A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.     

Timescapes of Security: Clocks,Clouds, and the Complexity of Security Governance

This article pulls together the disjointed complexification of security studies. Such analytical overview suggests that the perspective of “timescapes” allows for exploring the complexity that shapes meanings and practices of security and its governance. In this respect, it is the imperative to change that suggests the significance of complexity thinking to security studies—that is, it is alone in taking the discontinuities of global life seriously. Security, in this regard, is not merely about the clockwork of survival, but is redefined through the cloudlike adaptive contingency of “security as resilience.” In this setting, the security governance of complexity is identified through its dancing to the timescaped rhythms of uncertainty, cognitive challenges, complex risks, and exaptation prompted by the heterogeneity of global life.     

Some thoughts and responses to The Francis Report

This response to the report by lawyer Robert Francis into the failure of National Health Service (NHS) care in Mid-Staffordshire is fairly positive about its conclusions but points out that without consideration of personal, psychosocial factors in care, on the ward, in the institution things are unlikely to improve, the report leaves much unconsidered. Francis emphasises that patient care is at the very centre of the NHS, this is obvious but so often forgotten. He comments that the unhelpful blame culture still exists. Missing from Francis’ analysis is a psychological perspective – the systemic factors he mentions are administrative not relational. This response is an attempt to redress the balance in thinking about the improvement of care for patients and of the working lives of staff.     

Frustration and disappointment

The paper describes research on children’s responses to failures of gratification. Although this has always been an important area of consideration in psychoanalytic thinking, arguments are put forward for the child’s actual feelings of disappointment being significant in ways that have yet to be fully realised theoretically and clinically within Kleinian object relations. Since Freud first used the term ‘frustration’, it has been applied in psychoanalysis as a means by which to describe in an undifferentiated way all those responses to failures of gratification that have an aggressive content. It will be argued that, in a context of the historical shift in thinking from drive to relational models, there is now perhaps scope to posit the existence instead of two discrete object relational positions towards such failures of aim – that frustrated responses can be differentiated in important structural and developmental ways from disappointed ones, by suggesting that the former are schizoid, whilst the latter are depressive in quality. To try and begin to test the hypothesis that there might be an object relational distinction between feelings of frustration and feelings of disappointment, selected process notes from two training cases became the subject of a combined piece of clinical and theoretical research. I will outline how this research was undertaken and present the findings that arose from the clinical part of it. With the use of a content analysis, a method for gathering interesting quantitative data about the children’s various responses to the failures of gratification was arrived at.     

The present and absent object—on thinking and the capacity to symbolize

In this paper, Bion's different theories on the development of thinking will be introduced: on the one hand, his theory of thoughts as resulting from tolerance for the absence of the object, and on the other hand, dream thoughts and thoughts as resulting from the presence of the object, originally through the mother's containing function. The effects of failures in this development will be discussed; among other things, a hypertrophy of the apparatus of projective identification at the expense of thinking capacities. Briefly, a comparison will be made between a facilitating relation between container and contained and the oscillation between the paranoid-schizoid and depressive position, which Bion describes as a prerequisite for open symbolizing processes. Bion's theories and concepts will be supplemented by Winnicott's theories on the “creative illusion” and the breast/the mother as a “subjective object” as a precondition for the symbolizing capacity that later develops in the “potential space”. Very briefly, a comparison is made between Winnicott's term “the subjective object” and Segal's term “symbolic equation”. Clinical vignettes are interpolated.     

The cognitive underpinnings of creative thought: A latent variable analysis exploring the roles of intelligence and working memory in three creative thinking processes

The field of creativity has largely focused on individual differences in divergent thinking abilities. Recently, contemporary creativity researchers have shown that intelligence and executive functions play an important role in divergent thought, opening new lines of research to examine how higher-order cognitive mechanisms may uniquely contribute to creative thinking. The present study extends previous research on the intelligence and divergent thinking link by systematically examining the relationships among intelligence, working memory, and three fundamental creative processes: associative fluency, divergent thinking, and convergent thinking. Two hundred and sixty five participants were recruited to complete a battery of tasks that assessed a range of elementary to higher-order cognitive processes related to intelligence and creativity. Results provide evidence for an associative basis in two distinct creative processes: divergent thinking and convergent thinking. Findings also supported recent work suggesting that intelligence significantly influences creative thinking. Finally, working memory played a significant role in creative thinking processes. Recasting creativity as a construct consisting of distinct higher-order cognitive processes has important implications for future approaches to studying creativity within an individual differences framework.     

The role of positive thinking in social perceptions of cancer outcomes

Pressure for ‘positive thinking’ (PT; i.e. focusing on positive thoughts/suppressing negative thoughts to ‘fight’ cancer) burdens cancer patients facing health deterioration. It was determined whether PT exposure enhanced effort, control and responsibility attributions assigned to an individual for his/her cancer trajectory. Within an online blog a hypothetical same-gender person describes a personal cancer experience. 482 participants were assigned to one of six experimental conditions in which we manipulated PT exposure (blogger learns about ‘power of PT’ but does not try it, blogger tries PT, control/no PT) and cancer outcome (successful/unsuccessful treatment). A 3?×?2?×?2 multivariate analysis of covariance (with personal cancer experience covariates) tested PT exposure?×?cancer outcome?×?gender effects on attributions for the blogger's cancer outcome. Results indicate that PT exposure enhanced effort and responsibility attributions assigned to individuals for their cancer outcomes and that responsibility attributions differed as a function of gender. Findings suggest that exposure to the idea of PT may lead to cancer patients being perceived as culpable if they do not recover from the disease.     

The Vatican and Europe: Political Theology and Ecclesiology in Papal Statements from Pius XII to Benedict XVI

The article examines the origins and evolution of the Vatican's political theology and ecclesiology for Europe from Pius XII (especially after the Second World War) and including the pontificates of John XXIII, Paul VI, John Paul II and Benedict XVI. It seeks to examine the continuities of the ‘Idea of Europe’ in papal thought against a background of changing political context – the end of the Second World War, the Cold War, the fall of the communist state system, the emergence of a united but diverse Europe after 1989. The political structures of the continent now include within its geographic sweep Western and Eastern Christian churches which, divided by tradition and modern history, find their relationship a key marker in the contemporary religious identity of Europe. This reality is a significant framework for Vatican thinking on Europe especially for John Paul II and Benedict XVI.