Eyes wide open: Facilitating student therapists’ experiences with the unfamiliar

Psychotherapists and counsellors work increasingly with culturally different or unfamiliar clients in the context of global migration and relocation. This paper explores the learning processes of trainee therapists within a South African community clinic context which confronts trainees with cultural diversity and a range of complex and traumatic presenting problems. Learning within this context entails interfacing with the ‘unfamiliar’, a process which challenges students both culturally and personally. Drawing upon the ideas of Wilfred Bion we suggest the importance of supervisory reverie in helping students convert raw sensory data into reflective practice. We suggest that working within community clinic contexts prompts personal anxieties as well as context-related anxieties of persecution or annihilation, of narcissistic injury and of contamination. It is hoped that a psychodynamic understanding may prompt further debate regarding the training of therapists working with diverse populations and problems.     

Personal responsibility,empowerment and medical utilization: a theoretical framework for considering counselling and offset costs

The problem of effectively managing patients with functional somatic symptoms remains huge in both primary and hospital care, although the potential benefits of mental health interventions such as counselling or psychotherapy are still not widely accepted. Unfortunately, the cost-effective evaluation of counselling has been beset by methodological problems, which stem from attempting to make comparisons between counsellors with different types of training, therapeutic approach and case mix. Since these real-world variations in counselling practice are likely to remain, it is proposed that a different approach to the evaluation of cost-effectiveness should be adopted in the hope of accelerating acceptance of the value of psychological interventions for the army of patients who are currently labelled as ‘difficult’ or ‘heartsink’ and who do not receive the treatment they deserve from the health-care services. It is proposed that, since the common aim of almost all mental health interventions is to engender or enhance a sense of ‘personal responsibility’ in patients/clients, this core objective should form an agreed ‘yardstick’ against which to evaluate the impact of various mental health interventions. Furthermore, since personal responsibility and future health-care utilization (and associated costs) can be assumed to be directly causally related, it is proposed that offset costs should form the basis for future cost-effectiveness evaluations.     

The rehabilitation of the case-study method

The controversy surrounding the scientific nature of the case-study research method in psychotherapy is not new and can be traced to the time when Freud started publishing his works. Traditional, quantitative researchers have argued thatthe case-study method is anecdotal and non-scientific, dismissing the results and findings obtained by this method on the grounds that they lack validity and reliability.This article seeks to dispel the traditional misconceptions about case study.It conclusively argues that the case study,perceived from the postmodern perspective, is a completely legitimate research method and, moreover, better suited to a holistic, democratic psychotherapy as a discipline dealing with the understanding and change of interwoven complexities of intrapsychic and interpersonal processes that emerge and unfold within a wider socio-historical context.     

An advanced specialist-level training programme in psychodynamic individual psychotherapy of psychotic and borderline patients: the Finnish approach

Most training programmes in individual psychotherapy, including psychoanalytic training are, in practice, restricted to the treatmentof lessdisturbed patients than those who have succumbed to psychotic or severely borderline-level disorders. This has had a delaying effect on the development of psychotherapy with such patients. Psychotherapy of severely disturbed patients is usually regarded as a difficult domain and is often practised only by psychoanalysts or other psychotherapists specially dedicated to working with patients of this kind. Between 1994 and 1997, an advanced multi-professional training programme in psychodynamic individual therapy with an emphasis on borderline and psychotic-level disorders was organized through the Centre for Extension Studies of the University of Turku, Finland, to close the gap in systematic training for the treatment of the most serious psychic disorders, and also to integrate some of the special requirements of public and private psychiatric health care. Here we briefly describe the main elements of our training programme as well as some of our training experiences. It is important to emphasize that the training was not meant to replace psychoanalytic training. It is a question of a separate multi-professional programme based on psychoanalytic premises but with particular objectives of its own.     

The study of organizational behaviour in family business

Family businesses (FBs)—enterprises that are significantly influenced by family members and kinship ties—are ubiquitous and play a crucial role across all world economies. Because of the embeddedness of family and business systems in FB, these organizational forms are theoretically distinct from their non-family counterparts. Curiously, FBs have been largely overlooked in the organizational behaviour (OB) literature. The limited available research at the interface of OB and FB highlights the importance of FB as a unique context to advance OB theories, and of OB as a promising discipline to increase our understanding of FB. In a selective review of literature focused on the four topics of values and goals, leadership and power, trust and justice, and conflict, we discuss how insights from the general theory of communal and exchange relationships open exciting avenues for research at the FB-OB interface. Rich fruits of intellectual harvest await scholars who focus on behavioural research in FB.     

Regulatory focus and the family–work interface: The role of regulatory fit between cohabiting partners

The aim of the present study was to examine the impact of regulatory focus in goal pursuit and regulatory fit between marital partners on family conditions and the family–work interface. We hypothesized that when both partners are high on promotion focus (fit) they experience higher developmental possibilities at home and have an increased likelihood of family-to-work facilitation (FWF). In addition, we hypothesized that when both partners are prevention focused (fit) they experience less home demands and less family-to-work conflict (FWC). In total, 131 working couples participated in the study. Each partner provided information about his/her own regulatory focus, perceptions of home demands and home developmental possibilities, and experienced FWF and FWC. Results of moderated structural equation modelling analyses largely supported our hypotheses since the interaction between partners’ promotion focus predicted the levels of home developmental possibilities and FWF, whereas the interaction between partners’ prevention focus predicted home demands in the expected direction. In conclusion, the fit between partners’ self regulatory styles can influence family life and, consequently, the impact of family on work.     

Patients’ illness schemata of hypertension: The role of beliefs for the choice of treatment

It has long been believed that adult somatic complaints are associated with early family dysfunction. Yet, few studies have examined this hypothesis in community samples, where medically unexplained symptom complaints are estimated to be very common. Given the potential population-wide impact of subthreshold symptom complaints as well as questions about the extent to which findings with patient populations generalize to broader samples of community adults, the present study examines the influence of distal family factors on current adult somatic complaints relative to demographic and other psychosocial predictors. Results based on multiple linear regression analysis indicated that, after controlling for the other variables, family-of-origin functioning did not predict adult somatic complaints. However, self-reported symptoms of current depressed mood and low internal locus of control were significantly linked to somatic complaints (p?=0.001). These results lend support to questions about the generalizability of findings based on psychiatric groups to broader community samples, highlight the robust relationship between contemporaneous attributions of lower internal control, depressed mood, and somatic complaints, and suggest that early family environment may not be the most important focus of attention for health professionals providing care to adults in the community.     

Neighbourhood,school and family determinants of children's aspirations in primary school

Aspirations can be important for young children as well as adolescents. However, there is little research on the determinants of aspirations in young children. We carried out this study to investigate the early contextual (neighbourhood, school and family) determinants of occupational aspirations in primary school children. Our sample comprised children from the Millennium Cohort Study who lived in England in the beginning of our study period (n = 10,086; 5,126 boys). Occupational aspirations were measured at age 7 years, while their contextual determinants were measured in the previous data sweeps, at ages 3 and 5 years. We fitted structural equation models to test the role of family and neighbourhood socio-economic status (SES) and child ethnicity in predicting aspirations both directly and via their associations with parental involvement, household chaos, school-level achievement and child cognitive ability. We found that the only significant determinants of aspirations at age 7 years were family SES and ethnicity, and only in boys. Family SES and ethnicity were also related to parental involvement, household chaos, cognitive ability and school-level achievement, but none of these factors predicted aspirations. Supplementary analysis showed that family SES was a particularly powerful determinant of the aspirations of white compared to non-white boys.     

The Effects of a Multiple Family Therapy on Adolescents with Eating Disorders: An Outcome Study

Multiple Family Therapy (MFT) has gained increasing popularity in the treatment of eating disorders and many programs have been developed over the past decade. Still, there is little evidence in the literature on the effectiveness on MFT for treating eating disorders. The present study examines the effects of a particular model of Multiple Family Therapy on eating disorder symptoms, quality of life, and percentage of Expected Body Weight (%EBW) in adolescents with eating disorders (ED). Eighty‐two adolescents with ED, aged between 11 and 19 years, were assessed before and after treatment using the Eating Disorders Inventory 2 (EDI‐2), the Outcome Questionnaire 45 (OQ‐45) and %EBW. Results showed a significant increase in %EBW between the beginning and end of treatment, with a large effect size. 52.4% of patients achieved an EBW above 85%. Symptoms relative to all EDI dimensions (except for bulimia) significantly decreased during treatment. The three dimensions related to quality of life assessment also improved over the course of MFT. At the end of treatment, 70.7% of patients had a total OQ‐45 score below clinical significance. This study suggests that Multiple Family Therapy may benefit adolescents with eating disorders, with improvement on several outcome measures (%EBW, ED symptoms, and quality of life). However, the lack of a comparison group entails caution when drawing conclusions.