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Personality disorder: Complexity, countertransference and co-production
No full textIn 2003, the National Institute for Mental Health England published a landmark document, Personality Disorder: No Longer a Diagnosis of Exclusion, which highlighted the stigma experienced by individuals with personality disorder, their difficulties in accessing services and the widespread belief amongst health professionals that personality disorder was untreatable. Since then, there have been huge advances in the understanding of its aetiology, the emergence of evidence-based psychological therapies tailored to the treatment of specific personality disorders, and the growth of service provision for patients diagnosed with personality disorder in both the National Health Service (NHS) and the Criminal Justice System (CJS) in the UK. With increasing international research collaborations amongst academics and clinicians, and the promise of radical changes in the diagnostic conceptualisation of personality disorders in the forthcoming International Classification of Diseases, 11th revision, these are indeed exciting times in the field of personality disorder. So why are so many psychiatrists, including forensic psychiatrists, seemingly unaware of or lacking interest in these developments
Ways forward
No full textIn the previous sections of this book links have been made between work in the forensic field with accused and abused mothers and the social work and legal tasks of child protection. Contributors have demonstrated how, through the provision of services funded to provide longer-term therapeutic help, it is possible to address inter-generational cycles of abuse and neglect. However, these interventions, though highly cost effective, are not widespread. John Major, when he was Prime Minister of the UK, announced in 1993 that ‘Society needs to condemn a little more and understand a little less’ (Macintyre, 1993). Said in support of his proposal to lock up persistent young offenders, this statement, subsequently taken out of context, is often repeated and used as a way of inviting and encouraging public condemnation and discouraging exploration in search of greater understanding. Yet it is through understanding that we develop the political will to secure funding for services geared towards early intervention and prevention. Until we (a) acknowledge the exceptional demands of pregnancy and motherhood and (b) take action to reduce the societal shaming, blaming, stigmatisation and scapegoating of ‘bad mothers’ they will continue to be thought of as undeserving
Becoming comfortable with chaos: making collaborative multi-agency working work
No full textThis article makes a distinct contribution to the understanding of establishing multi-agency working. Using Horwath and Morrison’s framework, a collaboration is described in detail, bringing multiple agencies to work with children attending a new special school for those with social, emotional and mental health (SEMH) needs, and with their families. ‘Imaginal pictures’ of the multi-agency collaboration are outlined, with explanations of conscious and unconscious barriers to integrated working. Lessons are identified for future multi-agency collaborations, in terms of design and vision, membership, resourcing and leadership
Rare but heard: using asynchronous virtual focus groups, interviews and roundtable discussions to create a personalised psychological intervention for primary sclerosing cholangitis: a protocol.
Get PDFIntroduction: Primary sclerosing cholangitis (PSC) is a rare and chronic disease characterised by inflammation and fibrosis of the liver's bile ducts. There is no known cause or cure for the illness, which often progresses to end-stage liver disease requiring liver transplantation. Symptoms of PSC can be very burdensome on those living with the illness, leading to restrictions in daily living, as well as a greater risk of colorectal and biliary tract cancers. Limited voices from lived experience suggest that living with PSC can cause considerable psychological distress. This study, therefore, aims to explore how the illness impacts the psychological well-being of those living with the illness, and those supporting them. It also aims to create a personalised psychological intervention to support all groups.
Methods and Analysis: This project will take a layered qualitative approach to understanding the ways in which people experience living with PSC within their day-to-day lives. There will be two stages to this study, which will pilot a unique methodological process using online resources. The first stage will consist of asynchronous virtual focus groups (AVFGs) with those living with PSC and those who provide support for those diagnosed with PSC, and narrative interviews with both groups and health professionals. Both the AVFGs and the narrative interviews will be analysed using thematic narrative analysis. The second stage will comprise a roundtable discussion where the researchers and health professionals will devise a personalised psychological intervention to help to support those living with PSC and their supporters. The study duration is expected to be 18 months.
Ethics and Dissemination: The proposed study has been approved by the UK Health Research Authority and London-Queen Square Research Ethics Committee as application 18/LO/1075. Results from the AVFGs and the narrative interviews will be submitted for peer-reviewed publication. The findings of the study will also be presented nationally to PSC and medical communities, and a summary of the findings will be shared with participants
Fear of death or of murder? Challenges confronted in the modified psychoanalytic setting established by forensic psychotherapy
No full textThe fear, not only of death, but also of murder could be closely related in the forensic patient when gross, unconscious, archaic memories of loss and despair may be evoked by transferential interpretations within therapeutic relationships. This could produce compelling and potent feelings of revenge and acting out, which would need to be contained. When the fear of death occurs in the therapist’s countertransference feelings, beyond the secure settings of forensic psychotherapy, massive acting out may occur in the therapist to counteract his or her own threat of death. Karl A. Menninger (1938) wondered: “Is it hard for the reader to believe that suicides are sometimes committed to forestall the committing of murder? There is no doubt about it. Nor is there any doubt that murder is sometimes committed to avert suicide.
Gender diversity and non-binary presentations in young people attending the United Kingdom’s National Gender Identity Development Service
No full textThere has been a recent rise in the number of people who hold a non-binary gender identity. However, the proportion of young people attending gender services who identify as non-binary has not yet been investigated. This article presents the findings from a pilot study of newly designed questionnaire, the Gender Diversity Questionnaire, which included questions about gender identity and gender expression. Responses from 251 adolescents attending the United Kingdom’s National Gender Identity Development Service between June 2016 and February 2017 are reported here. The majority, 56.9%, of young people identified as trans, 29.3% identified as a binary gender (male or female), 11% identified as non-binary and 1.2% as agender. There were no significant differences in self-defined identities based on assigned gender or age. However, once young people were separated into these groups, some of them were very small; thus, a larger sample is required. In terms of aspects of gender expression that were important to the young people, the data formed five themes – name and pronouns, external appearance, the body, intrinsic factors and ‘other’. Strengths and weaknesses of the research are discussed as well as future work that will be conducted
Abordagem trialógica Tempo-Lineare: Trabalho terapêutico preventivo com crianças de 0 a 5 anos e seus pais
No full textManaging disruptive family members
No full textHow should conflict with a patient's relative be managed? Dr Gabrielle Pendlebury, Medicolegal Consultant at Medical Protection has some advice for practice managers about the steps to follow to resolve the situation
