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Can the Parent Development Interview (PDI-RF) inform assessment in a CAMHs Parent-Infant Psychotherapy service? A qualitative study using Thematic Analysis
Full text linkThe assessment is a core component of the process used by Parent-Infant Psychotherapists to ascertain the presenting issues, risks and needs of the parent/s and their infant to help decide if treatment is indicated or to make further recommendations. This study aims to determine how feasible and acceptable the Parental Development Interview (PDI) is within the routine assessment and to understand its potential as an assessment tool in the service. By applying the PDI (Aber, Slade, Berger, Bresgi, Kaplan 1985), the parent’s capacity for reflective functioning could be measured to ascertain if they can hold in mind their infant's thoughts and feelings. The objective is to incorporate the validated, manualised PDI (Aber et al. 1985) within the standard outcome measure sets currently used in NHS Child and Adolescent Mental Health Service Early Years Service. It is proposed that the PDI could provide a sensitive, nuanced qualitative measure to capture key information on parental reflective functioning and the relationship between the parent and infant. Thematic analysis was used to analyse data from six semi-structured interviews of parent participants. Findings show that parents found the PDI useful and accessible to provide insight into their relationship with their infant
Paternal PTSD or depression, adolescent mental health, and family functioning: A study of UK military families
Full text linkLimited research has explored the relationships between paternal mental health, adolescent offspring mental health, and family functioning in United Kingdom military populations. The authors investigated this in a study of 105 serving and ex-serving members of the United Kingdom Armed Forces, with adolescent offspring ages 11 to 17 years. It was found military fathers with symptoms of PTSD or depression had more family difficulties, particularly around communication. Their adolescent offspring were also more likely to meet criteria for mental health disorders. These findings demonstrate the importance of supporting military fathers and their families with mental health and well-being
Moments as a form of leadership
No full textIn this article, we want to explore leadership in the context of interactions and conversations we have had together across the three domains of aesthetics, production and explanation (Maturana, 1985; Penn, 1987; Lang et al., 1990). Our primary focus is in the domain of aesthetics from which what we explain and produce is shaped. The domain of aesthetics refers to "the emotion in the happening of living you recognise as aesthetics". Therefore, this refers to such notions as elegance, beauty, harmony, desirability, consistency, morality and ethics (Maturana, 1985)
Difficult encounters in psychoanalytic parent work: Exploring the clinical experiences of child and adolescent psychotherapists through qualitative enquiry.
Full text linkPsychoanalytic parent-work is a routine intervention offered by Child and Adolescent Psychotherapists in the UK. However, there remains a disjointedness in clinical approaches to this complex area, and it is described as a neglected area of practice. This study explored parent-work encounters which a group of Child and Adolescent Psychotherapists found more difficult than usual, and why. Four therapists spoke about their difficult encounters in psychoanalytic parent-work, during semi-structured interviews. Data was analysed qualitatively, using Interpretative Phenomenological Analysis. Participant encounters were formulated as including contact with something threatening, linked with Klein’s “bad” object, Bion’s “nameless dread”, and concepts of vicarious trauma. These were associated with collapses of thinking or meaning making, and distress experienced at the compromised or lost ideal self. This linked with a loss of meaning or disillusionment, including inner conflict arising from the wish to avoid knowing. Whilst participant experiences offer phenomenological universality, they appeared to be exacerbated by a profession-wide reluctance to think about trauma as it presents in the external world, rather than the playroom. Idealised expectations of psychoanalysts were noted, meaning experience of professional shame and inadequacy were more likely in situations of difficulty. Lastly, containing parental experience appeared more difficult for practitioners lacking a sturdy, integrated theoretical parent-work framework to draw upon. Overall, it is suggested participants had come to a complex, multi-layered and difficult work theoretically and practically unprepared. The Child Psychotherapy profession may benefit from further thinking around psychoanalytic parent-work as it is theorised and trained for. Without this, psychoanalytic practitioners may continue to find themselves overwhelmed as they draw upon primarily dyadic models of working, within a non-dyadic ‘external’ space
Exploring the views of child and adolescent psychotherapists on psychoanalytic remote work carried out during the COVID-19 pandemic: A reflexive thematic analysis study
Full text linkThe COVID-19 pandemic changed the way that child and adolescent psychoanalytic psychotherapists worked, almost overnight, by requiring the vast majority of therapy to be offered remotely, using telephone or video call. As the restrictions of the pandemic have been lifted, the interest in remote psychotherapy remains as an option that could widen access to treatment. There is a need to develop guidelines on best practice for on-going remote work. Prior to the pandemic very little psychoanalytic remote work was offered to children and adolescents. The literature regarding adult patients suggests a relatively high prevalence of psychoanalytic remote work taking place in recent years. This work with adults has received a mixed reception, with questions arising on how a psychoanalytic setting and approach can be maintained remotely. This research aimed to explore the views of a team of NHS child and adolescent psychotherapists working during the pandemic. Seven members of the psychotherapy team took part in a semi-structured interview, exploring their thoughts on the scope and limitations of remote work in child psychoanalytic psychotherapy. I used Reflexive Thematic Analysis (Braun and Clarke, 2006; 2022) to generate themes that represent the participants’ views. The findings of this study suggest that there are fundamental differences between in-person and remote child psychotherapy. Most significantly the absence of the patient and therapist being physically together appears to change the nature of communication and containment in the dyad. This study tentatively suggests that young patients with significant disturbance or impoverished capacities might struggle to make good use of remote work. Minimum requirements in the young person’s physical and family environment are also described. Recommendations for further research into specific aspects of remote work are made
An exploration of the uncanny and mystical influences developing leadership thinking, in the context of rising technological complexity and declining organisational certainty
Full text linkThis thesis is based on a research study conducted into understanding the uncanny and mystical influences developing leadership thinking. Using biographical interviews, the study examines how leaders use such alternative perspectives during periods of rupture and uncertainty in their professional careers. I will also consider how personal and professional biography is convergent in participants' understanding of the need for irrational thinking in response to the increasing logic of work. The thesis will go on to explore how the formation of superordinate objects may provide containment when other complex systems appear unable to do so
One hour a week observing the baby. A lot or a little?
No full textThe author aims to show that observers learn a lot from presenting the idea of an observation to parents, and that, while everyone is self-conscious at the start of an observation, research suggests that many parents find that they enjoy and benefit from the weekly visits. On very rare occasions observers need to think about risk and child safeguarding with the support of teachers. Research suggests that many parents enjoy the observer's visits and enjoy observing their baby more themselves. Observers learn a lot about themselves and, in their seminars, about other babies' development. Each observation is unique as observers discover week by week about their own observed baby and the other babies' developing minds and imagination
Clinician perspectives on endings and discharges in community mental health work
No full textPurpose:
The process of ending mental health support is often not well-attended to in practice or research, and clinicians in UK mental health services lack focused clinical guidance in this area. This paper aims to report on a service evaluation that sought to understand from clinicians working in a single adult community mental health team (CMHT) their experiences of discharge and issues arising in the process, factors considered in decision-making and what constitutes “good” endings and what support could be helpful to them in navigating this with clients.
Design/methodology/approach:
Semi-structured interviews were completed with six members of the multi-disciplinary team and analysed thematically.
Findings:
Clinicians described a range of criteria considered in discharge decision-making. Collaboration, planning and preparation were represented as key ingredients for “good” endings. Factors viewed as complicating discharge included complexity and changes in presentation, psychosocial contexts and re-referrals. Perceptions of clients’ feelings (resistance and dependence, fear and anger, relief and gratitude) and varying feelings evoked for clinicians (from little or no reported impact, to pride and confidence, sadness and worry) at the ending of the working relationship were reported. Suggested organisational supports for clinicians with endings and discharges involved opportunities to consult with colleagues, psychological formulation and advice and reflective supervision.
Originality/value:
There has been limited empirical attention to practitioner experiences of discharge in the work of CMHTs in a UK context; this practitioner-led evaluation explored clinician perspectives
