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This paper reports follow-up findings for an Mentalization based treatment (MBT) parenting intervention delivered to a community mental health sample. Parents completed the 12-week version of the Lighthouse Parenting Program (LPP) and were evaluated on parenting practices, parent-child relationships, parental mental health indicators, and child problem behaviour levels. We evaluated the extent to which improvements in mentalizing at follow-up mediated changes in parenting, parental adjustment, mental health, and child outcomes. Results included a reduction in parental coercive behaviours and child problems, improved parent-child relationship, and better parental psychological adjustment and mental health. Improvement in self-focused mentalizing were observed. Self-focused mentalizing mediated the changes in most outcomes from baseline to 3-month follow-up. These results provide strong preliminary evidence that the LPP improves parent and child outcomes. [ABSTRACT FROM AUTHOR]

Emotionally-based school avoidance (EBSA) is an important driver of persistent school absenteeism and may have worsened in the context of COVID-19. This paper describes the development of a brief parent-focused psychosocial intervention with the goal to address the lack of accessible early interventions for EBSA. The developmental process used a person-based approach with two phases. In Phase 1, qualitative data were collected about intervention preferences and priorities from N = 10 parents and N = 7 practitioners in a series of co-design workshops. Phase 2 refined an intervention blueprint based on iterative consultations with N = 4 parents and N = 3 practitioners. Framework analysis was used to organise findings around key intervention parameters, including relevant mechanisms, content, and delivery methods needed to provide effective, acceptable and feasible support for families affected by EBSA. The resulting blueprint incorporates three online modules to be delivered over three weeks with each module consisting of psychoeducational videos, self-completed learning tasks and a corresponding coaching session. Respective module content includes: (i) self-care strategies to increase parent wellbeing and self-efficacy; (ii) parenting strategies to change behavioural patterns that maintain child distress and avoidance of school; and (iii) strategic communication strategies to increase the quality of home-school relationships. The blueprint has been developed into a full prototype for a forthcoming feasibility study. Plain language summary: Since the onset of the Covid-19 pandemic, there has been a noticeable increase in children missing school. One significant contributor to this rise in absences is Emotionally-Based School Avoidance (EBSA). EBSA refers to a situation where a child stays home from school due to feelings of anxiety and distress about attending. Accessing timely support for children with EBSA can be difficult due to lengthy waiting lists for child and adolescent mental health services. This paper outlines the creation of a new, brief psychosocial intervention aimed at helping parents support their child experiencing EBSA. The development process involved two phases. In the first phase, we collaborated with 10 parents and 7 practitioners to gather ideas about the kind of support families require, what should be included in the intervention, and how to make it practical for families to use. Based on these discussions, we formulated a plan for the new intervention. The second phase refined this plan of the intervention to ensure its suitability for families. The intervention is called ISAAC: Intervention for School Anxiety and Absenteeism in Children. ISAAC consists of three online modules to be completed by parents over a three-week period. Each module includes videos, reflection activities and homework tasks which help the parent learn a new skill or try a different way of responding to their child's anxiety about attending school. Parents are also supported by a coach. The first module encourages parents to take care of their own wellbeing and manage stress. The second module helps parents to learn new ways to respond to their child's distress related to school attendance, while the third module provides guidance on effective communication with the child's school. The next step for this intervention is to see whether it is agreeable to parents and practical to deliver in the real-world. [ABSTRACT FROM AUTHOR]

Background: According to the United Nations Commissioner for Refugees (UNHCR), children and adolescents represent 41% of all forcibly displaced individuals. They have to deal with conflicts, violence, and the many difficulties of flight and resettlement during a critical stage of their emotional, social, cognitive, and physical development. They are more likely to experience mental health problems during migration. Despite the several known risk factors, it is frequently challenging for refugees and asylum seekers to get mental health care. In this paper we review available studies on interventions aimed at promoting mental health and at preventing common mental disorders in immigrant adolescents and children. Methods: The relevant PubMed, Scopus, PsychINFO and Web of Science databases were searched for papers published until March 21, 2023, using ("immigrants" OR "migration" OR "asylum seekers" OR "refugees") AND ("promotion" OR "prevention") AND ("mental health" OR "mental disorders" OR "psych*") AND ("children" OR "adolescents" OR "young adults") as search string. Fourteen articles qualified for the detailed review. Results and Conclusions: The majority of available interventions, although highly heterogeneous in format and content, showed significant improvement in several psychopathological dimensions, including trauma-related symptoms, psychological stress, anxiety, depressive and cognitive symptoms. Available studies on interventions for the prevention of mental disorders and the promotion of mental health in refugees and asylum seekers children and adolescents indicate that provided interventions were associated with a global improvement for participants. Implementation strategies to improve their scalability are highly needed. [ABSTRACT FROM AUTHOR]

Background: Youth violence and knife crime is increasing dramatically, so much so it has been described as a global epidemic. The social, economic and political forces fuelling this rise mean that minority groups are particularly affected. Aim: This paper reviews the literature primarily from a UK perspective, and illustrates the disparate factors that are influencing the rise in youth violence and knife crime and illustrates the complexities of integrating the perspectives of different disciplines into coherent intervention strategies. Method: We conducted a systematic review of the literature that explores both the causes of increasing youth violence and knife crime as well as some of the interventions that have attempted to deal with the problem. Results: A complex interplay of social, economic, mental health and political factors underpin the increase in youth violence and knife crime. An uneasy tension exists between a traditional criminal justice system-based approach based upon deterrence and punishment, and a more liberal preventative model focusing on adolescent mental health. None of the interventions thus far have been particularly effective. Conclusion: Youth violence and knife crime is a global social issue that causes untold suffering to individuals, families and communities as well as fear that reverberates through society. Interventions have often been devised through the lens of particular disciplines or ideologies. Integrating these perspectives into a coherent approach that is actually effective demands greater co-operation, dialogue and mutual understanding between disciplines and agencies, as well as a robust framework for the evidence-based assessment of outcomes. [ABSTRACT FROM AUTHOR]

This paper focuses on art productions by children participating in an art-based wellbeing intervention project in Kashmir. Drawing on feminist security studies, we conducted narrative analysis to explore how children represent in/security. The locations of in/security were the environment, the body, and the socio-political realm. Children articulated nuanced and complex representations of the natural and social world, influenced by local and global forces, and created their own meanings and practices of in/security. [ABSTRACT FROM AUTHOR]

In this paper, we sought to give voice to the unspoken issue of mothers' disintegrative responses—that is, intrusive thoughts and dissociative experiences—in the context of infant care. Three methodologies were employed: (a) in-depth interviews were conducted with 23 Israeli women up to 3 months postpartum; (b) 126 Israeli women up to 12 months after childbirth responded to an open-ended questionnaire; and (c) a clinical case study was performed. Mothers referred to intrusive thoughts as "attacks," and related primarily to three themes: fear of losing their grip, aggressive fantasies, and guilt and shame. Dissociative experiences were described as vague and elusive, with three major themes emerging: detachment, disorientation, and helplessness. We argue that the findings correspond with psychosocial approaches whereby disintegrative responses may be an indication of maternal ambivalence and a reflection of "contagious arousal" in which the mother identifies with the experience of the infant. The findings offer a new direction to clinicians working with mothers by suggesting that the mother's openness to these responses may be an opportunity for her to acknowledge subjective and repressed parts of herself and undergo a process of reintegration out of disintegration. [ABSTRACT FROM AUTHOR]

Experiencing the continued presence of the deceased is common among the bereaved, whether as a sensory perception or as a felt presence. This phenomenon has been researched from psychological and psychiatric perspectives during the last five decades. Such experiences have been also documented in the ethnographic literature but, despite the extensive cross-cultural research in the area, anthropological data has generally not been considered in the psychological literature about this phenomenon. This paper provides an overview aimed at bridging these two areas of knowledge, and approaches the post-bereavement perception or hallucination of the deceased in cultural context. Ongoing debates are addressed from the vantage point of ethnographic and clinical case study research focusing on the cultural repertoires (in constant flux as cultures change) from which these experiences are labelled as desirable and normal, on the one hand, or as dangerous and pathological, on the other. [ABSTRACT FROM AUTHOR]

The paper investigates the role of ethics and codes of conduct within psychotherapy organizations. It is argued that managerialist bureaucracies have usurped codes of ethics and put them in the service of compliance and control. The paper begins with a critical delineation of the three ways that philosophers have approached ethics: deontology, consequentialism and virtue ethics. It asks the question: is psychotherapy a scientific activity? The answers to this question gives rise to different sorts of ethical requirements. The paper then moves onto the ways that power relations within and between institutions inform thinking about ethics. It is argued that psychotherapy organizations are becoming increasingly managerialist in their structure and ways of working, a consequence of which is that communication is controlled and constrained, and that this in itself is unethical. [ABSTRACT FROM AUTHOR]

Background: The aim of this paper is the systematic review of psychological/psychosocial interventions for gender diverse youth under 18 years of age and their families, based on the published protocol: PROSPERO 2020 CRD42020163995. Methods: A search strategy was developed using key terms. An electronic literature search was completed using the following data bases (OVID MEDLINE; EBSCO CINAHL; ProQuest MEDLINE; OVID PsycINFO). Only studies published in English between 2001–2021 were included. This review is based on PRISMA guidance. Studies meeting inclusion criteria were quality appraised using the Mixed Methods Assessment Tool (MMAT). Results: 8405 studies were independently screened. Four studies met the inclusion criteria for the study. Parents of transgender youth attended between one and 11 psychological/psychosocial group interventions. Parents reported reduced isolation and increased knowledge, which enabled them to advocate for their young person's needs. Psychological/psychosocial group interventions were creating challenges in terms of group processes, with some parents dominating interactions. Psychological/psychosocial group interventions were positive for parents, but no outcomes were collected for transgender young people. Conclusion: More research is required to understand the role of group facilitators, the optimal group size and the number of psychological/psychosocial intervention sessions required. [ABSTRACT FROM AUTHOR]

This paper posits that mourning is fundamentally a social process. The inability to mourn has dangerous consequences for the individual and for society. Social support and community networks are necessary in order to tolerate the pain of loss and overcome the resistance through sharing in the group. Based on clinical material from a two-year analytic training group run in an NHS psychotherapy department, the author argues that the developmental and therapeutic process of the group corresponded to the unfolding of the mourning process. The development of the capacity to mourn brought transformation in the group, leading to a more coherent sense of identity, both of individual members and of the group as a whole. [ABSTRACT FROM AUTHOR]

In Western societies, human existence and illness are mostly constructed from the perspective of mind-body dualism: body and mind are considered to function independently, and the body/the physical as primary and more real. Research shows, however, that mind-body dualism is no longer tenable, especially in healthcare contexts. This led to the rise the biopsychosocial model, in which bodily experiences, including illness, are seen an interplay of the physical and the psychological, and the social. This model is the current gold standard for treating chronic pain. As these perspectives on the body and illness are potentially conflicting, and discursively constructed, this paper examines whether they are a source of misalignment in interactions between chronic pain patients and their doctors in a pain clinic. The analysis shows these perspectives indeed lead to misalignment, for instance when discussing the relevance of psychotherapy, and lead to intricate uses of argumentative resources to account for the differing perspectives on (the treatment of) pain. [ABSTRACT FROM AUTHOR]

This article shares an author's perspective with regards to the contributions of Trigant Burrow in the field of group psychoanalysis. Furthermore, this article deals with how Burrow's influence is kept alive by his loyal followers. In addition, the author also talks about the similarity between his own thinking with that of Burrow's specifically in the aspect of species-connectedness and the organismic foundations of an individual's existence on the nature of dreaming consciousness.

The paper asks: what makes for an ethical supervision? It begins by looking at the differing ethical requirements in situations of persons and things (science), and in situations of persons and persons. It is argued that if psychotherapy (and consequently supervision) is thought to be a scientific activity, then it will require the supervisor to subscribe to the ethics akin to those of the natural scientist. However, if psychotherapy and supervision are intersubjective relational activities, then the ethical requirements will be those of reciprocity and mutuality. Also necessary will be notions of prefiguration and emergence. [ABSTRACT FROM AUTHOR]

This paper describes the involvement of peer trainers in Tree of Life groups for young people living with Type 1 Diabetes. The approach is informed by narrative therapy and collective narrative practice and principles, where people are seen as separate from problems and the focus is on creating opportunities for people to tell and witness one another's preferred identity stories. Young people who have participated in a Tree of Life day are invited to join the project as peer trainers who help facilitate, engage group participants, witness their stories and consult to the project. Involving peer trainers also aims to create a community where preferred identity stories can be lived and witnessed. This paper describes the training for peer trainers and the building of community. [ABSTRACT FROM AUTHOR]

It is often suggested that the Greek tragedians present clinically credible pictures of mental disturbance. For instance, some modern interpreters have compared the process by which Cadmus brings Agave back to sanity in Euripides' Bacchae with modern psychotherapy. But a reading of medical writers' views on the psychological dimension of medicine offers little evidence for believing that these scenes reflect the practices of late fifth-century Athenian doctors, for whom verbal cures are associated with older traditions of non-rational thought, and thus are scorned in favor of more "scientific cures" based on diet or medication. This paper will argue that Athenian tragedians, working from older traditions that advocated verbal cures for some mental ailments, do understand the potential psychological effects that their work can have on audiences, since tragedy requires psychological interaction with its audience in order to be effective. From a close reading of select scenes in Euripidean tragedy, this paper suggests that the experiences of the characters who experience suffering in Euripides' Heracles and Bacchae are analogues of the experiences undergone by the spectators of tragedy at large. Parallels are made between the way that Agave and Heracles are both talked back to sanity by looking upon what has happened, and the way that tragedians make their audiences observe lamentations and meditations that follow the central tragic act, to help them return from the intense emotion provoked, perhaps, by the violence they have seen. [ABSTRACT FROM AUTHOR]

Viewing psychology as a cultural activity associated with technologies of the self, and noting the cultural phenomenon of the Jungian movement internationally, this paper presents a reading of Jung's 'A Study in the Process of Individuation' through the lens of dialogism. Jung's study pivots on the interpretation of paintings by a middle-aged American woman, 'Miss X', whom he treated in 1928. The present paper critically examines dialogical aspects of the Jungian text, such as Jung's metaphor of a dialogue with the unconscious, how he and his patient co-constructed her 'inner' dialogue, and the text's dialogue with its audience. It is concluded that the process of individuation described by Jung is fundamentally dialogical, evincing the human capacity to co-construct meanings of self-experience and thereby to change how we experience our own selves. [ABSTRACT FROM AUTHOR]

The scientific basis for practice in child psychiatry has developed apace. And has thrown up several quandries for an accepted paradigm for good practice anchored to the diagnostic schema developed in adult psychiatry. This paper hopes to stimulate discussion about where alternative paradigms might lead us on a path to precision medicine as applied to child psychiatry. [ABSTRACT FROM AUTHOR]

Background : Evidence indicates that the more traditional and behavioural parenting strategies are ineffective when parenting a child who has experienced developmental trauma. Recognising the need to parent with an attachment focus, the current paper evaluates the effectiveness of running the [Enfys] Nurturing Attachments Group, virtually, within the context of the COVID-19 pandemic. Method : A pilot feasibility study evaluated eight bespoke groups. Consenting professionals and co-professionals completed the Brief Parental Self-Efficacy Scale (BFSS), Care Questionnaire (CQ) and the Parental Reflective Functioning Questionnaire (PRFQ). Results : One hundred forty individuals attended the groups, with 51 (36%) completing both pre-and post-measures. The results provide evidence that professionals and co-professionals reported statistically significant positive increases on both the BPSS (d =.55) and CQ (d =.62). For the PRFQ, the results showed a statistically significant decrease on the Pre-mentalising sub scale, a non-significant mid-range score for Certainty about Mental States and a non-significant increase for Parental Interest and Curiosity in Mental States. Conclusion : The study has demonstrated initial viability of effectively facilitating the [Enfys] Nurturing Attachments Group, virtually. Importantly, it has also shown that the group can be run with professionals alongside co-professionals. [ABSTRACT FROM AUTHOR]

Objective: Patients with a combination of long-term physical health problems can face barriers in obtaining appropriate treatment for co-existing mental health problems. This paper evaluates the impact of integrating the improving access to psychological therapies services (IAPT) model with services addressing physical health problems. We ask whether such services can reduce secondary health care utilization costs and improve the employment prospects of those so affected. Methods: We used a stepped-wedge design of two cohorts of a total of 1,096 patients with depression and/or anxiety and comorbid long-term physical health conditions from three counties within the Thames Valley from March to August 2017. Panels were balanced. Difference-in-difference models were employed in an intention-to-treat analysis. Results: The new Integrated-IAPT was associated with a decrease of 6.15 (95% CI: −6.84 to −5.45) [4.83 (95% CI: −5.47 to −4.19]) points in the Patient Health Questionnaire-9 [generalized anxiety disorder-7] and £360 (95% CI: –£559 to –£162) in terms of secondary health care utilization costs per person in the first three months of treatment. The Integrated-IAPT was also associated with an 8.44% (95% CI: 1.93% to 14.9%) increased probability that those who were unemployed transitioned to employment. Conclusions: Mental health treatment in care model with Integrated-IAPT seems to have significantly reduced secondary health care utilization costs among persons with long-term physical health conditions and increased their probability of employment. [ABSTRACT FROM AUTHOR]

One of the most distinctive aspects of contemporary psychiatry is its firm grounding in a neurological and biochemical framework for the interpretation of mental life and its disturbances. In the absence of any strong neurological understanding or systematic knowledge of active pharmaceutical substances, one might expect that early ancient medicine readily resorted to non-somatic approaches to healing mental suffering. Instead, what is usually labelled "therapy of the word" and other forms of what one may call psychotherapy emerge relatively late in Greek medicine, only in the first centuries of our era. This paper provides an overview and analysis of this development in ancient history of psychology, philosophy and medicine, covering a broad period of time from the fifth century BCE to the end of the late-antique period, the fifth century CE. The focus is on the very idea (or lack thereof) of the curability of mental disturbance, and on the particular branch of therapeutics which addresses the psychological and existential condition of the patient, rather than his or her physiological state. [ABSTRACT FROM AUTHOR]

Given the nature of the discipline, it might be assumed that clinical psychology is an ethical profession, within which effective ethical decision-making is integral. How then, does this ethical decision-making occur? This paper describes a systematic review of empirical research addressing this question. The paucity of evidence related to this question meant that the scope was broadened to include other professions who deliver talking therapies. This review could support reflective practice about what may be taken into account when making ethical decisions and highlight areas for future research. Using academic search databases, original research articles were identified from peer-reviewed journals. Articles using qualitative (n = 3), quantitative (n = 8) and mixed methods (n = 2) were included. Two theoretical models of aspects of ethical decision-making were identified. Areas of agreement and debate are described in relation to factors linked to the professional, which impacted ethical decision-making. Factors relating to ethical dilemmas, which impacted ethical decision-making, are discussed. Articles were appraised by two independent raters, using quality assessment criteria, which suggested areas of methodological strengths and weaknesses. Comparison and synthesis of results revealed that the research did not generally pertain to current clinical practice of talking therapies or the particular socio-political context of the UK healthcare system. There was limited research into ethical decision-making amongst specific professions, including clinical psychology. Generalisability was limited due to methodological issues, indicating avenues for future research. [ABSTRACT FROM AUTHOR]

The body is central to women's construction of premenstrual change as premenstrual syndrome (PMS), and to experiences of premenstrual distress. Embodied change, such as bloating or breast tenderness, can act as a marker of PMS. Within biomedical models, PMS is located within the body. Women's dissatisfaction with their bodies is also reported to be higher in the premenstrual phase of the cycle. What is absent from this analysis is the meaning and experience of embodied change, in the context of broader constructions of femininity and embodiment. In this paper, we adopt a feminist material-discursive theoretical framework to examine the role of premenstrual embodiment in women's premenstrual distress, drawing on open-ended survey responses and interviews with 83 women who self-diagnose as "PMS sufferers". We theorize premenstrual body hatred as subjectification, wherein women take up cultural discourse associated with idealized femininity and the stigmatization of the fat body, resulting in self-objectification, distress and dehumanization. However, women can resist negative cultural constructions of premenstrual embodiment. We describe the impact of psychological therapy which increases awareness of emotional and embodied change, resulting in greater acceptance of the premenstrual body and self-care, serving to reduce premenstrual distress and self-objectification. [ABSTRACT FROM AUTHOR]

An examination of the ostensibly secular, modern and scientific fields of medicine and psychotherapy reveals the persistence of religious, primitive and magical thinking. Practitioners appear to meet the public demand for magical enactments at least half-way. In doing so, they may persist with practices despite evidence of its ineffectiveness, or with disregard for the question of its effectiveness altogether, or with imperviousness to the discouragingly weak therapeutic effects reported in scientific papers. Examples are drawn from coronary surgery, contemporary psychoanalysis and group analysis. The situation for group analysis is of special interest. [ABSTRACT FROM AUTHOR]

Psychological therapy today plays a key role in UK public mental health. In large part, this has been through the development of the (specifically English) Improving Access to Psychological Therapies (IAPT) programme. Through IAPT, millions of citizens have encountered interventions such as cognitive behaviour therapy, largely for the treatment of depression and anxiety. This article interrogates how this national response to problems of mental ill-health – and the problematization itself – was developed, accounted for, and sustained. By imbricating economic expertise with accounts of mental ill-health and mechanisms of treatment, IAPT has revivified psychological framings of pathology and therapy. However, it has done so in ways that are more familiar within biomedical contexts (e.g. through recourse to randomized controlled trial studies). Today, the initiative is a principal player in relation to which other services are increasingly developed. Indeed, in many respects IAPT has transformed from content to context within UK public mental health (in a process of what I term 'contextification'). By documenting these developments, this paper contributes to re-centring questions about the place and role of psychology in contemporary healthcare. Doing so helps to complicate assumptions about the dominance of linear forms of (de)biomedicalization in health-systems. [ABSTRACT FROM AUTHOR]

The article reconstructs postpsychiatry's core propositions and briefly describes its theoretical background and assumptions. It also presents chosen aspects of postmodern psychotherapy, which seem to be in many ways similar to postpsychiatry's ideas. Although they are drawn from different inspiration, postpsychiatry and postmodern psychotherapy seem to come to similar conclusions, especially regarding the role of the patient in the therapeutic process, the meaning of psychiatric diagnosis, and the importance of the institutional, cultural, and social contexts in mental health practice and research. The paper also aims to place postpsychiatry and postmodern psychotherapy in a Polish context, focusing on the ethical challenges faced by psychiatry and showing that some of postpsychiatry's ideas and solutions to contemporary problems were already present in the Polish psychiatric literature of the 20th century. It also contains a brief description of the Polish social and historical context of psychiatry, as well as key aspects of the Polish legal system that relate to mental health and seem to reflect the nature of biomedical explanations of mental distress. It concludes that the model of psychiatric care postulated by "postmodern" approaches seems more ethical and scientifically and philosophically grounded and promises better treatment results than the "traditional" biomedical model. [ABSTRACT FROM AUTHOR]

Emmanuel Levinas’ semi-phenomenological analyses of the “face-to-face” encounter with “the other” are frequently alluded to in the therapeutic literature. Indeed, for some therapists, Levinas provides the conceptual apparatus to reconfigure traditional therapeutic practice. While acknowledging the importance of his work, in this article I raise critical questions about the way Levinas’ ideas are often used by psychotherapists. The discussion is divided into five sections: First, I provide a short explanation of the motivations for writing this paper. Second, I offer an overview of some prominent themes therapists typically draw from Levinas’ writings. Next, I present my own reconstruction of the face-to-face encounter. Then, drawing on the previous reconstruction, I outline the main questions Levinas-inspired therapists need to address. Finally, I reconsider the potential significance of Levinas’ work for therapists. [ABSTRACT FROM AUTHOR]

People in different cultures have different concepts of the person that underlie self-understanding and self-representation. These concepts influence many aspects of individuals’ life experience, including illness and expectations toward recovery. Psychotherapies aim to promote adaptive change in experience and behavior. This goal is embedded in a social and cultural context that promotes or sanctions a particular notion of personhood. If every system of psychotherapy depends on implicit models of personhood, which varies cross-culturally, then the goals and methods of therapeutic change must consider the cultural concept of the person. This paper reviews cultural concepts of the person in relation to communal values, practices, and systems of thought observed across many African cultural contexts. It presents a practical framework that can inform therapists working with African clients. Many African cultures promote a relational-oriented personhood, in which an individual manifests his or her personhood through connections to three distinct forms of agency: (a) spiritual agency, including God, ancestors, and spirits that influence the person; (b) social agency, including the family, the clan, and the community, with extension to humanity; and (c) self-agency, which is responsible for the person’s inner experience. This distinctive form of personhood underlies concepts of the “normal” person, understandings of mental illness, help-seeking behavior, and clients’ needs and expectations. Implications of this cultural concept of the person for psychotherapy with African clients are discussed. [ABSTRACT FROM AUTHOR]

Background: In a highly technical civilization like ours, in which the interest in human communication transcends academic barriers and clinical practice, it seems necessary to look back to Ruesch’s work in psychiatry. The main reason of it rests upon the idea that he was one of the few truly outstanding clinicians, researchers, and theoretical in the field of normal and abnormal communication. In fact, he did not only present a wealth of observational and clinical data; more importantly, he used these data to formulate creative hypotheses about the conflict between man and other human beings. Aim/Objective: The main purpose of this article is to pay tribute to Dr. Jurgen Ruesch (1909-1995), distinguished psychiatrist, communications experts and psychotherapist. For that reason, here we want to pay tribute to the enormous value of his work for the promotion of mental health and the clinical assessment of normal and pathological communication behavior. Methods: In working out his theoretical stance toward communication, all Ruesch’s works here have been reviewed. In line with this, the author also mentions similarities between Ruesch and other psychiatric/psychotherapeutic authors. Also similarities have been established between Ruesch and Frank on “non specific factors in psychotherapy”, and tensions within contemporary training of psychiatrists, almost predicted by Ruesch. Results and Conclusions: While some of Ruesch’s ideas about the nature and origins of communication has been discounted, many of his preoccupations are now part of the mainstream, and it is to here that we should look for evidence of his legacy. In fact, he has been the author of rich and fruitful ideas, which are essential to clinical understanding of mental diseases and their treatments. It is not surprising, therefore, that Ruesch’s burning interest in the clinical assessment of normal and pathological communicative behavior finds a significant echo in today’s proliferation of books, papers, and conferences on communication. For all that, we should honor him. [ABSTRACT FROM AUTHOR]

While monogamy is the norm for romantic and intimate relationships in contemporary western societies, having other sexual and affective interactions alongside a monogamous relationship is a common practice. Instead of a unilateral and/or covert non-monogamy, polyamory promises a consensual, ethical, and responsible non-monogamy. The personal transformation of normative cultural frameworks is fundamental to the experience of "becoming polyamorous." This article explores such occasions using the notion of liminality in order to illustrate the phenomenon of "liminal hotspots." Focusing on a specific and exemplary case describing the first stages of a polyamorous relationship, the paper explores the reordering of social formations involved. In this case, "becoming polyamorous" is expressed through a process of suspended transition where categories can be described as both/and monogamous/polyamorous and neither/nor monogamous/polyamorous. [ABSTRACT FROM AUTHOR]

Buddhist practices have been increasingly influencing psychotherapy. For over 20 centuries, Buddhism has been the religion of a majority of Sri Lankans. However, there is little documentation of the use of Buddhist practices in psychotherapy in Sri Lanka. This paper presents a case study in which Theravadan Buddhist mindfulness meditation and cognitive therapy practices were used in the treatment of a client with depressive disorder. The paper also summarizes the influence of Buddhist concepts and mindfulness meditation on psychotherapy and illustrate how Buddhist doctrine and practices can be considered a psychotherapeutic method. [ABSTRACT FROM PUBLISHER]

Hormones and surgery are the mainstay of treatments available routinely for transsexual patients in the UK. The condition and approach to it by mental health professionals are explored within the paper by the author who has run a specialist psychotherapy service for patients with gender dysphoria for eight years at The Portman Clinic in London. In the paper he describes the challenges posed by the therapist in treating these patients and important factors in the treatment to enable psychotherapy to be a useful treatment option. He details some of his experience of treating transsexual patients within a homogenous outpatient slow-open group analytic psychotherapy group. [ABSTRACT FROM AUTHOR]

A psychological understanding of interpersonal processes in terms of complementarity is not new. It is enough to mention Buber (the title of our paper refers to an expression of his), as well as Bateson and his definitions of double description, binocular vision and complementary and symmetric relations. We would like to clarify the nature of complementarity, and to point out the presence of this framework in some philosophical and scientific discourses about the person. Moreover, we think that the adoption of a framework of complementarity becomes a metaphysical necessity within what we have called 'hermeneutic constructivism', and that other constructivisms fail to acknowledge it, thereby losing much of their metatheoretical, revolutionary potential. We will document the possibility of adopting a framework of complementarity with respect to different pairs of poles, which specify as many phenomenal domains: (1) the relation between any entity and its environment; (2) the relation between modes of description; (3) the relation between the person and the world; and (4) the relation between people. In the final part of the paper we outline some implications of a consideration of complementarity for the psychotherapy process. [ABSTRACT FROM AUTHOR]

Background: Reports of low staff morale and high levels of patient complaints suggest that acute psychiatric wards are not achieving their full therapeutic potential. Aims: This paper reviews some of the 'therapeutic milieu' literature to identify ways of construing ward functioning so as to maximise therapeutic and minimise destructive processes within inpatient units. Method: Relevant papers are reviewed, providing an understanding that permits the inpatient clinician to consider and apply the pertinent concepts. Results: Five key therapeutic functions of the ward environment are identified--containment, support, structure, involvement and validation. Four destructive processes are described, relating to: the isolated patient; group phenomena; the contribution of staff; and structural manifestations in the ward. Conclusions: The inpatient ward can be construed as a 'whole', embodying a range of therapeutic functions, which may need rapid deployment and dismantling, as dictated by changes in ward conditions. The 'ward-as-a-whole' construct complements individualised models of patient care and the practical implications of such thinking could engender a greater sense of agency and job satisfaction in staff. [ABSTRACT FROM AUTHOR]

Mindfulness meditation and other techniques drawn from Buddhism have increasingly been integrated into forms of psychotherapeutic intervention. In much of this work, mindfulness is understood as a mode of awareness that is present-centered and nonevaluative. This form of awareness is assumed to have intrinsic value in promoting positive mental health and adaptation by interrupting discursive thoughts that give rise to suffering. However, in the societies where it originated, mindfulness meditation is part of a larger system of Buddhist belief and practice with strong ethical and moral dimensions. Extracting techniques like mindfulness meditation from the social contexts in which they originate may change the nature and effects of the practice. The papers in this issue of Transcultural Psychiatry explore the implications of a cultural and contextual view of mindfulness for continued dialogue between Buddhist thought and psychiatry. This introductory essay considers the meanings of mindfulness meditation in cultural context and the uses of mindfulness as a therapeutic intervention in contemporary psychiatry and psychology. [ABSTRACT FROM AUTHOR]

This paper will reveal our women as active theologians, dealing with the silent threat of approaching genocide, the end of so called ‘full-bloods’ of our race. Finding ways of healing, and being activists, living in the conscious and subconscious oppression. I am so proud that in the light of this, they emerge as responsible people, living constructive and influential lives. Yet the suffering takes its toll and they die young or are sick and disabled young. I donated my Harvard Post-doctoral Fellowship, the first Australian Indigenous Harvard Fellow, to helping this suffering, to prolong life. Part Three reflects where my fellowship in liberation theology and psychotherapy comes together in active Tiddas Theology for wholeness. [ABSTRACT FROM PUBLISHER]

Accumulating evidence suggests that children suffering deprivation and maltreatment at critical times in their development often pay a cognitive toll. While children vary to the extent that neurocognitive domains are affected, those factors influence how children process, manage and understand traumatic and attachment experiences as well as how they respond to treatment. Current research on trauma and attachment favor some aspects of cognition over others. The literature discusses attention, memory, cognitive biases, internal working models, beliefs and attributions as ways that impact an individual’s understanding of experience. Other categories such as working memory, processing speed, verbal, auditory or perceptual processing, metacognitive skills, and cognitive rigidity or flexibility rarely surface. This paper examines what is and is not known about the interface of cognition with attachment and complex trauma and how that knowledge can inform treatment. It explores existing research and offers a case vignette as an example of how that knowledge can be integrated into treatment strategies. [ABSTRACT FROM PUBLISHER]

In this paper, I explore how postmodern ideas about gender may impact on clinicians working with gender variant children and adolescents. The postmodern turn has built on the feminist rejection of the idea of ‘essential’ gender, to further interrogate accepted conceptions of sex and gender and the stability of all identity categories. Some queer theorists have taken a further step, viewing all gender as fictional and artificial and celebrating the subversive potential of transgender identities. However, those working clinically with trans adolescents may experience a troubling tension between, on the one hand, a view of sex and gender categorisations as undecidable and fragmented (as postmodern theory suggests), and, on the other hand, the apparent need of many for a coherent and settled sense of self. In particular, how do we justify supporting trans youngsters to move towards treatment involving irreversible physical change, while ascribing to a highly tentative and provisional account of how we come to identify and live as gendered? I conclude that the meaning of trans rests on no demonstrable foundational truths but is constantly being shaped and re-shaped in our social world. Clinicians must be accountable in this process; far from succumbing to a paralysing relativism, the task for clinicians is to be highly attuned to our young clients’ complex narratives and to question our complex investments in the positions we adopt. [ABSTRACT FROM PUBLISHER]

In this paper, we describe the use of an aim-based outcome measure used in routine outcome monitoring of child and adolescent psychotherapy within a child and adolescent mental health service. We aim to explore the clinical feasibility and implications of the routine use of this measure. We argue that use of the measure provides a simple and useful way of clarifying the focus of the clinical work and reflecting its progress, while also having the potential to illuminate the clinical picture by contributing an additional source of clinical information from a collaborative process with the patient, parents or both. We argue that while there are some cases where use of the measure may be impossible, or even perverse, in general it enhances rather than detracts from clinical work. [ABSTRACT FROM PUBLISHER]

This article provides an introduction to the thematic issue of Transcultural Psychiatry on local responses to trauma. To illustrate how local responses to trauma may be therapeutic, we consider the multiple dimensions or domains that may be targeted by healing rituals and interventions. We then outline a theoretical model of the generation of trauma-related symptoms and distress. We present the multiplex model of symptom generation which posits multiple cognitive, social, and physiological mechanisms by which various triggers can lead to severe distress among trauma victims in acute episodes, and which may be targeted in treatment. More persistent forms of distress can be explained in terms of the effects of persistent mood states and associated modes of cognitive processing and behavior that render individuals vulnerable to chronic symptoms and acute exacerbations. The beneficial effects of healing rituals and interventions may occur, in part, by inducing positive affective states associated with a flexible mind-set. We conclude by summarizing some of the contributions of the papers in this issue to understanding local therapeutic processes of healing. [ABSTRACT FROM AUTHOR]

The article provides an overview of the papers presented during a symposium held in Europe which focus on contemporary clinical challenges of group analysis. The first paper identifies six different areas that have to be taken into account for the practicing psychotherapist. Another paper provides the best basis for addressing the challenges of evidence-based practice in clinical setting. Another paper addresses the challenges for training programs in complying with university quality standards of accreditation.

This paper provides a selective review of the literature on the association between poor relationship adjustment (i.e., relationship discord) and the prevalence, incidence, and treatment of psychopathology. Relationship discord has been shown to covary with a variety of psychiatric disorders and predict the incidence of mood, anxiety, and substance use disorders and increases in depressive symptoms. The association between relationship discord and psychopathology is moderated by several individual difference variables, including variables that have been shown to increase risk for psychopathology. Relationship discord is associated with poorer outcome to individual-based treatments for several common psychiatric disorders, and couple-based interventions have been shown to reduce depression and substance use as well as improve relationship discord. [ABSTRACT FROM AUTHOR]

This paper theorizes how ancient literature can be used to inspire contemporary psychological understanding. We articulate a critical presentism that reads ancient literature symbolically without losing sight of important differences of meaning over time. Although ancient literature may inspire understanding of our present-day concerns, historical text cannot be used to explain contemporary understandings without charges of naïve presentism. A hermeneutics of archetypes is used to theorize a way of using ancient literature that remains critical of presentist claims to knowledge. Without losing sight of important socio-historical differences, the story of The Bacchae is used to illustrate how literature from the past can engender psychological understanding. [ABSTRACT FROM AUTHOR]

This paper examines the tensions between narrative therapy’s self-identification as a Foucauldian poststructural practice, and its attachment to the notion of personal agency. Michael White—narrative therapy’s primary author—used Foucault’s work as a theoretical foundation, moving us to pose a question that White did not address: Can the narrative therapeutic commitment to an agentive subject be sustained alongside White’s loyalty to the Foucauldian notion of power/knowledge and its account of the constituted subject? I argue that while Foucault is often criticized for not making space for freedom or agency, something like an agentive subject is implicit in, even required for, his constitutionalist perspective to work. Working through this problem could be useful for the developing field of narrative therapy. Three proposals are offered as a way of imagining this agentive figure, and their relevance to narrative therapy practice is discussed. [ABSTRACT FROM PUBLISHER]

The paper juxtaposes the cultural mediation of experience through drugs with that performed with text. As a sample of the currently radically changing relations between professional and lay knowledge in the field of drug interventions, the website of a Copenhagen institution for young drug users is discussed. In particular, six different readings are offered of the coexistense of (professional) “facts” and (lay) “narratives”: Taking off from the two opposite, critical-modern readings where one cancels the other, and the parallellist reading that acknowledges the two cultures as simply unrelated, a fourth reading identifies a post-modern convergence between science and common sense. An ideology critique of the pragmatic construction of such common sense reveals it as a disengagement of language from material aspects of practice that produces a dichotomy of authenticity and pretense, and serves to regulate exclusion. This leads to an alternative articulation of the website as contributing to the construction of collectives that challenge the culture of consumption in which addiction is embedded. In conclusion, it is claimed that in order to grasp and facilitate such a more substantial recognition, it is necessary to transcend the standpoint of civil society and embrace a transformative welfare-state collectivity. [ABSTRACT FROM AUTHOR]

Debates about the relationship between culture and gender, and the potential contradictions involved in simultaneously respecting both multicultural and feminist principles and values, have occupied an important place in theoretical discussion in the social sciences and humanities. This paper examines the relationship between gender and culture from the perspective of the psychotherapeutic encounter in a multicultural society, in this case contemporary South Africa. With the help of illustrative case material involving traumatically bereaved women who became subject to cultural ascriptions of maliciousness or murderousness, and where cultural beliefs potentially jeopardized gender rights, mental health and therapeutic recovery, the article argues that the relationship between gender and culture, viewed from a therapeutic perspective, can be seen to present complex conceptual and ethical challenges for the therapist. In addition, the structural, psychological and discursive positioning of the therapist and client in respect of warrants to speak and to accept or contest cultural constructions is recognized as implicated in particular kinds of therapeutic impasses. Both clinical and political concerns are discussed in order to illustrate the intersections between the intrapsychic and the social, as well as between the personal and the political. Two related lines of theory, that of intersectionality (derived primarily from feminist theory) and of psychoanalytic theory, are proposed and juxtaposed as a productive way of thinking about instances in which the interface between gender and culture presents particular kinds of problems in the consulting room for both clients and therapists. The necessity for a particular kind of critical self, group and cultural awareness is proposed. [ABSTRACT FROM AUTHOR]

A usual way of thinking about the relationship between personal construct psychology (PCP) and social constructionism (SC) is treating them as two separate entities that are similar in some aspects, but also very different in others. This paper aims at exploring some of the possible implications of reframing the relationship between PCP and SC. I point to two important implications: treating PCP as a discourse and adding a new metaphor of the person. Finally, I argue that the invitation to reframe the relationship between PCP and SC extends both approaches and offers more than each of them alone. On one hand, it extends and enriches SC theory and points to benefits of applying the PCP “toolkit” to constructionist therapy and research. On the other hand, proposed reframing contributes to PCP theory and points to new ways of addressing social construction in therapeutic conversations. [ABSTRACT FROM PUBLISHER]

Much of what is written in this special issue points to the need for a clinical workforce that has much greater knowledge and skills for working with children with a history of alternate care, including those who are subsequently adopted. Standard child clinical conceptualization, assessment methods, and formulations miss the mark for these vulnerable populations in a number of critical ways. The present paper proposes 10 principles to guide the design of mental health services for children in care, and those adopted from care. Effective specialization in child welfare work by clinical child psychologists, psychotherapists and psychiatrists, requires: (i) specialized knowledge and skills; (ii) a shift from traditional clinical practice to a clinical psychosocial-developmental scope of practice; and (iii) a strong advocacy role. To support such specialized practice, service design should be guided by: (iv) a primary—specialist care nexus, that includes universal, comprehensive assessments; (v) a shift from acute care to preventative, long-term engagement and monitoring; (vi) integration within the social care milieu; (vii) a shift from exclusion to active ownership of these client groups; (viii) normalization strategies; and (ix) alignment of services for these client groups. Finally, it is argued that mental health service provision for these children is strengthened by policy that promotes (x) “whole of government” accountability for their mental health needs. [ABSTRACT FROM PUBLISHER]

I report on the findings of a study into the use of humour in therapy, which forms part of ongoing attempts to identify new ways in which to enhance therapy towards a positive experience for both client and therapist. In contrast to the many clinical papers that deal with the patient's inability to cry and mourn, few discuss the inability to laugh or use wit and humour. Most research points to this behaviour as a maladaptive response and uses humour for developmental assessment. In contrast, this exploratory article describes a single case, where the client revealed a habitually resisted contact through deflection and where she moved from a denial state to full awareness to emotional wellness through the use of humour techniques. Furthermore, it is argued that humour can be taught and used constructively as a coping mechanism in potentially harmful situations. In addition, humour can create awareness with the client, therapist and other users to improve humour capabilities. [ABSTRACT FROM AUTHOR]

This article addresses the subject of sexuality in group analysis, and tries to locate it in a group analytic context. To do so, Foulkes' late paper on the 'Oedipus Conflict and Regression' (1972) is taken as a starting point. It is argued that both Foulkes, and later de Maré have convincingly shown that psycho-sexuality cannot be localized in the body, but has to be located in the group. This basic group analytic assumption has an affinity to certain Lacanian key concepts, namely the concepts of desire and of jouissance. Both are discussed and put into perspective. [ABSTRACT FROM AUTHOR]

Both psychology and psychiatry are dominated by individualistic accounts of paranoia (and, indeed, other forms of distress). As a corrective to these, this paper provides a social account of paranoia grounded in a minimal notion of embodied subjectivity constituted from the interpenetration of feelings, perception and discourse. Paranoia is conceptualized as a mode or tendency within embodied subjectivity, co-constituted in the dialectical associations between subjectivity and relational, social and material influences. Relevant psychiatric and psychological literature is briefly reviewed; relational, social structural and material influences upon paranoia are described; and some implications of this account for research and intervention are highlighted. [ABSTRACT FROM AUTHOR]