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The mine/d field of the internal world: The importance of the setting in work with boderline patients
No full textAnnual Research Review: Early intervention for infants and young children with, or at-risk of, autism spectrum disorder: A systematic review
No full textBACKGROUND:
There has been increased interest in early screening and intervention for young children with, or at risk of, autism spectrum disorder (ASD). This has generated a debate about the potential harms versus benefits of early identification and treatment. This review aims to identify the evidence base for early intervention in ASD.
METHODS:
A systematic review searching for randomised controlled trials (RCTs) of interventions for children up to 6 years of age with, or at risk of, ASD was undertaken. Characteristics and outcomes of included studies were collated and described in tabular format, and all included studies were rated according to the Cochrane Risk of Bias Tool.
RESULTS:
Forty-eight RCTs were identified, of which 40 were published since 2010. Most studies (n = 34) were undertaken in the United States. Included RCTs evaluated 32 different models of intervention. If blinding of participants and relevant personnel is overlooked as a source of bias, only six studies met criteria for low risk of bias across all domains of the Cochrane Risk of Bias Tool. The majority of studies had a relatively small sample size with only seven studies having a sample size >100.
CONCLUSIONS:
There has been a substantial increase in the number of RCTs evaluating early interventions in ASD. However, few studies, only 12.5% of the total, were rated as being at low risk of bias. Small sample size, unclear concealment of allocation and lack of clarity in the identification of the active ingredients in a diverse range of differently named treatment models were identified as challenges to the design, conduct and interpretation of studies. Improved co-ordination and design of studies is, therefore, required if future research in the field is to more clearly investigate the effects of early intervention for ASD
“I'm still fighting for the two of us”: How partners of UK veterans construct their experience of living with combat‐related trauma
Get PDFThere has been little qualitative research into the experiences of UK partners of veterans with PTSD. This study therefore aimed to explore how partners constructed their experiences of living with the condition. Fifteen female partners of male UK veterans were recruited and interviewed. Using a social constructionist thematic analysis, five themes were constructed: the women's need to subdue own emotional and behavioral responses; dilemmas about whether the veteran was unwell or ‘bad’; attempts at negotiating multiple roles; challenging the narrative of veterans as heroes; and the relational struggle with the transition to nonmilitary life. This study highlighted the importance of considering the veteran as existing within a relational and cultural context, and the need to include partners in therapeutic interventions
Negotiating sibling separation: A study of a method of group work with siblings in the adoption process and organisational responses
Get PDFThis was a study of the author’s practice innovation in therapeutic social work with siblings in
permanency planning that started in 2009 and continues. Clinical and research supervision of
the unfolding project facilitated a reflexive deepening and conceptualisation of the processes
involved producing the practice model which this thesis introduces.
The practice intervention focused on the relational and emotional needs of sibling groups of
children who all faced the inevitability of transition and potential separation from their own
siblings.
The research process involved three key aspects: thematic analysis of data arising from the
author’s group work with the children; conceptualisation of the author’s role as a boundary
spanner, and the use of transformational conversations which contributed to changes in policy
and organizational ways of thinking.
This thesis was underpinned by a psychoanalytic exploration of sibling relationships, group
work and child centered play therapy leading to the development of a new form of practice for
which the term Sibling-Centred Social Work is proposed
Violent states and traumatised organisations: Working with disappointed people in disappointing places
No full textIn this article, we build on our previous work to examine how staff teams working with 'un-housed minds' in health and social care settings can become (dis)stressed, dis-organised, disappointed and potentially traumatised. We will argue that this happens irrespective of whether the (dis)stressing experience seems to come from the work with clients or from the dis-orienting effects of organisational and social change processes. Using a psychosocial, group-analytically informed systems-psychodynamic approach we explore the complexity of the reciprocal relationships and the social and organisational parallel processes played out between those who provide these kinds of services and those who use them; also between those are employed and those who employ them, as well as between those who commission such services and those who must manage them.
We suggest that, in the current socio-economic climate, dominated by neo-liberal discourses around austerity and the 'undeserving poor' of the homeless, the workless and the 'worth-less', all staff teams concerned with the provision of different kinds of accommodation, care and support will become increasingly (dis)stressed and dysfunctional as they find themselves squeezed between the dis-organisation of the systems they work in and the distressing nature of working with the clients they notionally serve: between the ‘rock’ of increasing demand and dependent need and the ‘hard place’ of apparently decreasing resources.
Whether this is simply because there is just too much damage and dis-orderand not enough resources or whether it is because we do not care enough about the plight of our fellow citizens to organise ourselves better to think about how better to (re-)distribute the resources is a moot point. But in either case, in order to continue to practice ethically and to minimise the damage to all, we suggest that it is vital that teams can think together about the importance of opening up reflective spaces for structured conversations, within the wider cultures of
psychologically informed environments (PIEs), where these issues can be meaningfully thought about.
We will conclude by re-stating our view that, in order to be able to continue to work in these dis-appointing environments, it is imperative that we open up reflective spaces for team development, within which we can struggle together to make sense of these painful and potentially compromising personal, professional, organisational and socio-political challenges
An invitation to explore: A brief overview of the Tavistock and Portman Gender Identity Service
No full textSystemic supervision in statutory social work in the UK: systemic rucksacks and bells that ring
No full textThis paper provides a perspective on contemporary supervision outlining an innovative model of live systemic supervision implemented across a local authority children’s social work service. Following the Reclaiming Social Work model and the Munro Review of Child Protection, systemic approaches have become popular in English statutory social work. This intervention is distinct in that its focus was on developing and embedding systemic supervision through live mentoring. This approach enables different theoretical perspectives to sit alongside each other and inform practice. The paper explores four constructions of supervision as organisational development, as practice-based research, as ‘training to transgress’ and as adult learning. Using Proctor’s model, which allocates roles, a structure and a reflecting process within team supervision, the programme sought to embed change through the supervision and live mentoring of supervisors. The programme aimed to promote team resilience, reflexivity and relationship-based practice alongside a robust stance on risk. The paper describes the model of supervision and its application before discussing the issues raised in its implementation. We consider its relevance in other settings across professional boundaries
Non-strategic ignorance: Considering the potential for a paradigm shift in evidence-based mental health
No full textRandomised controlled trials form a central building block within the prevailing evidence-based mental health paradigm. Both methodology and paradigm have been widely problematised since their emergence in the mid-late twentieth century. We draw on the concept of ‘strategic ignorance’ to understand why the paradigm still prevails. We present focus group data gathered from 37 participants (service users, public, carers, general practitioners, commissioners) concerning the way they made sense of a randomised controlled trial of psychotherapy for treatment-resistant depression. Thematic analysis of the findings revealed an overall critique of randomised controlled trial methods which we refer to as ‘non-strategic ignorance’. Specifically, participants problematised the construct of depression, unseating the premise of the randomised controlled trial; they were sceptical about the purpose and highlighted its failure to show how therapy works or who might benefit; the randomised controlled trial was seen as inadequate for informing decisions about how to select a therapy. Participants assumed the treatment would be cost-effective given the client group and nature of the therapy, irrespective of any randomised controlled trial findings. Each area of lay (‘non-strategic’) critique has an analogous form within the methodological expert domain. We argue that ‘expert’ critiques have generally failed to have paradigmatic impact because they represent strategic ignorance. Yet parallel non-strategic critiques have common sense appeal, highlighting the potential power of lay voices. The discussion considers whether the evidence-based mental health paradigm is faced with epistemological problems of such complexity that the conditions exist for a new paradigm in which service user views are central and randomised controlled trials peripheral
The age of envy: How to be happy when everyone else's life looks perfect
No full textSocial media has created a world in which everyone seems ecstatic – apart from us. Is there any way for people to curb their resentment