Mandatory personal therapy: does the evidence justify the practice? In debate

ABSTRACT

The article addresses the question of whether the practice of mandatory personal therapy, followed by several training organisations, is justified by existing research and evidence. In doing so, it discusses some implications of this training requirement from an ethical and ideological standpoint, raising questions of import for training organisations and highlighting avenues for further research.     

Women's views about intimate examinations and sexually inappropriate practices by their general practitioners

Abstract

The aim of this survey of 472 adult women was to assess women patients' feelings about intimate examinations and their perceptions and experiences of sexually inappropriate medical practice. Two-thirds of women preferred a women doctor for intimate examinations. Slightly more than two-thirds found intimate examinations embarrassing and stressful, and strongly expressed the need for information and on-task, health-related comments during these examinations. General personal comments or non-medical touching were not particularly welcomed, even for the purpose of comforting the patient. There was a range of views about patients' personal relationships with doctors, with the lines between acceptable and unacceptable behaviour somewhat ambiguous. A small but significant number of women perceived that they had been sexually harassed (5%) or abused (3%) by a doctor, with this experience more common for non-English speaking women. Results were discussed in terms of implications for improved doctor practice, particularly during intimate examinations and with vulnerable patients.     

Voices of African Traditional Healers: Cultural Context and Implications for the Practice of Counselling in Sub-Saharan Africa

The healing paradigm implicit in many sub-Saharan African cultures is embedded in African cosmology, and thus the recognition of this is essential for understanding Traditional African Healing practices and implementing collaborative counselling practices. To this end, this article focuses on the cultural importance, or voice, of traditional healers in sub-Saharan Africa. The current article uses an ethnographic approach to analyse systematically the cultural context of indigenous healing practices in sub-Saharan Africa. The anthropological importance of Traditional Healing practitioners, the context of healing, and the changing legal and ethical status of Traditional Healers are addressed as pivotal in furthering the development of this crucial, yet under utilized resource. The authors propose that such cultural understanding is highly relevant to the work of professional counselors.     

Fatherhood today: variations on a theme

Freud explored the concept of the unconscious in some detail in one of his papers on 'metapsychology' in 1915. But this concept is crucial to the birth of psychoanalysis more than twenty years earlier. If we look closely at one of the early cases Freud described in his 1895 book with Breuer, Studies on Hysteria, we can see how that concept was also being born. This paper focuses on the case of Elisabeth von R, to show how the distinctive psychoanalytic understanding of the unconscious was starting to be used there to make sense of her hysterical symptoms. Freud's account and the words he chooses to frame it raise a number of questions about theory and practice in psychoanalysis, which we examine here in relation to unconscious love.     

Learning and teaching (briefly)

This paper was given as the Annual Ellen Noonan Counselling Lecture on July 2012 and retains some of the spoken style of the lecture. It uses examples of Ellen Noonan’s work to examine aspects of the process of teaching and learning psychodynamic practice. The difficulties of how to embed theoretical knowledge with its clinical application are discussed and the question of what are the key skills of the self-reflective practitioner is raised with reference to whether, and how, they can be taught or learnt. It is suggested that part of this process consists in helping students, and their teachers, to be more comfortable with not knowing, a concept that is both counter intuitive and counter cultural. From this aspects of contemporary therapeutic practice, with specific reference to psychodynamic short-term therapy, are addressed. The paper looks at the ambivalence felt by many psychodynamic clinicians towards working within a short-term paradigm in current workplace settings and how this might be addressed. The paper discusses the intrinsic qualities of a psychodynamic short-term approach and its relation to contemporary therapeutic modalities. It is suggested that the increasing managerial culture, leading to the ascendance of protocol driven, manualised and structured therapies, represents an attack on the relational and must be challenged.     

ADHD Assessment

Abstract

This study examined effects of negative versus positive symptom formats on the assessment and subsequent classification of ADHD in children in public schools. Symptoms associated with the disorder based on the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) were presented to parents and teachers of referred children according to both types of formats. Informants were then asked to indicate whether the symptoms described the child's behavior over the last six months. Overall, the negatively phrased symptoms appeared to generate response bias which resulted in an increased percentage of children meeting the DSM-IV criteria for ADHD. Additionally, the decision reliability or classification agreement between the two formats was low, suggesting the possibility of confirmation bias in the assessment process. Implications for practice and future research are discussed.     

Clinical Supervision and Professional Development Using Clients from Literature,Popular Fiction,and Entertainment Media

Abstract

The use of clinical supervision is central to mental health work. In this article, the authors propose using practice cases drawn from characters found in literature, popular fiction, biographies, television, and movies as one method for clinical supervision and professional development in the mental health skill areas of client assessment, case conceptualization, diagnosis, and treatment planning. The method is illustrated with clinical formulations pertaining to four practice clients: Scarlett O'Hara; Maya Angelou's Marguerite Johnson; the fairytale character, Hansel; and the Wicked Queen of Disney's Snow White and the Seven Dwarfs. Applications and limitations of the method are discussed.     

Materials used to support cognitive behavioural therapy for depression: a survey of therapists’ clinical practice and views

ABSTRACT

Use of supporting materials in cognitive behavioural therapy (CBT) is widely advocated, and homework increases effectiveness. The study aimed to identify materials most frequently used by CBT therapists to support CBT for depression, and those perceived clinically most effective. Questionnaires were sent to 3665 accredited CBT therapists asking about their use of resources commonly described in CBT manuals, and their views on effectiveness. Of 3665 approached by post/email, 994 (27%) responded. Another 33 completed the questionnaire via the study website. 818/1027 (80%) of respondents were accredited practitioners who deliver one-to-one therapy. Symptom measures, lists of problems/goals, activity schedules, behavioural activation diaries/plans, and case formulation worksheets were used “frequently” or “very frequently” by over 85% of respondents. Sleep diaries and computerised CBT were used least. Most resources were used within and between sessions. Activity schedules, behavioural activation diaries/plans, case formulation worksheets, thought records, and resources to support the identification of conditional beliefs were regarded as most effective. Symptom measures, sleep diaries, and computerised/online materials were considered only moderately effective. Therapists use a wide range of materials to support individual CBT. For delivering CBT, technology-enabled approaches should incorporate a range of materials to enable therapists to tailor treatment effectively.     

Sole Expression: A Trauma-Informed Dance Intervention

The primary treatment for individuals who have encountered violence and/or abuse is trauma-focused cognitive and behavioral modalities. However, these therapeutic approaches are not always effective for youth who have encountered this type of trauma. Trauma is often communicated through the body via physical ailments, particularly when words are insufficient to capture an individual’s experience or when adequate processing of the trauma is not possible due to profound stress. Dance offers an alternative form of therapy that can address “where” the trauma is held, relieve tension, and restore a sense of ownership with one’s body and mind. In this article, we discuss the development of Sole Expression, a trauma-informed hip-hop dance program for youth who have experienced abuse and/or exposure to violence. We provide an overview of establishing the team, securing funding, trauma training, program curriculum, and the related research. We conclude with recommendations for best practices that benefit both practitioners and the young people served.     

I am happy in my faith: the influence of religious affiliation,saliency, and practice on depressive symptoms and treatment preference

Religion is thought to significantly impact numerous areas of mental health, including depression. Using a 63-item questionnaire, the influence of religious affiliation, saliency, and practice on levels of depressive symptoms and treatment preference in a non-clinical sample of Christians, Muslims, Atheists, and Agnostics (N = 471) was investigated. No significant differences in depressive symptoms were found between affiliations. Saliency and frequency of practice had a weak negative correlation with depressive symptoms for Christians, but were not significant for Muslim participants. No significant differences of preference were found between affiliations for social, cognitive, and medical treatments. Treatment preference of religious-based treatments differed significantly between affiliations. Findings suggest that affiliation is not significantly related to depressive symptoms or treatment preference, and the influence of saliency and practice differs between religions. Limitations and implications of the current study are discussed, and directions for further research are identified.