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The relevance of the Tavistock model of consulting in the context of a crisis. Part 1 of 2 webinars
No full textAs part of our Centenary webinar series, organisational consultant Francesca Cardona led a panel discussion on the relevance of the Tavistock model of consulting in the context of a crisis, particularly focusing on the COVID-19 pandemic. With Vega Roberts, Ben Neal and Robyn Vesey.
Ben Neal looked at the implications of a psychoanalytic perspective on work during the COVID-19 crisis. He looked at the impact on people being forced to inhabit and work in unfamiliar digital spaces, the erosion of the boundary between personal and professional roles, and the loss of informal and liminal spaces.
Robyn Vesey shared some of her experiences working with leaders managing services, which like many have had to respond to the pandemic. She outlined the challenges they had to respond to, how they used consultancy sessions and how containment was a central part of this work
Pre-existing trauma and COVID-19: RCPsych COVID-19 Members' Webinar
No full textThe thirteenth of our one-hour webinars took place on Thursday 25 June, focusing on COVID-19: Trauma, Containment and Recovery and included the following speakers:
Organisational containment of anxiety during the pandemic
Dr Jo O'Reilly.
Pre-existing trauma and COVID-19
Dr Jo Stubley.
Managing pandemic related stress: The benefits of gardening and connecting to nature
Dr Sue Stuart-Smith.
This was followed by a live Q&A session, facilitated by Dr Maria Eyres, Academic Secretary, Faculty of Medical Psychotherapy
LGBTQ+ cancer patients: Are UK oncologists being supported to develop essential knowledge, attitudes and behaviours to provide quality care?
No full textOver 1 million people in the United Kingdom identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning) with increasing literature highlighting inequalities in their cancer care. A recent study of US oncologists revealed 53.1% were confident in their knowledge of health needs of LGB patients
and 36.9% of transgender patients. To date, no UK studies have evaluated selfperceived knowledge, attitudes and behaviours of oncologists about LGBTQ+ patients
“He’s always in my head, always in my mind.” A psycho-social study into the emotional experience of teaching a child at risk of exclusion
Get PDFThe purpose of this research was exploratory. It extends knowledge in the area of school exclusion by providing insight into the emotional experience of primary school teachers currently working with children at risk of exclusion. It utilises a psycho-social approach in order to explore the personal, social and relational factors involved in this experience and offers insights into unconscious processes. Six mainstream primary school teachers from six different schools were interviewed using the Free Association Narrative Interview (FANI) (Hollway and Jefferson, 2000). Participants were asked to write or draw some of their initial thoughts in relation to working with a child at risk of exclusion and also provided relevant biographical information. Interviews were audio recorded, transcribed and then analysed using a Thematic Analysis to initially identify common themes, and then a psychoanalytic lens was applied to offer deeper insights into participants’ emotional experiences. Two main themes were identified from the data. These were “knowing versus not knowing” and “us versus them.” These are explored in greater depth within the discussion and links are made to the theoretical insights of Bion (1962) and Klein (1946). A second level of analysis found that participants accounts showed evidence of investment in discourses that served a defensive function and greatly impacted on how they saw their role in working with children at risk of exclusion, and how they experienced their emotions in relation to this experience. Implications for EP practice are offered and it is concluded that psychoanalytic theory offers a useful tool for EPs supporting teachers working with children at risk of exclusio
The Discursive Performance of Change Process in Systemic and Constructionist Therapies: A Systematic Meta‐Synthesis Review of In‐Session Therapy Discourse
No full textDespite the emphasis of systemic and constructionist approaches on discourse and interaction, to date there has been no comprehensive overview of how change process is performed within in‐session therapeutic dialogue. In this paper, we present a qualitative meta‐synthesis of 35 articles reporting systemic and constructionist therapy process data from naturally occurring therapeutic dialogue. The studies were selected following the screening against eligibility criteria of a total sample of 2,977 studies identified through a systematic search of PsycINFO and MEDLINE databases. Thematic analysis of the 35 studies’ findings identified four main themes depicting change process performance: (a) shifting to a relational perspective, (b) shifting to non‐pathologizing therapeutic dialogue, (c) moving‐forward dialogue, and (d) the dialogic interplay of power. Findings highlight the interactional and discursive matrix within which systemic and constructionist change process occurs. Findings illuminate the value of qualitative research studies sampling naturally occurring therapeutic discourse in bringing this matrix forth, particularly when utilizing discursive methodologies like conversation or discourse analysis
Collaborative work with parents
No full textThe importance of working with the parents in a collaborative way when undertaking a therapy with a young child is demonstrated. This paper illustrates the depth and the different quality of the work when both the child and the parents are helped simultaneously. The paper illustrates the movement in the parents’ thinking from just reacting to the child’s behaviour as ‘being difficult’ to being able to think about the behaviour in terms of it ‘having meaning’ in which the child is conveying a feeling through her behaviour. As well as showing the parents’ psychological development, the clinical example describes the child’s more age appropriate developmental progress. More specifically, it shows how the child was able to relinquish her omnipotent behaviours of ‘always being in charge’ in favour of relying on parents who were psychologically more available to her. Observations show how, as they realized their child’s behaviour wasn’t simply designed to persecute them, the parents were jointly able to create ‘the cradle of concern’ to care for her. As the therapy progressed there was a diminution of unhelpful transgenerational family patterns
Autistic traits and cognitive abilities associated with two molecular causes of Silver-Russell syndrome
No full textSilver-Russell syndrome is a rare genetic imprinting disorder. Two molecular causes of Silver-Russell syndrome have been identified: loss of methylation on chromosome 11p15 (11p15 LOM) and maternal uniparental disomy for chromosome 7 (matUPD7). Current understanding of the cognitive and behavioural phenotypes associated with these two molecular subtypes is limited. This study aimed to address this gap in the literature. The Social Responsiveness Scale (SRS-2), was used to assess autistic traits in individuals with 11p15 LOM (n = 47) and matUPD7 (n = 32). A subset of participants with 11p15 LOM (n = 18) and matUPD7 (n = 15) completed in-person assessments: the Autism Diagnostic Observation Schedule (ADOS-2) and the British Ability Scales (BAS3). Overall, 37.50% of the matUPD7 group and 10.64% of the 11p15 LOM group scored above the SRS-2 severe clinical cut-off. Based on the ADOS-2, 33.33% of the matUPD7 participants and 11.11% of the 11p15 LOM participants scored above cut-off for autism spectrum/autism. Intellectual ability was significantly lower in the matUPD7 group (mean = 79.86), compared to the 11p15 LOM group (mean = 98.56). However, there was no evidence of an uneven cognitive profile associated with either group or of an association between autistic traits and intellectual ability. Although both 11p15 LOM and matUPD7 have the same clinical diagnosis of Silver-Russell syndrome, there are some differences in the cognitive and behavioural phenotypes between these two molecular subtypes. This has implications for considering access to services, intervention and support within these populations, particularly in relation to learning and behaviour
Exploring interoception through a psychoanalytic lens: An analysis of the relationship between the neuropsychological concept of interoception and the psychoanalytic concept of countertransference
Get PDFThis study examines the phenomenon of interoception – an individual’s perception or sense of their own body state (Pollatos, 2007) - and countertransference – the emotional experiences and reactions provoked in the therapist by a patient (Heimann, 1950). The study looks specifically at embodied countertransference – ‘the spontaneous arousal of physical feelings in the therapist ... ’ (Field, 1989: p.512). It employs theoretical and empirical research methods, both qualitative and quantitative, in order to capture something of the tension existing between empirical observation and the subjective emotional realm of feeling and intuition. The study explores links between interoceptive capacity and countertransference. Thirty-seven trainee child psychotherapists completed a qualitative countertransference questionnaire and Egan and Carr’s (2005) Body-Centred Countertransference Questionnaire. They performed an established interoceptive accuracy assessment (Heartbeat Counting (Schandry, 1981)) and completed a confidence measure pertaining to it. Data from the Heartbeat Counting task was used to generate a metacognitive measure of interoceptive awareness (Garfinkle et al, 2015). Empirical data pertaining to interoceptive capacity and body-centred countertransference were considered together, for the sample group as a whole and between training year groups, in order to explore the overarching research question: Is there a relationship between interoception and countertransference? Results: Interoceptive accuracy was not shown to increase with years of training in child psychotherapy. A statistically significant, non-linear, relationship between reported confidence on the interoceptive accuracy task and year of training was observed however; and interoceptive accuracy and reported confidence were also shown to be positively correlated. As a sample group, child psychotherapy trainees only approached ‘interoceptive awareness’. Embodied countertransference phenomena were universally reported, increasing in frequency with year of training to Year 3. In the qualitative research, countertransference emerges as a vital, albeit ‘opaque and disturbing’ tool, enabling the trainees to ‘go beyond words’ in their work with children and young people. A striking homogeneity was observed in participant responses, raising questions about the place for doubt and alternative perspectives upon a phenomenon much debated in psychoanalytic theory and the research literature. This a unique study contributing to the research literature in Child Psychotherapy. It highlights potential links between interoception and countertransference. Results may have implications for the training of Child Psychotherapists, in particular, to the attention that is paid to physical experiences. Further study of trainees and qualified psychotherapists may yield more connections between these two phenomena
An exploration of child and adolescent psychotherapists' experiences of offering Short Term Psychoanalytic Psychotherapy (STPP)
Get PDFPsychoanalytic psychotherapy is often thought of as a long-term treatment, however there is a rich history of short-term treatments in psychoanalysis and psychoanalytic psychotherapy. Short-Term Psychoanalytic Psychotherapy (STPP) was found to be as effective for the treatment of moderate to severe depression in adolescents aged 11-17 as CBT and a brief psychosocial intervention (BPI) (Goodyer et al, 2017), and the evidence base for time-limited psychoanalytic treatments with children and adolescents continues to grow. However, to the author’s knowledge there are no existing studies exploring child and adolescent psychotherapists’ experiences of offering short-term psychoanalytic treatments. The current study set out to investigate this topic by using qualitative data exploring child and adolescent psychotherapists’ experiences of offering STPP as part of a large randomized controlled trial (RCT), the IMPACT study, collected as part of the IMPACT: My Experience (IMPACT-ME) study (Midgley, Ansaldo & Target, 2014). Further qualitative data regarding the experiences of six child and adolescent psychotherapists offering STPP as part of everyday clinical practice was also collected, via a semi-structured interview developed from the interview used in the IMPACT-ME study. The two data sets were analysed using thematic analysis and interpretative phenomenological analysis, respectively. Child and adolescent psychotherapists offering STPP both within an RCT and everyday clinical practice reflected on their experiences of working with the time-limit, working with the STPP manual, and the roles of parent-work, supervision, and assessment. They also questioned: for which patients STPP might be a good fit; what STPP might be able to help with; how different STPP is from open-ended psychoanalytic psychotherapy, and how the profession might think about time and duration. They also reflected on the potential role of STPP in helping to manage resource and service-based pressures, and the influence an RCT might have on the experience of offering STPP. The experiences of the participants seem to suggest STPP could be helpful and valuable treatment option for children and adolescents with a range of mental health difficulties, and that STPP remained true to the core principles of psychoanalytic work. Interpretative ways of understanding the participants experiences are considered, along with the implications for the use of STPP within mental health services in the NHS
Welcome to the motherland. An exploration into how experience is storied through generations of African Caribbean immigrants
Get PDFMy research explores the ways in which African Caribbean families communicate with each other and the outside world in the context of living in England. This research interest is heavily influenced by my experience of migration to England. As an African Caribbean person on arrival in England my voice was met with mockery and often resulted in confusion. My professional experience of working within a Child and Adolescent Mental Health service highlighted a limited understanding of African Caribbean migrants and their descendants, and the extent to which they have to negotiate their lived experience.
My research questions are:
How do first generation Caribbean migrants tell their stories of migration and integration? How do they construct, contest, negotiate identities within this?
What if any stories, sayings from the Caribbean do they draw on to help them navigate their new context?
How does the next generation negotiate, construct, context identities within these stories/experiences?
The methodology section is divided into two distinct areas, the theory and the practical application. The focus is on post-modernist ideas of social construction and the critique of power in relation to the research process. In this I acknowledge the constitutive role of storytelling for the human experience. Using a semi-structured schedule, I interviewed two generations in an intergenerational dyad. The requirements were that one generation had to be a first generation migrant and the other had to be a second generation migrant or later. This allowed for sharing of stories in the presence of the next generation where meaning could be made together.
The data has been analysed using the Big and Small Story in Narrative Inquiry. This process is akin to the therapeutic process where we engage both the story of how we came to therapy (presenting issue) but pay attention to the manner and style in which this story is told, what identities are being claimed, what’s being deferred or avoided in the telling. I discovered that the African Caribbean person is a highly politicised human being for whom the racialised and cultural context is a significant part of life. I set out my key findings using the positions of three types of archetypal themes: the trickster, passer/conformer and resister/revolutionary. These were used to capture different ways people responded to power within their daily life.
The most significant part of my findings is Dubois’ (1903) concept of double consciousness. This idea describes the way black people carry their negotiations with power. There is a sense that they are constantly having to think about what is acceptable to the power base and how can this be negotiated. Interestingly, the African Caribbean people in my study didn’t name racism, oppression, or politics, so the practitioner has to. I invite practitioners to support what is being called ‘anti colonial practice’ (Heath, 2018). This practice acknowledges that the colonial presence is still active and to really undo this we have to engage in purposeful direct action. This requires a kind of “self-reflexivity plus”. This means engaging in the language of the clients, thinking about your actions with other critical thinkers, questioning your questions with yourself and others, and working with a transparency where we can see whether you have been helpful