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Dr Bowlby: a psychiatrist for our times
Get PDFInspired by his experience as a teacher in a special school, John Bowlby became a doctor in order to give psychological treatment to children and their families. His debt to psychoanalysis is evident, while his determination to give external life events at least equal weight with mental states led him towards attachment theory. This pathway is well known, but Bowlby's parallel career as a child psychiatrist doggedly independent of psychoanalysis or medical practice, is not. His intelligent curiosity about human relationships took him beyond the prevailing scientific and clinical fixation with diagnosis, which persists to this day. Dr Bowlby's clinical approach is a model for modern child and adolescent psychiatrists
Intensive psychoanalytic psychotherapy with looked after and adopted children: Exploring the experiences and perspectives of trainee Child and Adolescent Psychotherapists
Get PDFObjectives: This study sought to explore the experiences and perspectives of trainee Child and Adolescent Psychotherapists (CAPTs) offering intensive psychoanalytic psychotherapy to looked after and adopted children (LAAC) within Child and Adolescent Mental Health Services (CAMHS). The study was interested in researching both clinical experiences within the consulting room, as well as work with the network supporting the therapy, consisting of adoptive parents and foster carers, the professional network, and intensive case supervisors. Methods: Five trainee CAPTs were interviewed, using a semi-structured interview format. Interviews were transcribed verbatim and analysed using Reflexive Thematic Analysis. Results: The impact of experiences of trauma and loss were considered in relation to the: LAAC, carers, adoptive family and professional network involved, and on the therapy. The propensity for splitting and re-enactments due to the disturbing impact of trauma was emphasised. Concerns regarding pressures on the CAMHS and on the individual therapist and parent worker’s capacity to link-up and work collaboratively were raised. Intensive case supervision was deemed an important space where thinking and hope could develop. The prevalence of ambivalence, destructiveness and violence in the therapy was indicated. Participants emphasised the developmental focus of the therapy, and how the CAPT’s reverie was considered an essential aspect of the therapeutic experience. Variations and creativity in technique were emphasised as necessary for this population. Conclusions: The findings emphasise how trauma can have an ongoing impact on both child and network, leading to splits, fragmentation and re-enactments; pressures on CAMHS make this more likely to occur within the treating team, and the importance of linking up between professionals is stressed. Intensive psychotherapy can be experienced as both a threat to the child’s defences, but also a space where trust and understanding can grow, and where development can take place. Further larger-scale research on intensive psychotherapy is recommended
Shut in and cut off? An exploration of internal and external relationship dynamics of adolescents and young adults who are socially withdrawn and isolated in their homes
Get PDFThe aim of this research was to learn more about adolescents and young adults who
withdraw into their rooms, and who are isolated from society. I wanted to
investigate whether ‘Hikikomori’, a phenomenon found in Japan of people shutting
themselves away in their rooms for months and years, without attending education,
training or work, was relevant in Britain.
Data was gathered by a two-staged method: an audit conducted at a young people’s
mental health clinic, and semi-structured interviews with child psychotherapists and
a psychiatrist who had clinical experience of working with severely withdrawn
young people.
The audit was analysed using descriptive statistics. The key findings of the audit
were that 16% of overall referrals showed Hikikomori presentations of being shut
away in their room for several months or more, and a further 13% were social
isolated and at risk of Hikikomori. The audit further showed that such withdrawn
young people showed a higher engagement in psychotherapy compared to overall
referrals. It also showed there are some characteristics that are common amongst the
withdrawn group, in particular excessive computer use, experiences of bullying, and
fears that others would attack, control or humiliate them.
The interviews were analysed using Thematic Analysis, which identified four
overarching themes of ‘being stuck’, ‘relationship to the outside world’,
‘boundaries’ and ‘therapy, change and endings’. Their subordinate themes are
explored within psychoanalytic theories on adolescence, and concepts such as
‘psychic retreats’ and ‘pathological defence systems’, as well as psychoanalytic
investigations of the impact of the internet, leading to a consideration of the internal
objects and the inter-relationship dynamics present within severe withdrawn states.
The findings of the audit and the interview study were compared with each other and
put in the context of other research findings. The implications of the findings are
considered and recommendations made
Being safe and being brave: new thoughts on trauma, and adaptations to technique
No full textThis paper outlines ways in which more traditional psychoanalytic technique has been challenged by new findings about trauma and the optimal ways in which it can be worked with. In particular it outlines how therapists need to become much more knowledgeable about the risks of retriggering PTSD symptoms, and about dissociative symptomatology. In addition, in some cases it is suggested that psychoanalytic therapists might become braver in helping victims of trauma to feel anger about what happened to them, and that often for optimal recovery anger and rage needs to precede remorse, reparation and a bearing of depressive anxieties
The impact of Covid-19 and how parents deal with it. [TEST RECORD]
No full textJane Smith talks about her research....
Improving understanding of cancer in the gender diverse population
No full textThe number of people disclosing gender diverse identities is growing. We must act now to collect data on cancer incidence and outcomes, and promote inclusion in studies, in order to better understand cancer in this population and provide equitable cancer care
A quality improvement project to increase patient feedback in the psychotherapy department, Tavistock Clinic
No full textAims: A rigorous and systematic patient feedback system is important for identifying gaps, improving the quality of care and encouraging patient involvement in service delivery. In the Adult Complex Needs Service of the Tavistock Clinic, a tertiary psychotherapy centre, only 5% of patients have provided feedback when requested. This Quality Improvement (QI) project aimed at improving the return rates of the Experience of Service Questionnaire (ESQ) and the CORE Outcome Measure by 10% within a year.
Method: The QI methodology was used to help identify factors contributing to the low response rate, including views amongst stuff about how such feedback, and the method of its delivery, might affect a psychoanalytically-informed treatment. Previously these forms were posted or handed out in person. In the first Plan-Do-Study-Act (PDSA) cycle, the method of distribution was changed by sending out the questionnaires to patients electronically, using an online survey platform. In the second PDSA cycle, the CORE-34 questionnaire was replaced with a shorter version, the CORE-10. This was in order to test our hypothesis that a shorter questionnaire would result in an increase in the response rates.
Result: In the first cycle of change, 197 patients were emailed for both the CORE-34 and ESQ and a total return rate of 31% was achieved. This signified an increase of 26% in the response rate. Overall more ESQ forms were completed (35% uptake) compared to CORE-34 forms (28% uptake). In the second cycle 199 patients were emailed with the CORE-10 and ESQ forms. The response rate was 21% and 18% respectively. Although the response rates decreased slightly in the second PDSA cycle the results indicated that this method of distribution was capturing a greater range of patients who had not previously provided the service with this sort of feedback.
Conclusion: Sending out the outcome measures electronically and adopting shorter versions of the CORE questionnaire increased the feedback response rate significantly, and provided the service with useful data as to patients' experience of their treatment journey here
Donald Meltzer : A contemporary introduction
No full textIn this intelligent and insightful work, Meg Harris Williams presents a clear and readable introduction to the works of influential psychoanalyst Donald Meltzer. The book covers Meltzer’s ideas on key themes including sexuality, dreams, psychosis, perversion and aesthetics, and his work with both children and adults.
This book focuses especially on Meltzer’s views on the nature of psychoanalysis itself, as an investigative method conducted by the cooperation between two people. His intuitive understanding of dreams is underscored by a scholarly interest in philosophy and linguistics. The book will give readers a window into Meltzer’s clinical seminars and supervisions, as well as a comprehensive overview of his published work, all thoughtfully brought together by someone who worked with Meltzer for many years.
Bringing Meltzer’s ideas into contemporary context, this fresh approach to his work makes his rich and complex theories about our inner world accessible to all. Part of the Routledge Introductions to Contemporary Psychoanalysis series, this book will be of great importance to psychoanalysts, clinicians and scholars familiar with Meltzer’s ideas, as well as those seeking an introduction to his work
