The relationship between childhood adversity,psychiatric disorder and clinical severity: results from a multi-centre study

Although several studies have shown a clear association between childhood adversities and later development of a number of psychiatric disorders, a number of recent reports have cast doubts regarding the aetiological role played by abuse, neglect and loss, arguing that they are neither necessary nor sufficient to account for the development of subsequent psychopathology. In this study, we aimed to investigate the associations and predictive power of childhood adversities on later onset of Axis-I &-II psychiatric conditions and the impact on severity of psychiatric presentation in a large sample of patients. This cross-sectional multi-centre study evaluated patients (N = 1136) recruited in fourteen NHS psychotherapy departments in the UK. Patients were assessed using a number of rater-based questionnaires and self-rated measures. Multiple regression analyses showed that childhood experiences of loss and physical abuse were predictive of severe personality disorder and borderline personality disorder, but not of other less severe PD and Axis-I diagnoses. Sexual abuse predicted later onset of Post-traumatic Stress Disorder. In addition, we found that childhood abusive experiences were strongly associated with severity of psychiatric distress, interpersonal problems and global functioning. Having experienced two or more childhood adversities significantly increased severity of psychiatric distress, interpersonal malfunctioning and CORE scores.     

Book Reviews

Jung, C. G. Visions. Notes on the Seminar Given in 1930–34.
Edinger, Edward F. The Psyche in Antiquity. Book 1. Early Greek Philosophy. Book 2. Gnosticism and Early Christianity.
Margaret Arden. Midwifery of the Soul: A Holistic Perspective on Psychoanalysis. Collected Papers of Margaret Arden.
Rodriguez, Leonardo S. Psychoanalysis with Children: History, Theory and Practice.     

Interviewing a Therapist in the Presence of a Couple: A Description of the Therapeutic Process

A therapy research team interviewed a therapist in the presence of a couple. Following each of six consecutive sessions with a couple, an interviewer posed questions to the therapist and couple. While one question was standard to each interview, other questions were generated by team members who tracked the entire process via live observation. These questions were directed first at the therapist, then at the couple, and then focused on therapeutic process and outcome. Findings of this process for the therapy system included decreasing the hierarchy within the client/therapist relationship; increasing the client ownership and energy in the therapy process; discovering the presence of parallel processes between the systems; and informing the direction of future therapy sessions. Practical, clinical implications are discussed for a variety of therapy settings.     

Contributors to this issue

Geoffrey Blowers
Francis X. Charet
Terence Dawson
David Hewison
John Izod
William E. Kotsch
Patricia Michán
Joe Redfearn
Julieta Besquin Rubinstein
Mara Sidoli     

Seek and ye shall find: test results are what you hypothesize they are

Expert clinicians were given batteries of psychodiagnostic test results (Rorschach, TAT, Draw-A-Person, Bender-Gestalt, Wechsler) to analyze. For half, a battery came along with a suggestion that the person suffers from Borderline Personality disorder, and for half, that battery was accompanied by a suggestion that he suffers from Paranoid Personality disorder. In Study 1, the suggestion was made indirectly, through a background story that preceded the test results. In Study 2, the suggestion was made directly, by the instructions given. The experts saw in the tests what they hypothesized to be there. In particular, the target diagnoses were rated higher when they were hypothesized than when they were not. Copyright © 1998 John Wiley & Sons, Ltd.     

Developing coherence in community and clinical psychology: the integration of idealism and pragmatism

Illustrations of how ideas from community psychology may be integrated with clinical psychological thinking and practice are described from the perspective of a clinical psychologist working in the NHS. The intentions are to consider socially relevant conceptualizations of the causes of people's well-being and distress, and to develop ways of helping individuals and communities to clarify and address these causes. Incorporating an analysis of social power also necessitates a critical awareness of the limited potency of psychological interventions. © 1998 John Wiley & Sons, Ltd.     

Inside it was orange squash concentrate: trainees’ experiences of reflective practice groups within clinical psychology training

Despite many clinical psychology training programmes utilising reflective practice groups (RPGs) to develop reflective practice (RP) skills, there remains little research examining how trainees experience these groups. This study uses interpretative phenomenological analysis (IPA) to explore the experiences of eight qualified clinical psychologists who attended RPGs on one United Kingdom (UK) clinical psychology training programme. A purposive sample was recruited for single, semi-structured interviews. Five superordinate themes were identified: ‘The process: there were so many layers’; ‘The impact: an ongoing process’; ‘Commitment: I hated it, but I still went’; ‘The facilitator: a presence who was not always present’; and ‘Getting through it: finding ways to cope’. The findings illustrate the varied and complex experiences of the participants. Whilst the experience was often difficult, the participants were committed to attending and sought out ways to navigate it. The results are conceptualised in terms of existing psychological theory and literature. A critique of the research and suggestions for future studies are offered, including exploring the views of group facilitators and comparing how groups are utilised within different training programmes. Recommendations are made on the development of future RPGs, which include consideration of the facilitation style and the groups’ frequency and size.