Justification as Declaration and Deification

Theological accounts of the way God justifies sinners often struggle to combine forensic or declarative ideas about justification with transformationist ones. Luther seems to have especially steep problems here, not because he fails to think of justification as transformation – indeed deification – but because his forensic claims seem to take back what he says about transformation. Yet in the end Luther shows how forensic and transformationist ideas of even the boldest sort can cohere. At one level the concept of justifying faith as union with Christ extra nos combines the two, but their deeper unity is trinitarian: it lies in the Father's eternal verdict on the work of his incarnate Son, whose death and resurrection win for us the coming of the Spirit.     

Integrating Narrative Family Therapy in an Outdoor Behavioral Healthcare Program: A Case Study

Adolescent mental health is a significant societal concern in the United States. Diagnosable mental health disorders have been reported at rates of 10–20 % among children and adolescents and this does not include adolescents experiencing personal and interpersonal distress not meeting diagnostic criteria. Adolescents who do not respond to traditional mental health services are often placed in residential treatment centers or other out-of-home treatment programs. Outdoor Behavioral Healthcare (OBH) is growing as a viable treatment option for adolescents who struggle with emotional, behavioral or substance related problems; however, questions have been raised about how to integrate the family into an OBH treatment setting. This article describes a case study illustrating how techniques from Narrative Family Therapy can be used to accomplish this integration, and offers a view of using Narrative Family Therapy to further involve families in the treatment and post-treatment process in an OBH program.     

Addressing the dual relationship problem in forensic and correctional practice

The dual relationship problem in forensic and correctional practice emerges from conflict between two sets of ethical norms: those associated with community protection and justice versus norms related to offender/defendant well-being and autonomy. The problem occurs because forensic practitioners typically have their professional roots in mental health or allied disciplines such as psychiatry, clinical psychology, social work, or law, and as such, often struggle to ethically justify aspects of forensic and/or correctional work. First, the problem of dual relationships will be described and its nuances explored. As will become apparent, the problem extends beyond the straightforward conflict of roles and resides at the very heart of professional practice. It is a core normative conflict created by practitioners varying ethical allegiances. Second, contemporary ways of resolving the dual relationship problem will be briefly outlined, that is, approaches that assert the primary of one set of codes over the other or involve the construction of hybrid ethical codes. Third, after briefly reviewing the shortcomings of these approaches I present a possible way forward drawing from relational ethics and the concept of moral acquaintances.     

Notes on a Journey From Symbols to Multifractals: A Tribute to Guy Van Orden

Rejecting traditional cognitive science put us in a bind. On the one hand, traditional cognitive science is our heritage; our curiosity about the big questions of cognition led us initially to invest in the conventional approaches. On the other hand, we eventually became dissatisfied with the fundamentals of traditional cognitive science. Rather than criticize from the sidelines, we struggled for a new way to address the same problems with a new explanatory framework. Guy Van Orden spurred us forward on 2 counts. First, his work inspired us to consider fractal scaling as a new framework for exploring change in cognitive structure. Second, his provocative contrast between pink and white noises as diagnostic of interactions and components, respectively, intrigued us. Our struggle for a new direction became a struggle to understand what Guy meant and how his ideas might translate within our research domains. Guy helped us to forge a perspective that would have surprised us before, namely, the perspective that cognitive and, more generally, biological structure reflects turbulent flows structured over many different scales with multifractal fluctuations.     

Professional commitment: Does it buffer or intensify job demands?

The purpose of this study is to investigate whether professional commitment can be seen as a moderator in the relationship between job demands and emotional exhaustion among Norwegian nurses. Inspired by the job demands‐resources model, this study explores whether having a strong commitment to the nursing profession can be seen as a resource that buffers the effect of job demands on emotional exhaustion or, conversely, intensifies the impact of job demands. A survey that comprised Norwegian nurses who had graduated three years previously (N = 388) was conducted. Multiple regression was performed to test the hypothesis. The results provide support to a buffering effect; thus, individuals with a higher degree of professional commitment conveyed a weaker association between job demands and emotional exhaustion compared with nurses with a lower degree of commitment. Developing a better understanding of the potential buffering effect of professional commitment is of great interest. The present study is the first to utilize professional commitment as a resource within the job demands‐resources framework.     

HELPLESSNESS AND THE ANALYST’S WAR AGAINST FEELING IT

In our view helplessness is a primal, often intolerable feeling. It underlies and intensifies other feelings that are also hard to bear. Both analyst and patients face helplessness, and both resort to defenses, often intensely, in order to avoid it. The intensity of this battle can merit calling it a war. The analyst’s war is conducted using distancing, anger, blaming and disparaging as well as by intellectualizing the patient’s struggles. Patients then find themselves abandoned and helplessly alone. We analysts, of course, want not to fall into the trap of war, and we try to free ourselves from waging it. A major way we accomplish this is through continuously working, often with the help of analysis and self-analysis, to increase our capacity to maintain our emotional stability in the face of these intensities. We learn to find new forms of awareness, beyond words and ideas. It requires a new understanding of what is threatening to us, which fosters a deeper capacity to empathize with the patient. This helps us to find the psychic, physical and emotional space within ourselves in which to hold our helplessness and other profound affective experiences. In this way we become an increasingly steady resource for our patients as well as for ourselves.     

Interpreting our emotions

This essay looks at the important, but often neglected, contribution that self-interpretation makes to emotional self-knowledge. We engage in acts of self-interpretation when (A) we try to understand what it is that we are feeling, or, relatedly, what it is that we ought to be feeling. On such occasions, we draw upon social and personal narratives as well as on the emotional conceptual repertoires at our disposal. We also engage in acts of self-interpretation when (B) we try to ascertain the meaning or significance of an emotion, treating it as a datum, or piece of evidence, upon which to make inferences or further Interpretations. Although we often seem to have first-person privileged access to our mental states, the third-person strategy of self-interpretation can be a valuable source of self-knowledge. I focus here upon the role that self-interpretation plays in providing us with knowledge about our emotional experiences.     

Recognition of selfhood as struggle

The experience of selfhood is that of struggle, between conflicting demands, inevitable dilemmas, and shifting allegiances toward deciding what is for us. The complex nature of this struggle often makes the boundaries between health and sickness ambiguous. Therapeutic work is significantly dependent on the capacity to engage with such struggles. This is illustrated by two striking examples of successful work, as well as my own two analyses, and other clinical material.     

Nietzsche and the dilemma of suffering

In this paper, we attempt to view a long-held assumption in nursing as mistaken. That is, that patient suffering is something to be overcome. Utilizing Nietzsche's statements on Amor Fati, we carefully examine the cultural assumptions behind our denigration of suffering, look at specific nursing examples of this situation, and attempt the beginnings of a discourse on what it would take for nurses to overcome their own predetermined views of suffering in order to better help their patients "own" their own suffering.     

Interpretation as Shaped by Projective Identification

How to make interpretations during the course of psychoanalytic treatment is a recurring clinical question. Certain aspects of the analysis serve as helpful signposts along the way. Patients have particular interpersonal ways of presenting themselves. The unique intrapsychic manner the patient has of relating to us (transference) and our feelings (countertransference) to these matters give us clues to study. Our understanding of these situations may lead to the development of a hypothesis we may or may not choose to share with the patient. Projective identification is a complex mental mechanism that can often shape the content and manner of an interpretation.     

Dynamic interpersonal therapy in an NHS tertiary level specialist psychotherapy service

We describe the introduction of dynamic interpersonal psychotherapy (DIT) into an National Health Service (NHS) tertiary psychoanalytic specialist psychotherapy service. Training in DIT began as our contribution to Improving Access to Psychological Therapies and primary care services, supporting the training and supervision of their DIT practitioners. We then discovered DIT could be a valuable treatment within our own tertiary NHS service for patients with complex presentations. Currently fighting for survival, like many NHS psychoanalytic psychotherapy services nationally, we have adopted a manual-guided, psychoanalytically based therapy to broaden our tertiary clinical psychoanalytic service and accommodate trends in mental health service provision, whilst protecting the quality and integrity of our psychotherapy. DIT helped us continue providing relevant and beneficial psychoanalytic and psychodynamic services to individual patients despite limitations of the financially challenged NHS, NICE guidelines and Payment by Results. We outline the progress and outcomes for patients with complex mental health presentations, include individual case discussion and our experience of using the DIT approach within a traditionally longer term psychoanalytic psychotherapy service.     

Lower back pain in nurses working in home care: linked to work–family conflict,emotional dissonance,and appreciation?

In industrial countries home care services for elderly people living in the community are growing rapidly. Home care nursing is intensive and the nurses often suffer from musculoskeletal pain. Time pressure and job control are job-related factors linked to the risk of experiencing lower back pain (LBP) and LBP-related work impairment. This survey investigated whether work-family conflict (WFC), emotional dissonance and being appreciated at work have incremental predictive value. Responses were obtained from 125 home care nurses (63% response rate). Multiple linear regression showed that emotional dissonance and being appreciated at work predicted LBP intensity and LBP-related disability independently of time pressure and job control. WFC was not a predictor of LBP-related disability in multiple regression analyses despite a zero-order correlation with it. Redesigning the working pattern of home care nurses to reduce the emotional demands and improve appreciation of their work might reduce the incidence of LBP in this group.     

A crisis mental health intervention service: an innovative model for working intensively with young people on the edge of care

This paper describes the setting up and the first year of running of an innovative outreach service for adolescents on the edge of care that aimed at redressing family breakdown and preventing placements in the care system. It was a collaborative endeavour between social services and a child and adolescent mental health provision to facilitate the engagement of hard to reach young people and families that often presented high levels of risk. This article describes a distinctive model of applied psychoanalytic work with individuals, families and the networks of practitioners and agencies around the case. It focuses on the integration of two perspectives: the individual and the family on the one hand and the organisation on the other. Case examples illustrate how our psychoanalytic and developmental framework illuminated our understanding of frequently extreme acting out behaviour and parental difficulties in terms of underlying intergenerational trauma, which was often re-enacted. This framework also helped in understanding the difficulties that practitioners experienced and how these related to individual and family dynamics. The article describes the significance of containment in the treatment of adolescents and families in crisis as well as in supporting the professional network.     

Wo steht der Jugendmaßregelvollzug in Deutschland aktuell?

With up to 67% of all young offenders suffering from mental illnesses, the question of how professional care should be arranged for them arises. The ability to detain a young offender for an indefinite period of time in a forensic psychiatric institution represents the final solution in juvenile law. This currently affects approximately 300 patients nationwide, of which there is precise data available only for patients who were detained before the age of 18. This is due to the differing nationwide organisational structures within specific forensic psychiatric institutions for adolescents. There is currently a lack of forensic psychiatric units in several federal states providing treatment for adolescents. When examining under what basis, and when the relocation of a person from a young forensic psychiatric institution into the corresponding adult one occurred, and how long specific pedagogic facilities were provided to these individuals, the differences between various adolescent forensic psychiatric institutions become apparent. This especially concerns young adolescent offenders suffering from delayed mental development.     

From posts to protection: Ethical considerations regarding forensic psychiatrists and a duty to warn based on social media

Increasing use of social media in forensic mental health evaluations will lead to new challenges that must be resolved by forensic practitioners and the legal system. One such dilemma is the discovery of information that would typically trigger a legal duty and professional ethics obligation for mental health professionals to breach doctor-patient confidentiality to promote public safety and prevent harm to vulnerable third parties. Although the law and professional organizations offer clear guidance for practitioners in the treatment role, there is currently no clarity from the law or instruction from professional organizations on what mental health professionals should do if they discover such information during a confidential forensic evaluation. For example, a forensic evaluator may find evidence on social media of an evaluee’s threats to seriously harm others, abuse of children and the elderly, or severely impaired driving. There are no clear guidelines for how a forensic psychiatrist should respond in these complicated situations. We review the legal concepts and historical evolution of confidentiality, privilege, and mandated reporter duties that forensic practitioners should consider in these legally ambiguous situations. Finally, we discuss ethics frameworks practitioners can implement to determine their most ethical course of action when faced with such dilemmas.     

Zones of Proximal Emotional Development — Psychotherapy Within a Neuroaffective Perspective

This article outlines a conceptual framework for assessing personal and emotional functions of a person’s zone of proximal emotional development. The framework is based on the integrative theory Neuroaffective Developmental Psychology (NADP), which brings together attachment theory, neuropsychology, developmental psychology, and trauma theory. Within the NADP framework, this article describes a way of understanding children’s normal emotional mental organization and of examining how this mental organization may be developed or disturbed by relational issues. It also describes how a child’s mental organization can be disturbed and thus, without intervention, disturb the child’s personality development on a lifelong basis. The article presents three case vignettes, describing three children growing into adolescence with three different attachment patterns and suggested individually tailored intervention plans for each of them, relevant and useful for clinicians working with vulnerable children and families. Because the nervous system retains its plasticity throughout life, attachment is not necessarily an unchangeable pattern. That is why we as clinicians should develop psychotherapeutic methods and a research-based way of determining “what works for whom” by assessing the zone of individual proximal emotional development. The text outlines the characteristics of NADP and how it can be used to structure an intervention plan.     

Suffering–At the Bedside of the Dying

SUMMARY

Care of people at the end of life is a challenge for the person with a life-limiting illness, their family and friends, and their professional carers. Clinicians, including pastoral care workers, nurses, doctors, and allied health professionals, find themselves at the bedside of the dying. At times, the professional's sense of self is challenged both by the suffering that they witness (physical, emotional, existential, social, sexual, or financial) and a sense of helplessness to relieve not only the patient's suffering but also that of the people to whom the dying person is close. What framework can help us to deal with the suffering that we cannot help but encounter? Ultimately people connecting in a real and meaningful way with other people is probably the only way that each of us can confront suffering and not have it destroy us. Creating an environment where people can begin to, or continue to connect with others at a level that is meaningful for all concerned is a pivotal starting point in dealing with suffering in any encounter with people at the bedside.     

Ethical Principles and the Communication of Forensic Mental Health Assessments

Our premise is that ethics is the essence of good forensic practice and that mental health professionals must adhere to the ethical principles, standards, and guidelines of their professional bodies when they communicate their findings and opinions. We demonstrate that adhering to ethical principles can improve the quality of forensic reports and communications. We demonstrate this by focusing on the most basic principles that underlie professional ethical standards and guidelines, namely, Fidelity and Responsibility, Integrity, Respecting Rights and Dignity of Persons, and Justice and Fairness. For each principle we offer a brief definition and explain its demands. Then we identify ways in which the principle can guide the organization, content, or style of forensic mental health report writing, offering illustrative examples that demonstrate or abuse the principle.     

What We Share Is Who We Are and What We Do: How Emotional Intimacy Shapes Organizational Identification and Collaborative Behaviors

We focus on the concept of emotional intimacy among organizational members and investigate its influence on both their (a) perceptions and (b) behaviors. With regard to employees’ perceptions, we test whether it is organizational identification (operationalized as cognitive and affective identification with the organization) that influences emotional intimacy or the reverse. At the behavioral level, we investigate the interplay between employee emotional intimacy and organizational identification and their effects on employee interpersonal helping (OCB-Is; interpersonal organizational citizenship behaviors) and interpersonal conflict (CWB-Is; interpersonal counterproductive workplace behaviors). Based on a three-wave panel study among nurses working in a public hospital, our findings show that emotional intimacy influences organizational identification, and it represents a unique antecedent of OCB-Is and CWB-Is.     

Mental health professionals' support of self‐help groups

Objective. Self‐help groups and other consumer‐led services are viewed as valuable additions to mental health services. This study describes professional support for self‐help groups and examines the hypothesis that professional support of self‐help is influenced by the degree to which professionally‐led groups are viewed as more helpful than self‐help groups. Method. Survey data were obtained from a representative sample of over 900 mental health professionals employed in mental health agencies in a large US State. The survey assessed beliefs, behaviours, attitudes, and intentions toward professional and self‐help groups. Results. Respondents who perceive professionally‐led groups to be significantly more helpful than self‐help groups were less inclined to support self‐help groups through referrals, help in organizing groups, or financially. Conclusion. To the extent that professional support of the self‐help movement is diminished, valuable allies in the struggle to expand the reach of mental health services are lost. It is proposed that mental health professionals should obtain additional information about the benefits of self‐help and the constructive role that self‐help groups can play in expanding the availability and continuum of beneficial mental health services. Copyright © 2001 John Wiley & Sons, Ltd.