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This paper explores different factors that have been found to have a detrimental impact on the mental health of young adults today. The author demonstrates how environmental factors negatively impact internal processes, such as anxiety and low self-esteem. It looks at the various external factors that have led to a significant rise in perfectionism among the age group, such as a tougher social and economic environment, changes in parental rearing practices, social media and the way that young people come to define themselves narrowly by wealth and success. This is further exacerbated by the financial and psychological repercussions of the COVID-19 crisis on young people. The author explores her clinical experience as a psychotherapist working with young adults who never feel 'good enough'. The paper will suggest that parents, schools, universities, and employers need to understand that pushing for ever higher standards is problematic and proposes ways to help young adults to value themselves and be more resilient in tackling disappointments and challenges. [ABSTRACT FROM AUTHOR]

Research suggests that doctors experience higher levels of stress and mental health problems than the general population. Doctors frequently experience difficulty seeking help, and also challenges during psychological treatment, due to role reversal and competing ideologies. Focusing specifically on the under-researched area of doctors as patients in a psychological context, this paper explores the processes underlying role transition as well as the therapeutic relationship that follows. Furthermore, therapeutic reactions and adaptions of practice to this dynamic is also explored. A qualitative approach was employed and seven psychological therapists who had worked extensively with doctors as their patients were interviewed. Subsequent interview data were thematically analyzed. Six themes were generated: fear and pressure; status and control; variation of ideologies; change in practice; temporal changes; and help seeking and support. The main barrier to recovery for doctors is difficulty in accessing services owing to the high-levels of stigma and shame that may be experienced. This research identifies some of the adaptions made by psychological therapists within their practice when working with doctors as patients. [ABSTRACT FROM AUTHOR]

This essay is in part a response to a cluster of papers from the conference in Norway. Utilising these as a springboard to expand certain ideas, some latent, some more manifest in the papers, regarding the history and the terrain concerning the mental health issues in our culture. Fundamentally, this proposes that there is an unrelenting tension between two polarities: one reactionary and authoritarian, fixated on a concern with outcomes, propped up by closed systems of thought, managerial, habitually linked to adaptation and conformity; the other more romantically seen as revolutionary, unhandcuffing madness from mental illness, facilitating more expansive, freewheeling possibilities within all our lives. Much of this pays tribute to some of the major figures in the history of ‘anti-psychiatry’ (Basaglia, Cooper and Laing), with the costs involved, and goes on to trace out the genesis and consequences of the two predominant ‘clouds’ permeating our world, the paranoid and the digital … all converging on a naturalisation of our culture of surveillance, and an insistence on control. Otherwise known as a culture of fear. [ABSTRACT FROM PUBLISHER]

The aim of this paper is to summarize research into the tensions associated with medicalization in graduate counselor education in a primarily Canadian context. Counselor education, until recently, has largely embraced pluralistic traditions of practice that are potentially at odds with a medicalized approach to practice. Medicalization here refers to a diagnostic and treatment focus most commonly associated with use of DSM5 diagnostic procedures and evidence-based treatment. Tensions, in this study, refer to competing accountabilities encountered in reconciling medicalized with other approaches to practice. Following a review of relevant textbooks, graduate program websites and curricula, Master’s-level counseling students, counselor educators, and profession leaders were surveyed and/or interviewed regarding how medicalization influenced counselor education, and for how they responded to its influence. Data across all sources were analyzed using the mapping procedures of Situational Analysis, a method useful in analyzing contested phenomena and processes. We report our findings as navigable, negotiable, and dilemmatic tensions shaping the experiences of students and other stakeholders in counselor education. We recommend ways to enable students and educators to navigate and negotiate potential dilemmas associated with medicalizing influences on counselor education. We close by discussing the implications of our findings with respect to practice and training in the UK context. [ABSTRACT FROM AUTHOR]

Much of what are understood as ‘mental health difficulties’ reflects shortcomings in the ability to develop and sustain healthy relationships. Many of those embarking upon life as someone with a psychiatric diagnosis are people whose difficulties can be traced to adolescence, or even earlier in life. Unsatisfactory relational experiences during childhood are acknowledged contributors to subsequent psychological vulnerability. Numerous studies identify associations between other forms of relational disturbance, and the onset and maintenance of psychological difficulties. Some eighty years’ psychotherapy research has repeatedly suggested that the quality of therapeutic relationship is a major determinant of outcome. Sophisticated analyses of large databases now confirm this beyond doubt. All concur that social exclusion and stigma are the most disabling consequences of living as someone with a psychiatric diagnosis. None of these facts are disputed but there is continuing resistance to broad acknowledgement of their implications. This has many parallels with other examples of paradigm shift, as so clearly outlined by Thomas Kuhn. Uncertainties about the value of medical psychiatry and growing recognition of the role relationships play in the genesis and relief of mental health difficulties suggest that psychiatry can be seen in similar terms. This paper develops that thesis. [ABSTRACT FROM PUBLISHER]

This paper explores critical incident management in an Irish adult public mental health services with a population catchment area of approximately 245,000 people. Data were collected by non-participant observation, informal opportunistic interviews and formal psychoanalytic interviews. The amassed data were analysed using a Freudian/Lacanian framework. Findings indicated that due to the unconscious influence of the group, some critical incidents arise from staffs’ lack of consistent engagement with patients and failure to recognise or tolerate overwhelming levels of anxiety. Some critical incidents were managed by the imposition of restrictions or pseudo-treatment reflecting impatience, guilt, hatred and despair which compromises care. Incidents of acting out by service occupants were a consequence of the failure to work with transference. Staff interventions mirror patient and their family’s behaviours resulting in rejection, dismissal and banishment. Critical incidents may be more manageable if staff were provided with appropriate supports enabling them to operate differently: by better accepting negative feeling towards patients and learning transference management skills. The patient–staff relationship needs to be reconsidered in the light of two conclusions: firstly, that all staff are suffering from a constitutional lack to utilise their natural qualities to manage transference or more likely, membership of the group unconsciously prohibits the use of this natural skill. [ABSTRACT FROM AUTHOR]

In this published response to five studies in the present special issue, all representing qualitative research in the field of mental health, this research is approached as cultural and social practice. The five studies are looked upon as informative examples of research activity in mental health, and it is asked how that particular field is conceptualised as a form of human activity, how the authors position themselves in relation to the field, why they ask the questions they seek to answer and how epistemic queries concerning knowing and not-knowing manifest themselves and are addressed in the studies. The paper seeks to contribute to the debate on the uses of qualitative methodology in mental health research by explicating some of the differences and some of the similarities between the pieces of research at hand. [ABSTRACT FROM AUTHOR]

It has long been recognised that relationships are key to good mental health service delivery and yet the quality of the relational context remains poorly understood. This article brings together three studies that utilize very different methodologies to explore the various ways in which a process of therapeutic change can be aided or prevented by relational factors. All three studies took place within the context of therapeutic communities. The first study uses narrative ethnography and interaction ritual theory to explain how the mechanisms of everyday encounters in two therapeutic communities transform negative feeling into a sense of belonging and positive emotions such as confidence. The second study uses grounded theory to explore how the relational setting and the altered context of the researcher in a therapeutic faith community environment induces either a positive or negative quality of relationships. The final study uses a novel autoethnographic methodology to inform understanding of the relational experience of mental health treatment by comparing and contrasting multiple perspectives of different treatment environments. The paper concludes by identifying the expression and containment of affect in a congruent environment, belonging and hope, and fluid hierarchies of relational structures as key aspects of the relational context informing change. [ABSTRACT FROM PUBLISHER]

The mental health of refugees has been an increasingly researched area, but has been criticised for having an individualised and symptom-focused approach to understanding the experience of forced migration. This paper attempts to respond to calls to address this culturally limited and incomplete way of conceptualising responses to experiences of persecution and terror bound up within global hegemony and power inequalities. Interpretative phenomenological analysis was employed to analyse semi-structured interviews undertaken with six refugee mothers, with the aim of exploring how participants made sense of, and created meaning around parenting and family life in the UK. Three main themes emerged from the data analysis (a) loss as a constant companion to parenting; (b) a shifting view of the self as a mother; and (c) taking the good with the bad in family life. Methodological limitations, as well as implications for future research and clinical practice are discussed. [ABSTRACT FROM PUBLISHER]

Group therapy is a useful form of intervention for individuals with histories of extreme trauma. This paper will discuss the relevance of group interventions with refugees and asylum seekers who have suffered persecution and trauma in their home countries. Using case examples, this paper will illustrate how groups can provide an environment in which members can begin to work through past traumatic experiences and begin the process of finding a home in the UK, within a context of continued uncertainty and threat. The central principles of group analytic psychotherapy and how these can be applied and adapted to meet the needs of this specific group will be explored. Key issues, including working with an interpreter, cultural factors and dealing with high levels of vulnerability and dependency, will be discussed. The complex boundary issues arising from needing to intervene with practical issues outside the group therapy process will be considered. The paper will also explore the impact of this work on the group facilitators and ways in which this can be managed. [ABSTRACT FROM AUTHOR]

Increasing numbers of refugees are presenting to mental health services in Europe and Scandinavia and pose significant clinical challenges for practitioners. The most clinically challenging to engage in a psychotherapeutic context are survivors of torture and politically organized violence. Much of the literature on therapeutic work with torture survivors has tended to focus on psychodynamic approaches. There have also been attempts to describe other approaches, such as the use of testimony, with some attempts to study and describe cognitive behavioural approaches in torture survivors. It has been demonstrated that cognitive behavioural therapy is effective for PTSD, as recommended by the NICE (2005) guidelines for the assessment and management of PTSD in primary and secondary care. This paper will review and critique the current literature on therapy with refugees and survivors of torture. Through case examples, the use of CBT will be illustrated as an effective treatment intervention for this group. It will be demonstrated that the model can have effective clinical outcomes and provide a practical, problem-orientated approach to working with survivors of torture and political violence. This paper will also describe the use of assessment and treatment approaches using CBT principles, demonstrating the flexibility and applicability of the model. It also demonstrates the utility of CBT in different cultural contexts, despite perceived cultural limitations. Implications for assessment and practice in a cross-cultural setting will be discussed. [ABSTRACT FROM AUTHOR]

This paper aims to render the research literature on discourse analysis of psychotherapy more accessible to researchers and clinicians, and to provide a concise presentation and evaluation of both the usefulness and the implications of this body of research for our understanding of therapy process. Included in the review are studies which use discourse analysis on actual session transcripts. The studies are organized according to the stance they adopt towards psychotherapy, ranging from studies which take for granted psychotherapeutic assumptions and aim to illustrate the discursive basis of therapeutic notions, to studies which take a critical deconstructive stance towards therapy and examine the links between psychotherapy as social practice, wider systems of meaning and institutions. The main issues addressed by the studies reviewed are: the processes of meaning transformation, aspects of the client's subjectivity, the function of the therapist, as well as issues relating to power and the role of wider socio-cultural discourses. The paper discusses the contribution of discourse analysis to our understanding of therapy process and the enhancement of therapy practice, mainly in terms of promoting therapist reflexivity. [ABSTRACT FROM AUTHOR]

This paper explores the ex cathedra effect in psychoanalysis. It starts with the impact of the analyst's chair (cathedra) on the 'knowledge' derived from the analytic exchange-in particular, the structural alignment between the analyst and the client, and the ex cathedra authority transferred to analytic interpretations. It is argued that this authority-and the compulsion to 'know' that underlies it-is inevitably subverted by the unconscious processes it attempts to capture (through knowledge), in particular by transference, whose embossed and hollowed out forms, and various contusive elaborations (the bezoaric, caddis, karaoke and medusa effects), vitiate the linearity and closure of a set cognitive system (knowledge). The paper then moves on to examine how this ex cathedra effect has impacted on teaching-the transferral of this knowledge in trainings, notably in universities, where psychoanalysis has become a 'discipline', and how transference effects have inevitably and variously subverted (some may say corrupted) the teaching process. In particular, it suggests that the academic validation of clinical trainings hides an ex cathedra dogmatism-a pretence of formal knowledge and critical assessment which forecloses creative engagement with the unconscious. [ABSTRACT FROM AUTHOR]

This review offers a critical commentary on the contributions to this issue. It outlines four aspects to a critical approach and uses them to readv horizontally across all five papers. [ABSTRACT FROM AUTHOR]

In this paper, the authors present a model for therapeutic community programmes for those with severe and enduring mental ill health, based on social networks. These programmes have given birth to a range of therapeutic community which are, in fact, an innovative form of group psychotherapy. These new model do not depend on communal living. Some are groupings of apartments, others day units. Work schemes also feature here. And yet, as the authors outline, various components need to be present if these are to be considered genuine therapeutic communities and not just supported housing schemes. Additionally, a certain kind of training and clinical supervision is needed for the staff. [ABSTRACT FROM AUTHOR]

Public health and in particular mental health have been severely affected by the multitude of socioeconomic crises experienced by people in Greece. The severe austerity programmes, have reduced access to health services and increased demand for publically funded health care. This paper presents a case study focusing on the impact of these measures on the lives of mental health providers in one prefecture in Crete. Focus group methodology was applied and the data were analysed using thematic analysis. Analyses revealed three superordinate themes that converge at many levels and appear to be going counter to the circumstances: firstly, 'forging partnerships for mental health'; secondly, 'extending our reach'; and thirdly 'transformations in professional identity through praxis'. These themes are discussed using the words of the participants and the relevant literature. [ABSTRACT FROM AUTHOR]

In this paper it is argued that becoming a psychotherapist involves learning about the unknown, not so much as a commodity or as something to be acquired but rather in the sense of learning to speak from our unknowing. If learning about the unknown is considered important in being a psychotherapist, what are the best ways of developing such a practice? The unknown can be approached, broadly speaking, in two ways. Some writers attempt to explain the known of the unknown, for example conceptualised as the unconscious whereas others attempt to hold open the question of the unknown of the unknown. It is argued here that experience and experience of the relational is the milieu for the kind of learning associated with both the known of the unknown and the unknown of the unknown. These ways of viewing the unknown are considered by exploring how they emerge in both learning theory and psychotherapy. [ABSTRACT FROM AUTHOR]

The paper explores the effect of group participation on depressed women's 'doing depression' and 'doing pleasure' in Finland over three time periods. Quantitative data and qualitative data are analysed. To assess statistically the differences between the time periods, the Wilcoxon matched-pairs signed-ranks z-test is applied to the quantitative data. Coping with emotions through self-focused attention, depressed women are reluctant to initiate instrumental behaviour. They tend to respond to their lives in a ruminative way. Moving towards pleasure rather than depression characterized women's activities as a result of the group process; they learned to embody health, while envisaging hope for the future. Our emphasis on embodiment allows us to consider agency as a contemporary group therapeutic effect as well as to contextualize psychotherapy research within post-modern thinking. While the findings do not provide an indisputable list of the ways women's activities changed over time or all the advantages of group participation, they do suggest areas for future exploration in connection with depressed women's healthy embodiment in a healing group context and advance an understanding of how the experience and duration of depression can be altered if the public and private boundaries of depressed women's embodied routines are broken down and self-isolation is challenged. [ABSTRACT FROM AUTHOR]

In two opinion surveys, a total of 130 psychotherapists and psychotherapy students were asked to respond to questions about different aspects of treatment with psychotherapy combined with antidepressant medication. Their answers show that, at psychotherapy units belonging to regional psychiatry, an average of half the patients and at non-regional psychotherapy units nearly a quarter of the patient group were prescribed antidepressant medication. Usually medication is initiated before psychotherapy and more patients terminated than started medication during psychotherapy. The psychotherapists' experience of combined treatment was either positive, negative or mixed, the latter depending on which patients and which psychic problems were being treated. The reported specific effects on the psychotherapeutic work are presented as well as various aspects of how the medication prescription was performed. Regarding opinions of the interaction between psychotherapy and medication, some psychotherapists considered that the treatments were difficult to combine and should be kept separate, whereas the majority of the psychotherapists advocated an integration of the treatments. On the basis of the survey responses, this paper discusses different aspects of how the prescribing of medication during psychotherapy can be understood and carried out. [ABSTRACT FROM AUTHOR]