Fatal violence – from trauma to offence: A case study in forensic psychotherapy and trauma therapy with a migrant patient

Abstract

That persons who are objects of violence and traumatisation become offenders themselves is a typical feature of ill-fated cycles of violence in countries torn by fierce political, ethnic, and religious conflicts. Some refugees and migrants with this background present a challenge to forensic psychotherapy when they continue such patterns of physical force and criminal behaviour in a host country like Germany, and are found to be either not responsible or of diminished responsibility for their criminal acts by reason of mental disorders or addictions. Their offences create a critical legal situation for them, since they are threatened with deportation. At the same time, their clinical condition is critical, for they were possibly subjected to traumatic experiences by authorities in their past; their cooperation in the treatment can seriously affect their legal status. Finding a way out of these complications has to take these special factors into account. Our paper focuses on the case study of a refugee from North Africa, illustrating a model of cooperation in forensic inpatient treatment, special trauma therapy (narrative exposure therapy), and expert testimony.     

Reflective team and process-oriented supervision – a case study on differences

To meet the Swedish healthcare legislation’s requirements for evidence-based care, a work model for reflection has been developed, called a reflective team (RT). Because this RT model can be perceived as either a competitor of or a complement to caring supervision, this case study aims to explore what distinguishes these two in psychiatric care. Five members of one RT who are psychiatric nurses with previous experiences in caring supervision were interviewed. The transcribed interviews were analysed according to phenomenography. The findings reveal three qualitatively separated categories, which describe differences in focus, competencies, and relationships between confirmation and demands. It is concluded that an RT by no means replaces supervision. Instead, both can contribute to care improvement by complementing each other and increasing the professionalism of psychiatric nurses.     

What makes interruptions disruptive? A study of length,similarity, and complexity

Summary Classic work on interruptions by Zeigarnik showed that tasks that were interrupted were more likely to be recalled after a delay than tasks that were not interrupted. Much of the literature on interruptions has been devoted to examining this effect, although more recently interruptions have been used to choose between competing designs for interfaces to complex devices. However, none of this work looks at what makes some interruptions disruptive and some not. This series of experiments uses a novel computer-based adventure-game methodology to investigate the effects of the length of the interruption, the similarity of the interruption to the main task, and the complexity of processing demanded by the interruption. It is concluded that subjects make use of some form of non-articulatory memory which is not affected by the length of the interruption. It is affected by processing similar material however, and by a complex mentalarithmetic task which makes large demands on working memory.     

A multiple case study of teachers’ visions and reflective practice

Researchers have found that teachers’ visions of what they hope to instill in their students beyond curricular objectives are integral to their instruction and to larger decisions such as their career paths. The purpose of this research was to examine 10 in-service teachers, who taught in different geographic locations across the United States, their visions, and the ways in which these visions influenced their reflective curricular decisions and instructional actions. The researchers describe salient dimensions of visions, the actions teachers reported to enact visions, and the distance and tensions in enacting visions. Researchers used grounded theory and constant comparative analysis to analyze interviews, questionnaires, and artifacts. Findings explore the relationship between teachers’ visions and reflective practice as well as the alignment of instructional practices teachers report in supporting their respective visions. Implications for future research, theory, and practice are discussed.     

Development of a Brief Version of the Social Anxiety – Acceptance and Action Questionnaire

The Social Anxiety – Acceptance and Action Questionnaire (SA-AAQ; MacKenzie and Kocovski 2010) is a 19-item self-report measure designed to assess acceptance and action specific to social anxiety symptoms. The present research was designed to evaluate an abbreviated version of the SA-AAQ. This abbreviated scale was confirmed using an undergraduate sample (N = 148) in Study 1 and a clinical sample of individuals with social anxiety disorder in Study 2 (N = 137). Results indicated that an eight-item, two-factor model (acceptance and action) provided a good fit for the Brief SA-AAQ in both samples. Finally, we also found preliminary evidence in support of the convergent, discriminant/divergent, and incremental validity of the shortened scale. The Brief SA-AAQ shows promise as a useful and brief tool for the measurement of acceptance of social anxiety symptoms in socially anxious populations.     

Narrative responsibility and moral dilemma: A case study of a family’s decision about a brain-dead daughter

A brain death case is presented and reinterpreted using the narrative approach. In the case, two Japanese parents face a dilemma about whether to respect their daughter’s desire to donate organs even though, for them, it would mean literally killing their daughter. We argue that the ethical dilemma occurred because the parents were confronted with two conflicting narratives to which they felt a “narrative responsibility,” namely, the responsibility that drives us to tell, retell, and coauthor the (often unfinished) narratives of loved ones. We suggest that moral dilemmas arise not only from conflicts between moral justifications but also from conflicts between narratives and human relationships.     

A review of: “Philosophy and psychotherapy”

E. Erwin (1997) Philosophy and Psychotherapy, London: Sage, pp. 192, $37.50 (hb), $12.95 (pb)     

Extinction of a phobia of physical examination in a seven-year-old mentally retarded boy—A case study

Counterconditioning is a process in which aversive stimuli that ordinarily evoke emotional or avoidance responses are paired with positive stimuli which evoke incompatible activities. Several sets of operations have been employed to induce these incompatible activities (e.g. food, Jones, 1924; relaxation. Grossberg, 1964; positive imagery, Lazarus and Abramowitz, 1962; pharmacological agents, Friedman, 1966; laughter, Ventis, 1973).Although the Counterconditioning process has been successfully applied to a wide variety of emotional disorders, special problems arise when the procedure is applied to the mentally retarded. First, because of the limitations in cognitive abilities, it is generally impossible to train the subject in either relaxation or positive imagery processes. Consequently, it is necessary to place the child in direct contact with the anxiety-inducing situation. Secondly, it is often difficult to find an anxiety-free situation which is incompatible with the anxiety-arousing situation and which can be practically implemented, particularly when the phobia involved is complex.The purpose of this paper is to describe a case whereby a phobic response of physical examination by male doctors in a 7–yr-old mentally retarded boy was extinguished by pairing the examination with an anxiety-free situation, i.e. an extremely comfortable relationship between the patient and a nurse on the ward. Previous research had indicated that parents and people who have positive relationships with a person might possibly serve as effective anxiety reducers in fear-provoking situations (Jersild and Holmes, 1935).     

Bicycle helmets – A case of risk compensation?

Several studies have shown that bicycle helmets have the potential of reducing injuries from accidents. Yet, no studies have found good evidence of an injury reducing effect in countries that have introduced bicycle helmet legislation. Two of the most promising explanations for why helmet laws do not work as intended are risk compensation and shifts in the cycle population as a response to the law.The present article investigates whether the lack of effect of helmet wearing laws is due to risk compensation mechanisms or population shifts (i.e. discouraging cyclists with the lowest accident risk, and thereby increasing the overall average risk per cyclist). A random sample of 1504 bicycle owners in Norway responded to a questionnaire on among other things helmet use, bicycle equipment use, accident involvement, cycling behaviour and risk perception. Data were analysed by using structural equation model (SEM). The results show that the cyclist population in Norway can be divided into two sub-populations: one speed-happy group that cycle fast and have lots of cycle equipment including helmets, and one traditional kind of cyclist without much equipment, cycling slowly. With all the limitations that have to be placed on a cross sectional study such as this, the results indicate that at least part of the reason why helmet laws do not appear to be beneficial is that they disproportionately discourage the safest cyclists.     

Principles Behind Definitions of Diseases – a Criticism of the Principle of Disease Mechanism and the Development of a Pragmatic Alternative

Many philosophers and medical scientists assume thatdisease categories or entities used to classify concrete cases ofdisease, are often defined by disease mechanisms or causalprocesses. Others suggest that diseases should always be definedin this manner. This paper discusses these standpoints criticallyand concludes that they are untenable, not only when `diseasemechanism' refers to an objective mechanism, but also when`mechanism' refers to a pragmatically demarcated part of thetotal ``objective' causal structure of diseases. As an alternativeto principles that use the concept of disease mechanism oranalogous concepts, a pragmatic approach is suggested anddescribed. This approach has been suggested before, but inproblematic or inadequate versions. This paper proposes a versioncompiled of two ``pragmatic principles' and shows that they aremuch more adequate than the principle of disease mechanism. Withreference to a case study of a still ongoing internationaldiscussion of various candidates for a classification system formalignant lymphomas, including REAL (Revised European–AmericanClassification of Lymphoid Neoplasms) in which the concept ofdisease mechanism or analogous concepts plays a very small part,it is shown just how pivotal these two pragmatic principles canbe in actual discussions of definitions of diseases. Finally, itis pointed out that with regard to modern philosophy of languageit may, at least in some cases, be problematic to distinguishbetween the two pragmatic principles as they stand.     

Psychoanalytic inpatient psychotherapy of depression – Two naturalistic samples throughout the course of a decade

Background: While the general effectiveness of psychodynamic inpatient psychotherapy has been established, very few studies have specifically investigated the effectiveness of psychodynamic inpatient treatment of depression, though depressed patients represent the largest group of inpatients.

Method : This study investigated two naturalistic samples of depressed patients regarding treatment outcome as well as clinical and treatment characteristics. Patients were treated in a psychoanalytical psychosomatic hospital unit. Data was collected from 2000 to 2002 (N=234) and from 2008 to 2010 (N=514). Data was acquired at admission and discharge.

Results: The findings reveal high pre-post effect sizes for symptom reduction (SCL-90-R), general functioning (GAF) and medium changes of interpersonal problems (IIP). The improvement on the IIP was significantly higher for patients with comorbid personality disorder. Based on therapist ratings, the sample treated from 2008-2010 showed higher levels of impairment on several levels: chronic, complex, functional (GAF) and structural (OPD).

Conclusion: Findings indicate that patients show substantial short-term benefit following psychoanalytic inpatient psychotherapy, as practiced under naturalistic conditions. Open questions remain regarding the long-term nature of these benefits and the possible influence of placebo-effects.     

Humour and the super-ego: A case study of Paul Muldoon’s poetry

This article focuses on the workings of ‘humour’, a phenomenon that is often neglected in Freudian readings of literature, and also (perhaps relatedly) in the analysis of work with patients. Challenging views that the details of humour are best left uninterpreted, it explores how they can provide a mode of access to what is important. In particular, it focuses on the idea of Galgenhumor (literally ‘gallows humour’) in Northern Irish verse. The Ulster poet Paul Muldoon provides a ‘case study’ of someone using considerable humour while facing political atrocities. I aim to show that Muldoon can be viewed as a useful chronicler of ‘the Troubles’ and that a Freudian view of his humour can help readers to appreciate his significance. The method of the article is to interpret some of Muldoon’s verse by applying Freudian theory, working on the basis that poetry can sometimes achieve its effects in ways that are obscured to both the reader and the poet. I have not set out to psychoanalyze Paul Muldoon through a reading of his poems, but rather to stage a discussion of ways that humour can work, making use of Freud’s theories about the unconscious, especially his writings on humour. I examine how humour can create an outlet for affect while simultaneously assisting its repression, and also how it can leave memorable traces of traumatic experience, making it easier for the experience to become available for retrospective examination and exploration.     

The Other As Shamer Scale – 2: Development and validation of a short version of a measure of external shame

External shame arises from the perception of negative judgements about the self in the mind of others and is currently measured by Other As Shamer Scale (OAS). This scale has been used in numerous studies. This study sought to develop a valid and reliable shorter form of the scale, called OAS2, in an adult sample of 690 participants, using experts’ item ratings and Confirmatory Factor Analysis. The OAS2 consisted of 8 items, which replicated the unidimensional structure of the OAS (Matos et al., 2011) and revealed a good fit. The OAS2 had good internal consistency (.82), similar to the longer version. The OAS2 has good concurrent and divergent validity, being highly correlated with the OAS (r = .91). The OAS and OAS2 have very similar significant correlations with measures of internal shame, psychopathology and anger, with no significant difference between them. Our results, suggest that the OAS2 is an economic, valid and reliable measure of external shame.     

What makes a saint? A Lincoln case study in the communion of the local and the universal Church

Within the curtilage of Lincoln Cathedral lie buried the remains of three very different people to whom sainthood has been attributed: Saint Hugh, Bishop of Lincoln (d.1200); 'Little Saint Hugh' (d.1255), a child maliciously alleged to have been murdered by the local Jewish community; and Edward King (d.1910), Anglican Bishop of Lincoln. Hugh is a saint of the Catholic Church, commemorated by Catholics and Anglicans; 'Little Saint Hugh' was for a short while acclaimed by local people as a saint but never officially recognised as one; Edward King is commemorated by Anglicans but not formally recognised as a saint. The marked difference of approach to the attribution of sainthood between local Christians and Catholic Church authorities, as well as between Catholics and Anglicans, is illustrated by this case study, which raises important ecumenical questions: 'What makes a saint?’, ‘How are non-Catholics to regard the Roman Catholic procedure for beatification and canonisation?’, ‘To what extent can there be fully ecumenical calendars of local saints?’, ‘Does beatification offer a way forward by which Catholics may recognise the holiness of non-Catholic Christians?’     

Development and Validation of the Parental Authority Questionnaire – Revised

Baumrind's conceptualization of parenting style has influenced research and theorizing about child-rearing for more than 30 years, yet few clinical applications of this work have been realized. The purpose of this study was to examine the psychometric properties of a parenting style measure, the Parental Authority Questionnaire – Revised (PAQ-R). This project furthered the development and validation of the instrument by examining the factor structure, internal consistency, test-retest reliability, and convergent validity of the PAQ-R in a large, ethnically and socioeconomically diverse sample. The factor structure and reliability of the PAQ-R was modest, but generally within the acceptable range. Specifically, the Authoritarian and Permissive subscales of the PAQ-R had modest reliability and convergent validity; these PAQ-R subscales correlated with relevant subscales of the Parenting Scale and the Parent–Child Relationship Inventory. By contrast, the Authoritativeness subscale had poorer psychometric properties when used in lower SES, primarily African American populations. While African American mothers in the sample reported being more Permissive than did Caucasian mothers, these differences disappeared after controlling for income and maternal education. By contrast, African American mothers continued to report more Authoritarian attitudes even after controlling for income and maternal education.     

The politics of a conversion – the case of Robert Isaac Wilberforce

Robert Isaac Wilberforce (1802–1857) was an Anglican archdeacon and a supporter of the Oxford Movement. This article claims that his conversion to the Roman Catholic Church in 1854 had theo-political dimensions. To Wilberforce the constitutional establishment of the Church of England was not only a question of political pragmatics. His sacramental vision of the Church and his diagnosis of the actual ecclesiastical situation in England as ‘Erastian’ meant that his conversion could be seen as an act of existential political theology. His conversion is a strong suggestion that the Oxford Movement needs to be considered both as a spiritual and a political force in nineteenth-century England.     

Do private gestures have a self-regulatory function? A case study

One of the most fascinating phenomena in early development is that babies not only understand signs others direct to them and later use them to communicate with others, but they also come to direct the same signs towards themselves in a private way. Private gestures become "tools of thought". There is a considerable literature about private language, but almost nothing about private gestures. Private gestures pose an intriguing communicative puzzle: they are communicative, but with the self. In this paper we study two types of private gestures (signs) before language: (1) private ostensive gestures and (2) private pointing gestures. We show in a case study of one child between 12 and 18 months of age that both are used with a self-reflexive function, as a way of "thinking" what to do, in order to solve a problem in the conventional use of an object. The private gestures become self-reflexive signs.     

A review of: “Challenges to counselling and psychotherapy”

Alex Howard (1996) Challenges to Counselling and Psychotherapy, London: Macmillan, $11.99