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The ‘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
Consultation to Adoptive Parents and Adoption Professionals in Child and Adolescent Mental Health: Findings From a Quality Improvement Project Analysis
No full textThe mental health vulnerability of children and young people in foster and adoptive families is well recognised, which has led to the development of dedicated posts and care pathways in mental health care provision. This article reports on learning resulting from local quality improvement work in a single child and adolescent mental health service team. This work was concerned with the ‘front door’ of access to care for these groups and specifically addresses initial consultations with adoptive parents and adoption professionals, reporting findings from an analysis of reports from consultations undertaken over a 13-month period between April 2021 and May 2022. The analysis highlights that support can be sought by these parents and professionals for diverse issues relating to mental health which is also indicative of a high level of need amongst children and young people involved with specialist mental health provision. The analysis also has wider implications for practice in demonstrating the benefits of attending to clinical data to contribute meaningfully to practice-based scholarship in this type of specialist setting
Holding the vanishing organisation: Can an 'agile' work environment facilitate emotional containment?
Full text linkOver recent decades, ‘lean’, ‘activity based’ and ‘agile’ working environments
characterised by a non-proprietorial use of space and resources, networked
communication, and porosity between experience in public, private and
organisational contexts have proliferated within organisations. As this
transformation of the physical territory for office work has taken place, the
concept of the ‘vanishing organisation’ was proposed (Cooper and Dartington,
2004; Cooper and Lousada, 2005) to provide an account of how in a networked
society, established mechanisms for sustaining emotional containment in
organisations, through the maintenance of concrete and symbolic boundaries,
appear to no longer function or even exist.
The research explores the extent to which the contemporary workplace might
be supportive of or deleterious to emotional containment in organisations and its
implications for theory, practice and research within the systems
psychodynamic approach to consulting. Social photo matrix focus groups were
convened at four organisations which deployed elements of ‘lean’, ‘activity based’ or ‘agile’ workplace design to record narratives of the felt experience of
place at work, with further data gathered from detailed case notes covering the
researcher’s engagement with each organisation and personal reflexivity, in part drawing upon their personal memory of place in a transient institutional,
organisational and domestic context as a military child.
In-case analysis was carried out using a grounded theory exercise where social
photo matrix transcript text was used to develop axial codes which for each
workplace abductively invoked Freud’s exclamation in the Aetiology of Hysteria
of “saxa loquuntur!” [the stones speak] (Freud, 1896), as well as its
manifestation of ‘murality’ (Cox, 1995; Adshead, 2019), a concept developed
within forensic psychotherapy to refer to the experience of an instrumentally
derived and beneficial experience of ‘wallness’ realised through the pairing of a
bounded perimeter with an emotionally containing organisational and
institutional culture. This exercise generated rich and emotionally evocative data
for each site relating to the felt experience of place, as well as tentative
indications of the manifestation of patterns of emotional attachment (Bowlby,
1969; Ainsworth et al., 1978), basic assumption function (Bion, 1962) and
‘commensal’, ‘symbiotic’ and ‘parasitic’ forms of containment (Bion, 1970).
Further cross-case analysis of the gathered grounded theory axial codes helped
develop the hypothesis that rather than instrumentally facilitating emotional
containment, the workplaces served to both reflect the particular forms and
levels of containment arising within each organisation’s already-existing culture,
and in certain circumstances, to reinforce them
Walking a tightrope without a safety net: A systems and psychodynamic exploration into the experiences of Black women in senior leadership roles in the UK
Full text linkThis study employed a systems psychodynamic approach to explore the experiences of Black
women in senior leadership roles within UK organisations. A constructivist phenomenological
enquiry was undertaken, using a psychoanalytically informed method, Free Association
Narrative Interview (FANI) - which involved semi-structured interviews with a purposive
sample of six Black women of African and African-Caribbean heritage across various sectors
in the UK. The data was analysed using Grounded Theory, with a systems psychodynamic
lens applied to augment the findings.
The study revealed that Black women in senior leadership often struggle to fully take up
authority, and their experiences can be metaphorically described as “walking a tightrope with
no safety net.” Five key themes emerged: systemic racism enacted through microaggressions;
playing it safe; a projected sense of inadequacy; masking emotions; negative stereotype
threats.
Drawing from these findings, the study proposes three theoretical ideas for organisations to
explore in order to better understand the complex dynamics shaping these challenges. It
concludes with a set of recommendations for interventions aimed at creating environments in
which Black women in senior leadership roles feel seen, safe, and authorised to lead with
confidence and authenticity.
The three theoretical ideas proposed in this study to explain the difficulties faced by Black
women in senior leadership are:
1. Black women in senior leadership roles find it difficult to take up authority because
of systemic racism enacted in overt and covert microaggressions. They experience
the system as too dangerous, prompting the use of coping strategies to survive in
role.
2. Through unconscious group processes Black women may identify with negative
projections of failure and incompetence from the dominant groups, resulting in a
sense of inadequacy in role and failure to perform in authentic ways and take up
authority.
3. Black women often draw upon internalised personal defences. These defences
influence how they take up leadership roles. If personal defences fail, they will resort
to quitting to protect themselves
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
Full text linkBackground:
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
The complexity of treatment-resistant depression: A data-driven approach
Full text linkBackground - 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
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
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.
Full text linkThe 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
Fear and loathing, love and othering: the legacy of early Oedipal struggles as manifest in racialised dynamics in the consulting room
No full textThis paper takes as its premise the idea that transferential phenomena emerge out of the endless interactions between the wider social context, including myriad social injustices, and the inter and intra psychic events psychoanalytic therapists are more familiar with thinking about. Freud’s was a neuro-psycho-social model of development, with the interrelationship between internal life and social practices carefully mapped in ‘Totem and Taboo’ (1913) and ‘Civilisation and Its Discontents’ (S. Freud, 1930). However, what Freud left undone, and is still only nascent in its development, is the work of mapping how this interaction between internal and external, between psycho and social, manifests in the consulting room. Focusing on race, as one aspect of identity that powerfully impacts transferential phenomena, the paper presents accounts of clinical events, one disguised, one fictionalised, to explore the meaning of the author’s own Whiteness in this context. Using a Kleinian and post-Kleinian understanding of very early Oedipal struggles, ‘Whiteness’ is formulated as an anti-developmental merger with the ideal breast