generated five themes: The Seedlings, The Transformation Process, Integration and Conceptualisation of One’s Approach, Relationships and Interactions Then and Now, and Learning from Occupational Experiences to Empathise with One’s Patient. Participants reported a sense of identity disintegration and reintegration, facilitating a deeper understanding of self and patient. The findings underscore the value of prior experience in shaping therapeutic work with children, young people and families, as well as associated tasks such as teaching, managing, research, and supervision. The study illustrates a cultivated sense of ownership and belonging in these CAPPTs and offers insights for recruitment, training, and reflective practice—suggesting that engaging with one’s occupational history can enrich the development of child psychotherapists
Effects of the Family Nurse Partnership on all eligible mothers: a data linkage cohort study in England
No full textBackground: An intensive programme of home visiting, the Family Nurse Partnership (FNP), is received by around one in four first-time adolescent mothers in selected areas in England. During home visits, nurses support mothers to make choices about healthy pregnancies, improving child development, and fulfilling their own aspirations and ambitions. Evidence is needed of the wider effects of the FNP, including for mothers not enrolled in the programme (who might experience unintended effects). We evaluated child and maternal outcomes for all eligible mothers giving birth before, during, and after the period in which FNP was active in local areas.
Methods: We created a linked cohort of 237,185 eligible mothers, aged 13-19, who gave birth between April 2010 and March 2019, and who had a first antenatal booking appointment (or a date of 28 completed weeks of gestation, if missing) when FNP was active in their area. We used administrative hospital data to identify unplanned maternal/child hospitalisations up to 2 years after birth for children born and mothers delivering before, during and after FNP was active. Generalised linear models were used to adjust for background regional time trends, maternal characteristics, and clustering of outcomes within residential areas.
Results: We found no evidence of differences in unplanned hospital admissions for children born during the FNP period (36.9% versus 36.0%, relative risk [RR] 1.01; 95% CI 0.99-1.02), or after FNP was active (37.1%, RR 1.0; 95% CI 0.95-1.06), compared with those born before FNP was active. There was no evidence of differences in child admissions for maltreatment/injury-related diagnoses or for maternal admissions for adversity-related diagnoses.
Conclusion: Child and maternal outcomes were similar before, during and after FNP active periods, suggesting that the FNP did not have a wider impact on outcomes in all eligible mothers, including those not participating in the FNP
Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror, by Judith Herman
No full textTrauma and Recovery by Judith Herman was published in 1992. This article explores its relevance and legacy for today in the trauma field, particularly with the new ICD-11 diagnosis of complex post-traumatic disorder
Psychoanalytic aspects of the Watch Me Play! approach: the psychic energy of attention
No full textThis article discusses the origins of Watch Me Play! (WMP) in psychoanalytic infant observation. The WMP approach aims to help caregivers to enjoy being with their baby or child and promote their child's development. Parents are supported by a practitioner to allow their child to play freely, give their full attention to watching the child playing, and talking with the child about their play or, with a baby, echoing their sounds. Then the parent and practitioner reflect together on their observations of the child's play and the experience of watching the child play. Developed in 2011 and manualised in 2019, WMP is now used in services for children and families in the UK and internationally. Parents have reported that giving their child their full attention allows them to get to know their child better, notice more about their child and feel more confident about their parenting and about their child's capacities. A case study is linked to ideas about attention in Freud and Bick, the importance of surprise in Bick's thinking about psychoanalytic infant observation, and the life instinct as described by Freud and Klein
Complex trauma: the Tavistock model. A phase based multi-modal service held within a psychoanalytic frame
No full textIn this paper I hope to offer an understanding of the different kinds of complex trauma presentations we see in the Tavistock Trauma Service and will use amalgated clinical examples to illustrate these. We work in a trauma-informed manner using a phase-based approach of stabilisation and safety, trauma processing, and reintegration and reconnection. All of this is held within a psychoanalytic frame
Creating a holding environment in an organisational setting: A systems psychodynamic first person action research perspective
No full textA key function of an organisational consultancy practitioner, working from a systems psychodynamic perspective, is to hold individuals in a psychologically safe place as they engage in difficult conversations. A key question in this regard is how the practitioner goes about attempting to create a holding environment in a complex organisational setting. This research, which uses first person action research methodology, and was conducted as part of a professional doctorate, explores the creation of a holding environment. The author, in her role as a practitioner in an organisational setting, inquired into how she created a holding environment using a systems psychodynamic lens. Inquiring in the present tense with triple attentiveness to the outer data of sense, the inner data of consciousness, and the intellectual data of her understanding, the author shows and illuminates with case material how she attempted to create a holding environment. While others have made reference to the experience of the consultant in creating a holding environment, the contribution of this article is to do so systematically using a specific research methodology. Seven key elements emerged in the research. These elements include (1) negotiating with key authority figures within the organisation, (2) creating psychological safety in the group, (3) dreaming and reverie, (4) communicating with group participants including attuning and mirroring, (5) creating space for needs, vulnerabilities, and emotions, (6) enabling insight and understanding, and (7) holding environments-in-the-mind
Free association and qualitative research interviewing: perspectives and applications
No full textPurpose: This paper contributes to a dialogue about the psychoanalytic concept of free association and its application in the context of qualitative research interviewing. In doing so, it also adds to wider discussion regarding the relationship between clinical psychoanalysis, psychoanalytic psychotherapy and qualitative research.
Design/methodology/approach: Critical consideration of different perspectives on the application of free association in the qualitative research interview, extending earlier work addressing this issue. Differences and similarities in the way the concept of free association is articulated are examined regarding its framing in psychoanalysis and psychoanalytically oriented psychotherapy.
Findings: Whether researchers see themselves as borrowing, applying or drawing inspiration from free association, there is scope for muddling distinct ways of viewing it as it is conceived in psychoanalysis.
Originality/value: Considerations are outlined for researchers interested in psychoanalytically informed methods to be mindful of
“Before people see the autism, they see my race”: An intersectional exploration of the lived experiences of masking and camouflaging Black Autistic girls in UK education using IPA and DisCrit
Full text linkAbstract
The experiences of Black Autistic girls in UK schools are shaped by complex layers of identity that significantly impact their educational journey. Existing literature highlights a significant gap in research on the Black Autistic experience, particularly regarding masking and camouflaging Autistic traits. By centring the voices of Black Autistic girls with experience of masking and camouflaging in school, this research aims to address that gap, being the first of its kind. This study sets out the historical and current socio-political context of autism, disability, race, and gender, addressing the intersectional and socially constructed nature of identity. Employing Interpretative Phenomenological Analysis (IPA), semi-structured interviews were conducted with 4 Black Autistic girls aged 16-18 years. The findings revealed five group experiential themes that underscore the importance of acceptance and belonging, managing social norms, the intersection of autism with race and gender, sensory challenges, and the critical role of support and understanding. Using Disability Critical Race Theory (DisCrit) to understand these experiences at a societal level, this study argues the need for a nuanced understanding of how societal structures, rooted in norms of Whiteness and ability, impact their lives and strategies for social interaction, such as masking and camouflaging behaviours. This novel study's contributions are not only to enrich the academic discourse on intersectionality within autism research but also to inform and transform educational practices, with implications for practice being drawn from the research. It encourages Educational Psychologists and related professionals to actively challenge normative structures and advocate for equity, ultimately fostering environments where all students can thrive authentically. Strengths and limitations, along with potential directions for future research, are discussed
Autistic SPACE(S) in Social Work
No full textSocial work has a vital role to play in supporting Autistic people of all ages. Whether in facilitating access to other services, such as housing, enhancing quality of life, or in a safeguarding capacity, social workers have a legal and moral responsibility to ensure their practice ensures full, equitable involvement of Autistic people. Regrettably, research evidence indicates practice is not always inclusive and can fall short in responding effectively to Autistic people’s needs. This article adds to recent UK practice guidance and social work scholarship concerning social work and autism. It does so by introducing a framework developed by Autistic doctors for meeting Autistic people’s needs in medical settings known as ‘Autistic SPACE’ and exploring how it could be used for social work contexts. The five core autistic needs recognised in the SPACE framework are addressed, i.e. Sensory, Predictability, Acceptance, Communication and Empathy. How a practice-near social work perspective may aid in developing the framework further is also considered, extending the acronym from SPACE to SPACES to highlight the significance of Social Safety and Support