The person in narrative therapy: a post-structural,Foucauldian account

Having a facial anomaly is more than likely to cause some degree of psychological discomfort. Prior to establishing the most appropriate psychological intervention, there is a need to determine how having an atypical appearance manifests in day-to-day life. Counselling/psychotherapy provides people with the opportunity to talk about their experience - to tell their story. the aim of this heuristic investigation is to determine the lived experience of having a cleft lip and the potential need for counselling/psychotherapy. A heuristic approach was selected as the most appropriate method and one which would enable participants to talk about their experience. It also requires the researcher to have personal experience of the phenomenon. This study highlights the lack of opportunity to talk about how the presence of a facial disfigurement impacts upon life. Even within the family, it seems, the norm was that ‘it' was there, yet not spoken about. Counselling/psychotherapy could therefore provide a form of education. Provision of such a service would give people a choice. A discussion on the limitations of heuristics indicates the importance of the researchers' awareness, of their own experience, in relation to the phenomena being investigated. In conclusion, a counsellor/ therapist is considered to be an essential member of the multi-disciplinary cleft team, caring for persons with clefts from birth to maturity.     

Time and again: Intermittent Brief Dynamic Therapy

Abstract

The author notes that in many of the settings in which Brief Therapy takes place that a client may return after the ending for a further series of sessions. Time-limited therapy has placed an emphasis upon the termination phase of the therapy and linked this to the process of individuation and separation. Such an approach, as articulated by Mann (1973 Mann, J. 1973. Time-limited psychotherapy, Cambridge, MA: Harvard University Press.  [Google Scholar]), which draws conceptually from the work of Winnicott (1965 Winnicott, D. W. 1965. The maturational processes and the facilitating environment, London: Hogarth Press.  [Google Scholar]) and the notion that the infant achieves unit status from the original undifferentiated merger with the mother, is not easily compatible with Intermittent Brief Dynamic Therapy. The work of attachment theorists and Stern (1985 Stern, D. N. 1985. The interpersonal world of the infant, New York: Basic Books.  [Google Scholar]) provide an alternative basis upon which to conceive of the development of the infant. While emphasizing the importance of attending to affects at points of separation and ending, as is evidenced in the work of Della Selva (2004 Della, Selva P. C. 2004. Intensive short-term dynamic psychotherapy, London: Karnac.  [Google Scholar]), such a framework is more readily compatible with the development of Intermittent Therapy, and with the realities of the settings in which much brief work takes place. The author also comments upon the flexibility inherent in Winnicott's own practice of brief consultations, and the implications of this for the development of Intermittent Brief Dynamic Therapy. The paper includes a case study that illustrates this debate and which provides evidence for the therapeutic potency of a form of Brief Dynamic Intermittent Therapy where a dynamic focus maintains a structuring pattern to the narrative over a sequence of several periods of Brief Therapy, spread over a number of years.     

Roth and Pilling's competence framework for clinical supervision: How generalisable is it?

Background: Roth and Pilling's (2009) competence framework for the supervision of psychological therapies was commissioned as a training resource for the UK Government's ‘Improving Access to Psychological Therapies’ (IAPT) programme. Aims: This paper considers the extent to which it reflects current supervisory practice in the UK. Method: Supervisors' opinions of the non‐modality‐specific competences were surveyed using an online survey form and two emailed survey forms. Findings: Regardless of their professional background, participants felt able to identify with the majority of competences surveyed; however, a minority elicited disagreement. Here, findings suggest that those who drew on cognitive and/or behavioural theory, and were members of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) might be more confident in their ownership than others. However, small sample sizes in the email surveys prevent firm conclusions from being drawn. Conclusions: Regardless of the theoretical approach they subscribe to, supervisors should find the framework helpful as a guide to best practice.     

Shame and violence in ‘Starred Up’

Shame plays a powerful role in triggering violence, sometimes with fatal consequences. It is fundamentally important to understand and treat the roots of this aggression and its links to an internal sense of shame. In this paper, I will discuss the contribution of forensic psychotherapy to this project and link it to the excellent depiction of violence, shame and the development of insight and impulse control through psychotherapeutic work in the powerful film, ‘Starred Up’, written by Jonathan Asser and directed by David Mackenzie. At the 2015 Birkbeck summer conference, I was asked to speak to the themes of the film and relate them to my work with violent male offenders and their psychotherapeutic treatment. As a clinical and forensic psychologist and forensic psychotherapist, I have been heavily involved in assessing and treating men and women with violent histories in prisons, mental health services and community settings over the past 25 years. I see the film through the lens of forensic psychotherapy, filtered by my own clinical encounters. I discuss its main themes in relation to the challenges and possibilities of the therapists who work with men with entrenched violence and the underlying issues at stake for the men themselves.     

Brief dynamic counselling: Making the right choice

Abstract

Brief dynamic counselling has become a frequently practised method of treatment. This paper examines the usefulness of short-term therapy for certain clients and describes the relevant selection criteria. However, it is argued that there exists a real danger to the client should they be inappropriately referred for this work. Demands upon therapy services often mean that therapists are under pressure to have a rapid ‘through-put’ of clients. This may lead to some clients being treated in a way that is unsuitable and inadequate for their needs. It is suggested that, more than being inadequate, such a situation could cause additional harm to the client. Professional assessment is considered to be of vital importance. Case material is included in order to illustrate the difference between clients who are likely to benefit from short-term counselling work and those for whom the longer time duration is an essential part of the therapeutic relationship and process. In terms of therapy service provision, the need for flexibility and the need for availability of a variety of treatments are discussed.     

Dyadic Flexibility in Early Parent–Child Interactions: Relations with Maternal Depressive Symptoms and Child Negativity and Behaviour Problems

Lower levels of parent–child affective flexibility indicate risk for children's problem outcomes. This short‐term longitudinal study examined whether maternal depressive symptoms were related to lower levels of dyadic affective flexibility and positive affective content in mother–child problem‐solving interactions at age 3.5 years (N = 100) and whether these maternal and dyadic factors predicted child emotional negativity and behaviour problems at a 4‐month follow‐up. Dyadic flexibility and positive affect were measured using dynamic systems‐based modelling of second‐by‐second affective patterns during a mother–child problem‐solving task. Results showed that higher levels of maternal depressive symptoms were related to lower levels of dyadic affective flexibility, which predicted children's higher levels of negativity and behaviour problems as rated by teachers. Mothers' ratings of child negativity and behaviour problems were predicted by their own depressive symptoms and individual child factors, but not by dyadic flexibility. There were no effects of dyadic positive affect. Findings highlight the importance of studying patterns in real‐time dyadic parent–child interactions as potential mechanisms of risk in developmental psychopathology. Copyright © 2012 John Wiley & Sons, Ltd.     

Chapter 2 Using Self Psychology in Brief Psychotherapy

Abstract

This article seeks to help clinicians make the translation from theory to practice when using self psychology to do brief psychotherapy. After a theoretical overview and review of the literature, a series of organizing questions and frameworks is provided to facilitate the clinician's capacity to apply a self psychological point of view to the understanding and conduct of brief treatment.     

Chapter 1 Pluralism,Pragmatism, and the Therapeutic Endeavor in Brief Dynamic Treatment

Abstract

This article places representative formulations of brief dynamic psychotherapy in the larger context of psychoanalytic thought, reviews relational perspectives that inform contemporary approaches to time-limited treatment, and identifies tasks in continued development of theory, research, and practice. In doing so, it emphasizes the need to consider a broader range of psychopathology, dysfunction, and need in formulations of brief intervention and to develop more flexible and realistic approaches in treatment of vulnerable and underserved populations. The growing emphasis on theoretical pluralism and pragmatism in therapeutic practice generally should facilitate efforts to broaden the base of brief dynamic treatment.