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Work Discussion in English nurseries: reflecting on their contribution so far and issues in developing their aims and processes; and the assessment of their impact in a climate of austerity and intense audit
No full textIn this paper, we argue for the past and continuing relevance of Work Discussion, as a model of professional reflection for nursery practitioners, which is attentive to emotional experience in work relationships.
The development of Work Discussion in English nurseries is described with illustrations, from a psychoanalytic perspective, of aspects of the processes of discussion and their underlying dynamics; and we also explore the introduction of Work Discussion to the training regimen of early years’ teachers.
Finally, the paper summarises the key findings arising from an evaluation of Work Discussion sessions, with nursery practitioners working with vulnerable two-year -olds, held at weekly intervals for a year, and facilitated jointly by early years’ care and education specialists together with child psychotherapists
Epistemological flaws in NICE review methodology and its impact on recommendations for psychodynamic psychotherapies for complex and persistent depression
Get PDFThe UK draft NICE guideline on depression in adults was sent out for stakeholder consultation between July and September 2017. The final guideline publication date currently remains ‘to be confirmed’. This paper sets out key concerns with the methodology employed in the guideline and its impact on recommendations for psychodynamic psychotherapies for complex and persistent depression. The draft largely ignored the subjective experiences and voices of service users, carers and members of the public, using out of date limited evidence of service user and carer experiences. The guideline fails to incorporate what limited qualitative evidence it reviewed into any treatment recommendations. The Guideline Committee created its own method for categorising depression by longevity, severity and complexity. This has resulted in erroneous and unhelpful classifications of research studies under groupings which do not match clinical and service user experiences or US and European approaches, rendering analyses and conclusions unreliable. We also outline instances of incorrect classification of psychodynamic treatments (such as inclusion of non bona fide treatments or exclusion of relevant bona fide treatment studies) which enables the omission of a recommendation for psychodynamic psychotherapy for complex and persistent depression. Depression is often a long-term condition or can become so if immediate care is inadequate; yet the draft recommendations are all made on the basis of short-term outcome data (with often less than eight weeks between baseline and outcome). NICE guidelines for long-term physical conditions would treat this evidence as inadequate. Finally, the draft guideline used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system of assessing methodological quality in such a way as to produce a systematic bias in favour of drug trials, selectively omitting trial data with long-term follow-up points and those which used non-symptom outcomes. Herein, we consider the increasingly evident limitations of the paradigm NICE works within for ensuring patient choice and equity of access to a wide range of therapies
The complex dynamics of performance management and improvement in Local Authorities. A psychoanalytic study of how a Local Authority organisation functions and survives an Ofsted inspection
Get PDFThe aim of this study was to explore how Children’s Services Departments respond to inspections undertaken by the Office for Standards in Education (Ofsted) to improve performance. The fieldwork setting for this study was in frontline Children’s Service Departments in two Local Authorities. Information referred to in this study pertains to the period when the two Local Authorities were going through a process of change in response to the Ofsted inspections. Information was obtained through qualitative research using ethnographic methods: psychoanalytic participant observation, interviews and organisational documents. A combination of a psychoanalytical theoretical framework and organisational metaphors was used to explore the conscious and unconscious process experienced by individuals going through a process of change.
This study has highlighted the complex issues arising from the inspection regimes and the impact of such regimes on individuals and groups in organisations. Within this, the unconscious processes play a significant role. The anxieties and the subsequent defence mechanisms deployed at an individual and organisational level influence the direction of the organisation. What was apparent in this study was the critical role leadership plays in determining the health and functioning of an organisation in implementing the primary task in particular during periods of organisational stress.
This study shows that to understand the journey of performance improvement in organisations and organisations’ relationship with the inspection institutions, it is important to understand the organisations’ culture and ‘organisation held in the mind’ of the workers. Organisation in the mind is what the workers perceive to be the organisation they are working for. It is equally important to understand ‘the inspection in the mind’ of the workers. The dynamics between the ‘organisation in the mind’ and the ‘inspection in the mind’ is crucial in understanding the responses of individual and organisations to inspections.
This study confirms that for any sustainable transformation to occur to improve performance, leadership needs to work through understanding the organisation ‘in the mind’ of the workforce before implementing any changes. The understanding of the organisation ‘in the mind’ should determine what change is required. Changing the mind-set of the workers and subsequently the culture of the organisation is paramount in effecting any sustainable organisational development. It is only then can real transformation take place when workers have a clear realistic view of their organisation and its function and the view of the internal and external institutions
Breaking the Silence: An IPA study exploring the experiences, thoughts, feelings and perspectives of teachers working with Selectively Mute children.
Get PDFResearch has shown that Selective Mutism occurs more frequently within the school setting particularly when children first start school. A great deal of the research available on Selective Mutism within the school setting is based on evaluating intervention and there is currently a gap in the literature concerning the experiences of teachers. Therefore, the purpose of this research was to give teachers a voice and provide greater insight into how Educational Psychologists can support teachers when working with a Selective Mute in the classroom. Five teachers’ perspectives were gained using semi-structured interviews and Interpretative Phenomenological Analysis was used to analyse the data. Superordinate themes emerged for each of the five teachers leading to six overarching themes that were identified across the whole sample: attempting to create an inclusive environment; taking ownership for helping the child to speak; using others as a source of support; a challenging experience for the teacher; the frustration of teaching a Selective Mute and requiring support and training from other professionals. The findings have been discussed in relation to existing literature and theory. Implications for teachers, the Educational Psychology service and the local authority were considered in regard to providing training and supervision in order to support teachers more effectively
Parenting early adolescents with Autism Spectrum Disorder before and after transition to secondary school
No full textAlthough early adolescence is a challenging period for all parents, parents of children with autism spectrum disorder (ASD) face additional challenges. At present, little is known about their concrete parenting behaviors during this stage of their child’s development. The main goal of this study was to explore what behaviors parents adopt and investigate how these relate to parenting dimensions previously described in the literature. In addition, we aimed to explore the feelings and cognitions of parents regarding their parenting behavior. Parents of 17 early adolescents aged 11 to 15 years with ASD were interviewed. Starting from three general parenting dimensions (warmth, parental control, and autonomy support) and two parenting dimensions of particular relevance in ASD (stimulating the development and adapting the environment), our analyses produced an integrated framework with three core dimensions: warmth, behavioral control, and stimulation. Our findings suggest that parents make strategic decisions in parenting their children with ASD: they report adapting their behaviors at many levels, although these behaviors per se are not ASD specific
If in doubt, don't cross them out
No full textTaking the decision to remove a patient from the practice list is often made following difficulties that can have a negative impact on other patients but also on practice staff. In such cases, it is vital to follow the correct protocols, says Gabrielle Pendlebury
Towards the barnahus (child house) multi-agency model of care for child sexual abuse: the value of a family therapist and a young person advocate
No full textBackground: Lack of appropriate support following sexual abuse can lead to long-term emotional, physical and social problems. The Child House will be launched in 2018. As a first step, a Child/Young Person Advocate (CA) and a Family Therapist (FT) joined the Paediatrician in an established clinic for the assessment of historic child sexual abuse.
Objectives: To determine the value of integrated psychosocial and advocacy services in the clinic.
Method: A retrospective review of notes for 20 patients before integration (BI), compared with 22 patients after integration (AI) was carried out. Outcome measures included emotional and behavioural needs and referrals.
Results: In the BI versus A1 cohort, 8 (40%) had emotional problems and 3 (15%) were in police proceedings versus 12 (55%) and 3 (13%) respectively.
Only two patients were referred to their local Mental Health Service before integration.
In the AI cohort, 10 patients had the FT in the paediatric consultation and one had a further appointment in a week, five in two or more weeks and four were referred to another FT for psychological support. Two made a new disclosure in the clinic and were referred to social care.
Six patients had the CA present at the paediatric consultation for support with the court process and one had an appointment later. One parent was referred for domestic violence support.
Conclusions: This study showed having the FT and CA join the consultation provided 17 of 22 (78%) patients, immediate or early management for mental health needs and police proceedings. A multidisciplinary team supports the varied needs of our patients and is at the centre of the Barnahus model. Future research will review the child and parent opinion about this model and also the outcomes for the child
