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The state of the psychoanalytic nation, Volume I
No full textThis book charts the ways in which psychoanalytic psychotherapy has been implemented, developed and researched within the public sectors of twelve different countries around the world. It discusses how psychoanalytic practitioners locally have responded to the challenge of evidence-based practice. For each country the authors describe:
How people can access talking therapies as part of the national healthcare system, including a brief history of how this system has developed and the place of psychoanalytic psychotherapy inside/outside of this system historically.
How clinicians train and qualify as a psychoanalytic practitioner, and demographic profiles of their communities of psychoanalytic practice.
How evidence-based practice has impacted the mental health system and, in particular, access to and provision of talking therapies e.g. through the development and implementation of treatment guidelines.
How outcome monitoring and reporting of access, waiting times and recovery rates are used in the commissioning and provision of psychological therapies.
What is needed to secure a viable future for psychoanalytic psychotherapy
Safeguarding adults: The impact emotional and unconscious factors have on decision making
Full text linkThis research project examines unconscious and emotional factors that influence
decision making in adult safeguarding work. The author builds upon research into
child protection that highlights the complexities of ‘rational decision making’. Adult
safeguarding is relatively new compared to child protection, and academic
research into the day-to-day practice of adult safeguarding professionals is
limited. Intense levels of anxiety experienced by practitioners and organisations
makes it an extremely challenging area of practice.
The author uses psychoanalytic theory as a way of understanding and making
sense of adult safeguarding as a social work task. Over more than 12 months,
data was collected through observation and free association narrative interviews
in a local authority safeguarding team. The results show that numerous
unconscious and emotional factors influence the decision-making process and
practice decisions. This directly affects those tasked with protecting vulnerable
people. Some are obvious, however many are hidden and the extent of their
influence often passes unnoticed.
This study provides fresh insight into how practitioners make decisions. It
demonstrates powerful ways in which unconscious and emotional dynamics
affect practitioners’ responses. Understanding this more fully can inform the
support that practitioners require from their organisation in order to make better
decisions. It concludes that specialist adult safeguarding teams ought to be
reconsidered as operational arrangements. This is particularly due to the level of
expertise and understanding required being grossly underestimated and the
emotional and psychologically demanding aspects of the work
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
Full text linkThis 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
A psychoanalytic exploration of CAMHS clinicians’ experiences with children and young people who do not feed. An Interpretive Phenomenological Analysis
Full text linkThis research project explores the experiences of four Child and Adolescent Mental Health (CAMHS) clinicians who have worked with children and young people who restrict or refuse food. The participants were identified through purposeful sampling and the data was collected through semi-structured interviews. The interviews were transcribed and coded using Interpretive Phenomenological Analysis. The findings are arranged in 4 Group Experiential Themes that reflect the experiential themes the participants described in undertaking this work: their internal experiences, their experiences of the patient, their experiences of the patient’s parents and their experience of the network and their professional context. The analysis of the findings indicates that clinicians need to feel meaningful connections and have supportive relationships. The success of the work is connected to the clinician supporting the patient to build a new type of relationship that is more realistic and allows for vulnerability and dependence. To do so the clinician has to manage painful feelings in both the patient and in themselves. Clinicians are in contact with projections of extreme anxiety and aggression from both the patient and the patient’s parents and therefore the patient’s parents’ history influences the trajectory of the work. The professional context of “not feeling alone” is highly influential in clinicians’ decision to keep working in this area. Physical recovery is important, but not the main focus
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
‘If we are not great, then we can’t be great with the kids’: A grounded theory of successful teaching assistant-teacher partnerships for inclusive education
Full text linkUsing constructivist grounded theory methodology, a theory of ‘relational interdependence’
was constructed by the author and six teaching assistant-teacher working pairs from six
mainstream primary schools in one London borough. Each pair self-identified as having a
successful partnership for inclusion and took part in an intensive dyadic interview about their
partnership. The emerged theoretical model centred on ‘relational interdependence’ within the
pair and between the pair and the children they teach. This construct is further explained by 12
theoretical categories. The theoretical process of these categories was explained by four
pathways: the pairs’ interpersonal success influencing the quality of their work and interactions
(1) and their capacity for this work (2), the positive impact of their partnership on the children
(3) and the influence of the partnership on its context and the context on their partnership (4).
Findings are discussed considering the extant literature and development of the theory, the
limitations and contributions of this research and areas for future research
Women’s engagement with community perinatal mental health services: a realist evaluation
Full text linkBackground: In recognition of the burden of Perinatal Mental Health problems, NHS England invested £365 million to transform women's access to mental health care, including investment in Community Perinatal Mental Health Services. This study examined how elements of provider care affected women's engagement with these services.
Methods: Semi-structured interviews were conducted with 139 women and explored their experiences of care from 10 different Community Perinatal Mental Health Teams; including which service components participants believed made a difference to their initial and continued engagement. Realist analysis was used to create context-mechanism-outcome configurations (CMOCs) across interviews, since not all parts of the configurations were always articulated within singular interviews.
Results: Four key pillars for engagement were identified: perinatal competence, relationship building, accurate reassurance, and reliability. The way perinatal competencies were relayed to women mattered; compassion, understanding and consistency were critical interactional styles. The extent to which these factors affected women's engagement varied by their context and personal characteristics.
Conclusions: As mental health problems increase, disproportionately affecting vulnerable populations, it is critical to continue to ensure support is not only available, but appropriately meets the needs of those individuals. Our findings suggest that key staff behaviours applied at the right time can support women's engagement and potentially contribute to better treatment outcomes
Breaking the cycle with trauma-focused mentalization-based treatment: theory and practice of a trauma-focused group intervention
Full text linkTrauma-Focused mentalization-based treatment (MBT-TF) is an adaptation of mentalization-based treatment (MBT) specifically developed for patients suffering from attachment or complex trauma, with the possibility of co-occurring borderline personality pathology. The creation of MBT-TF was driven by previous research and observations that interventions centered on mentalizing could be significantly improved by directly addressing the impact of trauma. MBT-TF aims to mitigate symptoms that arise post-trauma, such as hyperarousal, hypervigilance, intrusions, flashbacks, avoidance behaviors, dissociative experiences, negative perceptions of self and others, and ensuing relational difficulties. Implemented as a group intervention, MBT-TF typically spans 6–12 months. From a mentalizing perspective, trauma, particularly attachment trauma, leads to a failure in processing the effects of trauma through and with others. Stress and attachment behavioral systems are disrupted, which undermines the capacity for epistemic trust, and impairs mentalizing abilities. This paper offers a concise summary of the reasoning for MBT-TF’s creation, its theoretical underpinnings, and its clinical strategy for addressing the adverse impacts of trauma. It further details the treatment phases, their main goals, and their interventions, supplemented by clinical case examples that underscore MBT-TF’s distinctive attributes and frequent clinical hurdles
Dangerous Journey: Memories of Containment in Cuba
Full text linkThe author reconstructs and theorises the immediate, challenging period that follows the end of a personal training analysis. He takes the experimental approach of self-analysing the emotional turbulence with the use of diary entries and dreams from a two-week tourist trip to Cuba, revealing his preoccupation with attempts at maintaining the psychic space established in his long analysis. He hopes his autoethnographic reverie may generate further thought and debate regarding the implications and possible meanings of this universal but underreported time-point for the psychoanalytic clinician; and be of interest to others who may have similar experiences they connect with
Exploring young people’s perspectives on digital technology and mental healthcare: pilot study findings
No full textBackground: Digital technology affords opportunities to expand mental healthcare beyond the clinic setting, supporting sustainable delivery. A pilot qualitative study was undertaken with a view to using the experience gained from it to develop a substantive project in this area.
Aim: To identify and better understand the perceived barriers and benefits to using digital technologies when delivering mental healthcare to young people.
Method: In-depth semi-structured interviews were conducted with three young people under the care of a child and adolescent mental health service (CAMHS) team. The interview data were analysed thematically.
Findings: Three main themes were identified from the interviews: digital identity and digital literacy; trusting and accessing digital health resources; and therapeutic relationships, choice and convenience.
Conclusion: The findings of this pilot study reinforce the importance of avoiding a ‘one-size-fits-all’ approach to integrating digital technology in CAMHS. It was also identified that it is important to carefully consider the involvement of parents when conducting mental health research with children and young people