MAKING ROOM FOR MADNESS IN MENTAL HEALTH: THE IMPORTANCE OF ANALYTICALLY‐INFORMED SUPERVISION OF NURSES AND OTHER MENTAL HEALTH PROFESSIONALS

In this paper, I discuss the importance of psychoanalytically informed supervision and training of nurses and other professionals in mental health settings. Using examples from supervision groups I will illustrate how a psychoanalytic approach to mental health can complement other ways of thinking about practice and management. Psychoanalysis provides a framework for understanding the relationship between the internal world of the patients, the therapeutic relationship and the social system. I will also argue that this understanding helps to develop and maintain therapeutic factors while reducing the risk of damaging behaviour and beliefs.     

BEING DRIVEN MAD: TOWARDS UNDERSTANDING BORDERLINE AND OTHER DISTURBED STATES OF MIND THROUGH THE USE OF THE COUNTER‐TRANSFERENCE

In this paper material is presented from supervision groups run for nurses and other mental health professionals. The patients presented to the group came from different mental health settings with a diagnosis that included borderline features and/or other disturbed states of mind. All of the patients described caused strong counter‐transference feelings of sympathy, confusion, anger, hopelessness and guilt. Although these views were not expressed in formal ward rounds or recorded in clinical notes, evidence of their influence could be seen in the staff's attitude toward these patients. In supervision groups staff would either say that the patients were victims of mistreatment or they adopted a rather moralistic tone saying, ‘the patient is attention‐seeking’, ‘manipulative’ or ‘not mentally ill’. Psychoanalytic supervision which puts the transference and counter‐transference relationship at the centre of practice can help staff to think about their feelings and digest them in a way that makes use of them as evidence rather than discarding them as purely subjective. It also helps to reduce the toxic effects of the patient's projections upon the clinician's mind and this in turn helps to reduce retaliatory or manic clinical decisions. In this paper I argue that staff teams need time to reflect on their practice in handovers and clinical meetings and that psychoanalytic supervision can offer a particularly valuable clinical perspective on patients with Borderline features. This sort of support should be seen as an essential part of the work of nurses and other mental health professionals rather than an unaffordable luxury.     

Screening for malingering in a criminal-forensic sample with the personality assessment inventory

In this study, the authors examined how overreporting of psychopathology indices on the Personality Assessment Inventory (PAI; L. C. Morey, 1991) performed as screening measures for malingering in a sample of 166 defendants undergoing pretrial court-ordered evaluations in the federal criminal justice system. Using results from the Structured Interview of Reported Symptoms (SIRS; R. Rogers, R. M. Bagby, & S. E. Dickens, 1992) as the criterion measure of malingering, the authors found that the Negative Impression scale (NIM) was the most effective PAI screening measure (cut score > or = 81 T). NIM performed as well as an established comparison measure from the Minnesota Multiphasic Personality Inventory--2 (J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989; Infrequency [F] cut score > or = 95 T), supporting the use of either of these indices as reasonable screening measures to identify potential malingerers for subsequent evaluation.     

Did she mean to do it? Acquiring a folk theory of intentionality

The ability to both identify and explain others’ intentional acts is fundamental for successful social interaction. In two cross-sectional studies, we investigated 3- to 9-year-olds’ (n = 148) understanding of the folk concept of intentionality, using three types of intentionality measures. The relationship between this type of reasoning and false belief and interpretive mind understanding was also examined. Judgment of the appropriateness of an explanation was based on adult responses (n = 20). Overall, the results indicated that the ability to both identify and appropriately explain a range of intentional acts does not fully emerge until 7 years of age or later. The pattern of explanations revealed the gradual development of a folk concept of intentionality. Preschool- and early school-age children focused on the protagonists’ desires and actions, whereas 8- and 9-year-olds and adults were more likely to reference the protagonists’ awareness and skills.     

Flexibility of Established Habit

(Geldard, Frank A. The Human Senses. New York: Wiley, 1953. Pp. 365.) Reviewed by John Paul Nafe.