Child psychotherapy then and now

The following is the text of an introductory presentation given on the occasion of the 40th Birthday Conference of the Journal of Child Psychotherapy. It provides an historical overview of the Journal's development, and in particular compares and contrasts the first two issues of the Journal with the two most recent. The importance of research is emphasised.     

Well-suited partners: psychoanalytic research and grounded theory

Abstract

Research is a ‘core activity’ of ‘central importance in improving mental health and social care’ (NIME, CAMHS National Conference, 2005 CAMHS National Conference. January 2005. Research in CAMHS Conference Handbook January,  [Google Scholar]). This paper examines the philosophical issues confronted when considering psychoanalytic clinical research. It is argued that a well-suited partnership can be formed between psychoanalytic clinical research and Grounded Theory. The methodological issues encountered when using Grounded Theory to analyse qualitative clinical data are explored. The well-suited partnership formed between Grounded Theory and psychoanalytic clinical research has the capacity to provide explanatory mechanisms, findings that are translatable to routine clinical practice, and to discover new ways of grouping young people so that they are alike in the most significant aspects of their mental health presentations. This makes further clinical trials more reliable. Psychoanalytic clinical findings are used together with a range of material from different sources to develop concepts and theory that are readily accessible to the wider professional community. Illustrations will be provided from the author's doctoral research into Risk-Taking, Dangerous Behaviour.

Selon l'Institut National de la Santé Mentale en Angleterre [NIME], la recherche est une “activité fondamentale” d'une “importance cruciale pour l'amélioration des soins en santé mentale et dans le cadre social” [Colloque National des Services de Santé Mentale pour Enfants et Adolescents, 2005]. Dans cet article, l'auteur étudie les problèmes auxquels sont confrontés les chercheurs en clinique psychanalytique. Il affirme qu'un partenariat tout à fait opportun peut être établi entre la recherche clinique psychanalytique et la théorie inductive ancrée dans le réel (“grounded theory”). Il explore les difficultés méthodologiques que soulève cette théorie inductive appliquée à l'analyse des données cliniques qualitatives. Ce partenariat tout à fait opportun entre la théorie inductive et la recherche clinique psychanalytique est capable de fournir des mécanismes explicatifs et des résultats qui peuvent être mis en application dans la pratique clinique ordinaire; en outre, il permet d'envisager de nouveaux regroupements par catégorie basés sur les aspects les plus significatifs de la pathologie présentée par les jeunes. Les contrôles cliniques complémentaires sont alors plus fiables. Les observations cliniques psychanalytiques sont associées à un éventail de matériel de sources différentes pour développer des concepts et des théories à la portée de tous les intervenants de ce secteur. L'auteur illustre ses propos à partir de sa thèse de doctorat de troisième cycle portant sur la prise de risque et les comportements dangereux.

Mots-clés: Recherche clinique psychanalytique, méthodologie de la théorie inductive ancrée dans le réel (“grounded theory”), philosophie de la science, psychothérapeute d'enfants, spécialiste de Niveau 3 des Services de Santé Mentale pour Enfants et Adolescents, refuges

Riassunto: La ricerca è ‘attività principale’ di ‘importanza centrale per il miglioramento della salute mentale e dell'assistenza sociale’ (NIME, CAMHS National Conference, 2005). Questo articolo esamina le questioni filosofiche che si incontrano quando si considera la ricerca clinica in campo psicoanalitico. Si sostiene che un buon rapporto di partnership possa essere stabilito tra la ricerca clinica psicoanalitica e la Grounded Theory. Vengono esplorate le questioni metodologiche che si incontrano quando si usa la Grouded Theory per analizzare dati clinici qualitativi. Il rapporto di partnership che si stabilisce tra Grouded Theory e la ricerca clinica psicoanalitica ha la capacità di fornire meccanismi di spiegazione, risultati che sono traducibili nella pratica clinica di routine, e di scoprire modi nuovi di raggruppare i giovani in modo che siano simili per gli aspetti pi[ugrave] significativi della loro presentazione in salute mentale. Tutto ciò rende pi[ugrave] affidabili ulteriori prove cliniche. I risultati clinici psicoanalitici vengono usati con una serie di materiali di origini diverse per sviluppare concetti e teorie che siano facilmente accessibili alla pi[ugrave] ampia comunità dei professionisti. Verrà fornito del materiale dal lavoro di dottorato di ricerca dell'autore sul comportamento di rischio e sul comportamento pericoloso.

Parole chiave: ricerca clinica psicoanalitica, metodologia della Grounded Theory, filosofia della scienza, psicoterapia infantile, Tier 3 Specialist CAMHS, rifugi

Forschung ist eine ‘zentrale Aktivität’ von besonderer Wichtigkeit in der Verbesserung von psychischem Wohlergehen und Sozialfürsorge’ (NIME, CAMHS Nationalkonferenz 2005) Dieser Artikel untersucht philosophische Fragestellungen, mit denen man konfrontiert wird, wenn man psychoanalytische klinische Forschung in Betracht zieht. Es wird argumentiert, dass eine gut funktionierende Partnerschaft zwischen psychoanalytischer klinischer Forschung und grounded theory hergestellt werden kann. Es werden die methodologischen Fragen, auf die man stösst, wenn man grounded theory benutzt, um qualitative klinische Daten zu analysieren, exploriert. Die gut funktionierende Partnerschaft zwischen ‘grounded theory’ und psychoanalytischer klinischer Forschung hat die Fähigkeit, Erklärungsmechanismen und Ergebnisse bereitzustellen, die routinemässig in klinische Praxis übersetzt werden können, und neue Arten der Gruppierung von jungen Leuten zu entdecken, sodass sie sich in den signifikantesten Aspekten ihrer Präsentierung ähneln. Weitere klinische Versuchsreihen werden dann mehr verlässlich. Es werden klinische Ergebisse zusammen mit einer Reihe von Materialien von verschiedenen Quellen benutzt, um Konzepte und Theorien zu entwickeln, die für die weitere professionelle Gruppe leicht zugänglich sind. Es werden Illustrationen aus der Doktorarbeit der Autorin über das Eingehen von Risiko und gefährlichen Verhaltensweisen gegeben.

Keywords: Psychoanalytische klinische Forschung, Methodologie der ‘grounded theory’, Wissenschaftsphilosphie, Kindertherapeut, Kinder-und Jugendpsychiatrischer Dienst, Zufluchtsorte     

Using Community Surveys to Inform the Planning and Implementation of Environmental Change Strategies: Participatory Research in 12 Washington Communities

A number of studies have demonstrated the efficacy of environmental change strategies (ECS) in effecting community-level change on attitudes and behaviors related to underage drinking (Treno and Lee in Alcohol Res Health 26:35–40, 2002; Birckmayer et al. in J Drug Educ 34(2):121–153, 2004). Primary data collection to inform the design of these strategies, however, can be resource intensive and exceed the capacity of community stakeholders. This study describes the participatory planning and implementation of community-level surveys in 12 diverse communities in the state of Washington. These surveys were conducted through collaborations among community volunteers and evaluation experts assigned to each community. The surveys were driven by communities’ prevention planning needs and interests; constructed from collections of existing, field-tested items and scales; implemented by community members; analyzed by evaluation staff; and used in the design of ECS by community-level leaders and prevention practitioners. The communities varied in the content of their surveys, in their sampling approaches and in their data collection methods. Although these surveys were not conducted using traditional rigorous population survey methodology, they were done within limited resources, and the participatory nature of these activities strengthened the communities’ commitment to using their results in the planning of their environmental change strategies.     

The Position of Metapsychology in the Formation of Psychoanalytic Knowledge and the Concept of “I” (Ego)

Psychoanalysis is unique in that competence in the field can be achieved only through applying the method to oneself. Different psychoanalytic schools differ in their understanding of the unconscious, about how to approach it, or how to define the specificity of the psychoanalytic interaction. Consequently, there are differences in the criteria for the definition of the ‘good-enough analysis’. There are many different opinions about how to select candidates, organise the curriculum and length of training. To define psychoanalytic talent is difficult; the uncertainty in the definition of criteria to use for selection is great; the problematic overlap between personal analysis and training is constantly present; to achieve conditions in which learning and creativity can develop is complicated by trainee, supervisor and their relationship to the Institute. Confrontations about training are often heated and divergent, as well as repetitive. Systematic studies about psychoanalytic education are very few. After a short discussion of the different concerns about selection, personal versus training analysis and the ambiguities of the supervisory situation, the author gives a review of three studies on how psychoanalytic education—as viewed by trainers and trainees—is conducted and experienced at the Swedish Psychoanalytic Institute. Training is felt to be well grounded in theory and tradition; nonetheless most do not have a sufficiently clear picture of training as a whole. Both candidates and trainers see the development of a psychoanalytic identity as the goal of training, where the competencies to be acquired are equated with important personality qualities. The candidates have a feeling of “being chosen"; they “wish to belong to a group who share an interest and fascination for psychoanalytic thinking and theory". All praise the warm and open atmosphere, and the mutual and continuous evaluations and the deep involvement of all. The surge to be rooted in an overreaching psychoanalytic ethic, the culture of gratitude within the Institute and the devotion to the task to train psychoanalytic clinicians for the future may preserve an idealised image of psychoanalysis and the fantasy that psychoanalysts are exceptional persons and give a mystifying colour to the psychoanalytic profession. This might also stand in the way of a more radical change in the traditions of training—according to the rather drastically changing climate in which psychoanalysts of the future will have to work.     

Recovery of affect and structural conflict

This paper deals with fragmented or dispersed affects states with special reference to deep depression. The clinical material presented consists of two patients; a seriously depressive man, and a female patient with a schizoaffective psychosis which has been treated and followed up by the author since the end of the 60s. The hypothesis is that, in a serious depression, as well as in traumatic states in general, the genuine affect tends to be dissected into its two constituents: a diffuse bodily excitation and dismantled drive-instinctual urges devoid of affective meaning. The author arrives at the conclusion that the analytic situation represents a metaphorical frame where the recovery of affect becomes possible when the disruptive experiences of the past are dealt with in the transference. The integration of affect signifies a major structural achievement, making the perception of reality possible without sacrificing affective experience and genuine interest in life. The author deals with the foundations of the structural theory and proposes that the early frame of primary identification comes to play a crucial rôle in the advanced psychic organisation. On the one hand, it carries the capacity of psychic representation and metaphorical thinking. On the other hand, as projected onto the future, it defines the frame of the ego-ideal and forms the basis for metaphorical interpretation of the superego demand.     

The Evidence Base for Occupational Therapy in Mental Health: More Systematic Reviews Are Needed

To shape its work, the Research Centre for Occupation & Mental Health is interested in research priorities. Systematic reviews develop an overview of the research available about an intervention, which can provide evidence to underpin practice. They also however, identify gaps in the knowledge base and so are useful for research-prioritization exercises. A rigorous literature search identified only four systematic reviews about occupational therapy in mental health, which suggests that more are needed to underpin practice. This article also explains a six-stage process for conducting a systematic review that can be used by occupational therapists in mental health.     

A Qualitative Study of Community–University Partnerships That Support Psychosocial Occupational Therapy

Community partner voices are important to understand because they provide the contexts in which occupational therapy (OT) students research community-identified needs and together, create evidence-based occupation-focused programs while developing clinical reasoning skills in a natural context. The purpose of this study is to understand how community partners experienced partnerships that support community-based research in psychosocial settings. This retrospective study explores the perspectives of community partners that hosted OT students for two-semester service-learning project over 3 years. Findings revealed partners value effective communication with faculty and students, spending time observing, listening, and developing meaningful relationships with clients and staff.     

Natural character: psychological realism for the downwardly mobile

Nancey Murphy recently offered a proposal for altruistic self-renunciation as the core theory of a Christian research program in psychology. Her argument intersects with recent concerns in moral psychology that theory should be constrained by the lives of ordinary people, an idea known as psychological realism. This article considers limitations for altruistic self-renunciation through research with L’Arche assistants for the developmentally disabled. Incipient, “natural” character is evident through the ambivalence of these everyday altruists, creating a difficult methodological challenge for the psychological realist. Consequently, a novel approach for the mathematical analysis of subject narrative is explored with the use of a powerful computational linguistics program.