Tavistock and Portman E-Prints Online
Not a member yet
2774 research outputs found
Sort by
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
Aconseguir l’inefable: Sobre l’emocio, la intuicio I la creativitat en la trobada psicoanalitica [Reaching the ineffable: On emotion, intuition and creativity in psychoanalytic encounter]
No full textThe ‘Promoting Racial Inclusion in Training’ Reflective Framework (PRIT): Development of a tool to support EPs when designing and delivering training
No full textSince the Black Lives Matter Movement (BLM) of 2020, issues relating to anti-racist practice have been increasingly present. In education, there has been discourse around needing to decolonise curriculums, to ensure they are more reflective of global history and relate to diverse populations. Many Educational Psychology Services (EPS) and training courses have stated their commitment to developing their anti-racist practice. One example of action being taken on the Tavistock & Portman course, is the implementation of the ‘Promoting racial equity in Educational Psychology Services’ task in the first year EPS placement. This paper outlines one of these projects, which explores EP practice in relation to delivering training, in one Local Authority (LA). A brief description of the task is included, along with results from a focus group with EPs, as well as explanation relating to the development of a tool to support future practice. Reflections on the task are included, along with considerations for practice
Sharing formulations and interpretations with interview participants in psychoanalytically informed research: some considerations
No full textThis article builds on methodological literature addressing ways in which qualitative research interviewing can utilise principles derived from psychoanalysis and psychoanalytic psychotherapy, focussing on the sharing of interpretations and formulations with research participants. We review the accounts of different researchers who have considered the sharing of formulations and more formalised quasi-dynamic interpretative comments in this type of psychoanalytically informed interview research. Via this review and considering our experience as practitioner researchers, we suggest that careful reflection is required. The notion of interpretative work in psychoanalytic psychotherapy is potentially easily misapprehended because the term interpretation can refer to a range of (at times, very different) practices. Moreover, the terms of reference for dialogue in research and psychotherapy are fundamentally different for those engaged in them; an interpretation or feedback will not likely be received in the same fashion in a research interview as it would be in a psychotherapy session. Therefore, would-be research participants should be informed about the type of interview being used, with questions asked about their expectations. Furthermore, they should be encouraged to speak about what they may anticipate will be related to them of findings/analyses
Watch Me Play!: protocol for a feasibility study of a remotely delivered intervention to promote mental health resilience for children (ages 0–8) across UK early years and children’s services
Get PDFBackground:
Half of mental health problems are established by the age of 14 years and 75% by 24 years. Early intervention and prevention of mental ill health are therefore vitally important. However, increased demand over recent years has meant that access to child mental health services is often restricted to those in severest need. Watch Me Play! (WMP) is an early intervention designed to support caregiver attunement and attention to the child to promote social-emotional well-being and thereby mental health resilience. Originally developed in the context of a local authority mental health service for children in care, it is now also delivered online as a low intensity, scalable, preventative intervention. Although WMP shows promise and is already used in some services, we do not yet know whether it is effective.
Methods:
A non-randomised single group feasibility study with embedded process evaluation. We propose to recruit up to 40 parents/carers of children aged 0–8 years who have been referred to early years and children’s services in the UK. WMP involves a parent watching the child play and talking to their child about their play (or for babies, observing and following signals) for up to 20 min per session. Some sessions are facilitated by a trained practitioner who provides prompts where necessary, gives feedback, and discusses the child’s play with the caregiver. Services will offer five facilitated sessions, and parents will be asked to do at least 10 additional sessions on their own with their child in a 5-week period. Feasibility outcomes examined are as follows: (i) recruitment, (ii) retention, (iii) adherence, (iv) fidelity of delivery, (v) barriers and facilitators of participation, (vi) intervention acceptability, (vii) description of usual care, and (viii) data collection procedures. Intervention mechanisms will be examined through qualitative interview data. Economic evaluation will be conducted estimating cost of the intervention and cost of service use for child and parents/carers quality-adjusted life years.
Discussion:
This study will address feasibility questions associated with progression to a future randomised trial of WMP
Systemic and narrative work with unaccompanied asylum-seeking children: Stories of relocation
No full textSystemic and Narrative Work with Unaccompanied Asylum-Seeking Children: Stories of Relocation provides a contextualised, research-based understanding of how to enhance and support the emotional health and well-being of unaccompanied asylum-seeking children.
The framework presented in this book is an innovative intervention that enhances the well-being of children who have experienced trauma by improving the therapeutic abilities for all who support and care for them. This book presents the evidence base for this new systemic and narrative trauma-informed framework of care, creates a wider understanding of working with trauma responses in unaccompanied asylum-seeking children and offers coherence for practitioners wanting to use this approach. The authors provide a physiological view, as well as identify embodied aspects of trauma experience, and describe a narrative approach developed from a clinical understanding of trauma, as well as presenting the words of children who took part in the project. Creating a common multi-disciplinary language, this approach can be used to improve coherence, coordination, and excellence within the whole system.
This book is essential reading for all practitioners working with unaccompanied asylum-seeking children. It will also be of interest to students and trainees of social work and other mental health disciplines, as well as other professionals seeking to understand the needs of this group
The complexity of treatment-resistant depression: A data-driven approach
Get PDFBackground - Recent systematic reviews highlight great variability in defining and assessing treatment-resistant depression (TRD). A key problem is that definitions are consensus rather than data-led. This study seeks to offer a comprehensive socio-demographic and clinical description of a relevant sample.
Methods - As part of a pragmatic randomized controlled trial, patients (N = 129) were managed in primary care for persistent depression and diagnosed with TRD. Data included previous treatment attempts, characteristics of the depressive illness, functioning, quality of life, co-occurring problems including suicidality, psychiatric and personality disorders, physical health conditions, and adverse events.
Results - Findings show a severe and chronic course of depression with a duration of illness of 25+ years. Overall, 82.9 % had at least one other psychiatric diagnosis and 82.2 % at least one personality disorder; 69.8 % had significant musculoskeletal, gastrointestinal, genitourinary, or cardiovascular and respiratory physical health problems. All but 14 had severe difficulties in social and occupational functioning and reported severely impaired quality of life. Suicidal ideation was high: 44.9 % had made at least one serious suicide attempt and several reported multiple attempts with 17.8 % reporting a suicide attempt during childhood or adolescence. Of the patients, 79.8 % reported at least one adverse childhood experience.
Limitations - Potential for recall bias, not examining possible interactions, and absence of a control group.
Conclusions - Our findings reveal a complex and multifaceted condition and call for an urgent reconceptualization of TRD, which encompasses many interdependent variables and experiences. Individuals with TRD may be at a serious disadvantage in terms of receiving adequate treatment
How do parents experience “Watch Me Play!” alongside the multi-disciplinary assessment of their under-five year old’s social communication difficulties? An Interpretative Phenomenological Analysis.
Get PDFThe project aimed to explore parents’ experiences of Watch Me Play! alongside the assessment of their under-five year old for social communication disorders, including possible autism. WMP sessions were scheduled fortnightly in parallel with routine meetings comprising the assessment process within the multi-disciplinary assessment team. WMP clinicians, all child and adolescent psychoanalytic psychotherapists, conducted the WMP sessions. Semi-structured interviews were designed to take place pre-and post-intervention during which parents were asked to talk about their experiences. Clinicians were not interviewed and the WMP intervention had no bearing on the outcome of the assessment. Parents of children at the top of the existing waiting list were invited to take part: four took part in pre-WMP interviews. Two subsequently withdrew leaving two who completed the full study. Data from interviews (four pre-WMP, two post-WMP) was analysed using Interpretative Phenomenological Analysis. The study was very small and so findings cannot be generalised but analysis of the data indicated that for some, WMP enabled greater attunement between parent and child and could contribute to greater confidence in parents’ experience of relationships with clinicians and in the assessment process
Socially withdrawn young people: How do child and adolescent psychotherapists understand and experience working with them in a London mental health context? An interpretative phenomenological analysis
Get PDFThis research project aimed at learning more about adolescents and young adults who withdraw into their rooms away from society, in the eyes of the child and adolescent psychotherapists who work with them. The study explored this concept, first identified in Japan as ‘hikikomori’ (shutting in), in a UK context, where it is rapidly growing, particularly in the aftermath of the Covid-19 pandemic, and it is increasingly coming to the attention of mental health services. The aim of the project was to investigate child and adolescent psychotherapists’ understanding and lived experiences of working with withdrawn young people in order to begin to contribute to a knowledgebase around this topic that can hopefully, with further research, have implications for future clinical services in Great Britain. The study incorporates firstly a review of the literature and secondly an empirical project that took place in two London-based mental health settings in the form of four semi-structured interviews with Child and Adolescent Psychotherapists who had clinical experience of working with withdrawn young people. The interviews were analysed using Interpretative Phenomenological Analysis and five main themes emerged: ‘the who and the what’, ‘contributing factors’, ‘a retreat from life’, ‘an entrenched problem’, and ‘the road to recovery’. These themes and their subthemes were explored in relation to empirical studies in the literature and psychoanalytic theories on ‘psychic retreats’ and on adolescence. The implications of the findings were considered and recommendations made