Consulting with gargoyles: applying narrative ideas and practices in counselling supervision

This article explores waysin which narrative ideas and practices might influence supervisory relationships in counselling and psychotherapy,and questions some of the taken-for-granted assumptions implicit within counselling supervision. This paper, which represents ‘work in progress’ towards further conversations, rather than an exhaustive study,is illustrated with stories from the author'sown practice as a supervisor and trainer and educator of supervisors.     

Correspondence

Response to Chess Denman's review of Green, André and Stern, Daniel's Clinical and Observational Psychoanalytical Research: Roots of a Controversy. ( JAP , 46, 3)     

Hydrogen diffusion in ultrafine-grained iron with the body-centered cubic crystal structure

The role of grain boundaries in Fe on hydrogen diffusion has been investigated by electrochemical permeation tests using ultrafine-grained Fe produced by high-pressure torsion (HPT) processing. Permeation tests were also conducted on cold-rolled and water-quenched Fe to understand the trapping effect of dislocations and vacancies. Hydrogen diffusion was delayed in all these discs. However, the delay mechanism in the HPT-processed disc was different from that in rolled and water-quenched Fe. Grain boundaries do not act as trapping sites but slow the diffusion. The diffusion coefficients of hydrogen were significantly decreased by HPT processing on account of the high activation energy for hydrogen diffusion in grain boundaries.     

Code of Ethics of the National Society of Genetic Counselors: Explication of Revisions

The Code of Ethics (COE) of the National Society of Genetic Counselors (NSGC) was adopted in 1992. In 2004, the NSGC leadership appointed the Code of Ethics Work Group (COEWG) to consider revisions to the NSGC COE based on advice from the NSGC legal counsel, and to consider additional changes given growth in the scope of genetic counseling practice since the adoption of the original COE. After input from the NSGC membership, changes to the COE addressing the recommendations of the NSGC legal counsel were approved in December 2004. The COEWG then reviewed ethical codes and codes of professional conduct from 22 professional organizations, deemed to have similar goals and philosophies to the NSGC, searching for themes that encompassed genetic counseling practice that might not yet be addressed in the NSGC COE. Additional revisions to the COE were proposed, and after feedback from the NSGC membership, the revised COE was approved in January 2006 by majority vote of full members of the NSGC. The explications for the 2004 and 2006 revisions are presented.     

So many lifetimes locked inside: reflecting on the use of music and songs to enhance learning through emotional and social connection in Trainee Clinical Psychologists

Music is universal; it can provide a common language that speaks from the heart enabling others to connect with the private felt experiences of others regardless of differences within or between people. This ability to empathise with, and understand, the position of others from differing backgrounds is an important competency within the therapeutic work of Clinical Psychologists. There are many facets to diversity just as there are many facets to music. Diversity in music genres can reflect diversity in people. Indeed, there is music to cater for all tastes, cultural/ethnic backgrounds, gender, age and generations with listening often being guided by individual preferences. In the United Kingdom training to become a Clinical Psychologist consists of a university-based 3-year full time professional research doctorate funded through the National Health Service. Trainees work on placements 3 days a week and attend university for academic and research teaching 2 days a week. As part of the academic programme, Trainees undertake experiential learning through workshops and methods such as Problem-Based Learning (PBL). One of the PBL exercises is based on a typical referral within an Adult Mental Health (AMH) service. For the AMH PBL exercise music is used to enhance trainees’ ability to connect emotionally with the personhood of referrals, consider associated complexities, and to reflect on personal and professional boundaries and reflective practice during training and beyond. This paper reflects on the utility of music and songs to enhance the learning experience.     

Toward Holistic,Compassionate, Professional Care: Using a Cultural Lens to Examine the Practice of Contemporary Psychotherapy in the West*

The author describes work undertaken in New Delhi with two young Indian women and their families from 1995 to 1999. Both presented with depression and suicidal ideation. One was severely cerebral palsied, the other was diagnosed with endogenous depression. As an integrative therapist, the author looks at her work from several perspectives. The debates highlighted here focus on the optimal usefulness of each of these perspectives in different situations, both the benefits and the limits and the very limits of contemporary psychotherapy itself. The author uses a cultural lens to explore the use of the self of the therapist and issues around boundaries, continuity, ethics, and compassion in psychotherapy.*Part of this work has been published in N. Hutnik (1999). An unusual intervention: Disability and abuse. Psychological Foundations - The Journa1, 1, 81–84, and is reproduced here with the permission of Psychological Foundations, New Delhi.**My heartfelt thanks are offered to Reenee Singh, friend of many years and very competent family therapist, who offered me her comments on an earlier draft of this paper.     

Mission,Reconciliation, and the Politics of Place

Through the retelling of some familiar biblical stories – Jonah, Acts 1, Acts 10 – and gospel narratives of inclusion, this paper looks at the transformation of politics and identities made possible by the sending of the Holy Spirit and the mission of reconciliation to which Christians are called. Through an examination of the themes of power, prejudice, partnership, and identity, the paper aims to offer a concrete approach to rethinking the spaces and places where a reconciling mission can be enacted. Central to an understanding of reconciliation are the disruption and transgressing of boundaries in which Jesus engaged. In addition to this, Jesus creates these unique spaces for reconciliation around his very person, and the Spirit leads the church into these same contexts. Finally, selections of John 17 are examined through a biographical lens in order to offer a new understanding of the politics of identity and the surprising contexts where God’s Spirit reconciles all things in Christ.     

Relationships,not boundaries

The authors find it more useful to payattention to relationships than to boundaries.By focusing attention on bounded, individualpsychological issues, the metaphor ofboundaries can distract helping professionalsfrom thinking about inequities of power. Itoversimplifies a complex issue, inviting us toignore discourses around gender, race, class,culture, and the like that support injustice,abuse, and exploitation. Making boundaries acentral metaphor for ethical practice can keepus from critically examining the effects ofdistance, withdrawal, and non-participation.The authors describe how it is possible toexamine the practical, moral, and ethicaleffects of our participation in relationshipsby focusing on just relationships rather thanon boundaries. They give illustrations andclinical examples of relationally-focusedethical practices that derive from a narrativeapproach to therapy.     

Traversing boundaries: clinical ethics,moral experience,and the withdrawal of life supports

While many have suggested that to withdraw medical interventions is ethically equivalent to withholding them, the moral complexity of actually withdrawing life supportive interventions from a patient cannot be ignored. Utilizing interplay between expository and narrative styles, and drawing upon our experiences with patients, families, nurses, and physicians when life supports have been withdrawn, we explore the changeable character of boundaries in end-of-life situations. We consider ways in which boundaries imply differences – for example, between cognition and performance – and how the encounter with boundaries can generate altered meanings important for understanding decisions and actions in these contexts. We conclude that the reliance on mere roles to support the moral weight of withdrawing medical interventions is inadequate. Roles that lead us to such moments are exceeded by the responsibility encountered in such moments. And here, we suggest, is the momentous character of withdrawal: it presents the grave astonishment, the trembling awe, in the not-being-there of the other in death.     

Boundaries in the doctor-patient relationship

Boundaries in the doctor–patient relationshipis an important concept to help healthprofessionals navigate the complex andsometimes difficult experience between patientand doctor where intimacy and power must bebalanced in the direction of benefitingpatients. This paper reviews the concept ofboundary violations and boundary crossings inthe doctor–patient relationship, cautions aboutcertain kinds of boundary dilemmas involvingdual relationships, gift giving practices,physical contact with patients, andself-disclosure. The paper closes with somerecommendations for preventing boundaryviolations.