The prevalence of stalking of psychological therapists working in primary care by current or former clients

The prevalence of being a victim of harassment or stalking among the general population of the UK is held to be 11.8 per cent. There has been speculation that the prevalence rate would be higher for psychological therapists, as they could be at risk from their own clients. This study analysed the prevalence of job‐related experiences of harassment or stalking in a postal survey of psychological therapists who worked in primary care. The results showed a prevalence rate of more than twice the national average at 24 per cent. The stalkers, who were equally male or female, fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders. The implications of these findings for training and practice are discussed.     

Lorenz Curves: A New Model for the Distribution of Psychiatric Services

The growth of child and adolescent psychiatric services based on the wraparound philosophy raises new questions for medical directors, investigators, and clinicians interested in improving quality of care and outcomes. Typically, quality improvement studies have focused on standardizing care and decreasing variation while community based services following a wraparound model are by definition individualized. To date, little information on how to evaluate such services in a managed care environment has been available. We present one option for evaluating the distribution of medical services and the extent to which providers individualize services for children with severe emotional disorders. Specifically, we (a) review the philosophy and goals of wraparound services, (b) introduce the Lorenz curve as a tool for determining the degree of inequality in service distribution at a given institution, and (c) present a case study on the use of Lorenz curves by a Medicaid Behavioral Health Organization in profiling behavioral providers.     

Improving Health Care Utilization, Improving Chronic Disease Utilization, Health Status, and Adjustment in Adolescents and Young Adults with Cystic Fibrosis: A Preliminary Report

We conducted a randomized clinical trial of a 3-session written self-disclosure intervention for patients with cystic fibrosis (CF). Patients (n = 39) who were at least 15 years of age and diagnosed with CF participated in the intervention. Participants in the intervention arm were asked to write in the health care setting about an important emotionally distressing issue of personal significance for a 20-min period of time and two additional 20-min writing episodes at the patient's home, which were prompted by telephone calls. Patients in the control condition received standard care alone. Findings revealed that the intervention resulted in a reduction of the number of days patients spent in the hospital over a 3-month period. The intervention did not have an impact on physiological (Forced Expiratory Volume and Body Mass Index or subjective markers of health status. These findings extend those of Pennebaker's (cf., J. Smyth, 1998) demonstrating an effect of the written-self-disclosure intervention on health care utilization. These preliminary findings are promising and justify further investigation of the modified intervention in other chronic illness populations.     

Anaesthesia or psychotherapy: Eradicating thoughts or working them through

The author presents two sessions from the analysis of a depressive narcissistic doctor, which are characterised by a mixture of co-operation and pseudo-co-operation. The dialogue is in parts intellectualised, complicated, lifeless and schizoid. Points at which the patient shows surprising insights are then partly denigrated by him, on the basis that change is not to be expected. Semi-lifeless contact assists the defensive claustrophobia that he experiences in meaningful contact. It becomes very clear that he is then afraid of entering into an openly aggressive conflict that entails the existential threat of object loss. However, this has so far been avoided. The secret pleasure in an anal-narcissistic, sadomasochistic addiction to doubt persists in the partial denigration. The patient's artificially maintained self-doubt and doubt of the object reinforce a genuine confusion that consists in never knowing exactly what lies behind the helpful and needed object.     

Exploring the “New” Frontier of Spirituality in Health Care: Identifying the Dangers

Enthusiasm is growing in nursing and medicine for addressing spirituality and religious needs in patient care. We urge caution and stress the need for greater awareness of the dangers involved. The first danger is the lack of any attention given to how informed consent might be relevant to the topic of patient autonomy in spiritual health care decisions. The second danger is that the major health care providers, nursing and medicine, are not adequately educated to provide such care. The third danger is that we have not yet sufficiently clarified the roles of the various providers and as a consequence coordination of quality spiritual care is in jeopardy.     

Brief Report: Safe at Home Base: Working Parents' Reasons for Choice of Home-Based Child Care

The current generation of working parents faces new challenges to the traditional family model. Despite this, they select forms of home-based child care more than any other type of care. Prior data also reveal that parents who use home-based care, center-based care, and family day care all cite quality as the primary reason for their choice. Given the similarity of reason and the difference in care actually used, working parents who use home-based care were interviewed on additional reasons for their choice. These parents lacked confidence in center-based care and preferred their children to receive one-to-one attention. Age of child, cost of care, and availability of centers did not affect choice. These adults seem to be selecting home-based care in an attempt to provide care as close as possible to parental care. They are making a statement on the importance of the home environment even as their participation in the workplace increases.     

Attention-Deficit Hyperactivity Disorder: The Medicalization of Misbehavior

During the past decade, there has been an increase in the diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD). This syndrome, typically diagnosed in childhood, is characterized by inattention, hyperactive motor behavior, and distractibility. Current prevalence rates obtained in various countries generally exceed the 3–5% reported by DSM-IV. Reasons for increased ADHD prevalence include changes in diagnostic standards, overlap between ADHD and other externalizing disorders, nonspecific behavioral criteria, and the rapid effects of stimulant medication on cognitive functioning. However, social, cultural, and economic factors may also contribute to increased diagnosis. ADHD has become a common topic in the lay media. Popular discussions of ADHD may serve as a metaphoric expression of social anxieties, particularly with respect to children. At the same time, ADHD has rapidly become incorporated into a medical model, with emphasis on pharmacological treatment. Reductions in mental health and educational services, as well as economic pressures of managed care, may also contribute to medicalization of behavioral problems. Collaboration between psychologists and primary care physicians can lead to more accurate diagnosis and appropriate treatment of ADHD and related disorders.     

A Christian for the Christians, a Christian for the Muslims! An Attempt at an Argumentum ad Hominem

Schmidt and Egler's critique of Christianity's exclusivist claimto truth rests on two suppositions: (a) that inter-religiouspastoral care for dying patients requires a respect for theircultural backgrounds which necessitates accepting the equalvalidity of their respective (non-Christian) religions, and(b) that exclusivism is incompatible with the Christian love-of-neighborcommandment. In opposition to this critique, (a) the authors'own "pluralist" understanding of Christianity is refuted ontwo levels. First, it leads to inconsistencies in the authors'own (and very adequate) understanding of pastoral care, especiallywith regard to their notion of intolerance, and second, it isirreconcilable with explicit New and Old Testament claims toabsoluteness. In addition, (b) the authors' understanding ofthe way in which "exclusivism" justifies intolerance and missionaryviolence is shown to rest, first, on a secularized reductionof Christianity, i.e., of Christians' own "religious identity"as well as of the Christian way of "helping those in need,"and second, on a merely theoretical (rather than also practical)view of Christians' commitment to God. As a corollary to thatrefutation, a reconsideration of the truly Christian sourcesof obedience and charity is recommended.     

Message in a bottle: a comparative study of spiritual needs of children and young people in and out of hospital

Using the metaphor of a message in a bottle as a framework and sending an S.O.S. to adults, the question of what are the three biggest needs of children and young people was asked. Data consisting of 107 important needs of children and young people was collected from 36 children and young people both in and out of hospital: in hospital by chaplains and other health care professionals, and out of hospital by children and youth work undergraduate students. This was a convenience sample across the United Kingdom with the majority of respondents in the Midlands. The data were coded and then thematically analysed and separately compared to Maslow’s hierarchy of needs. Emotional needs was the largest theme for hospitalised children and young people and relationship needs for the non-hospitalised children and young people. For both groups Maslow’s level 3 need of belonging was the greatest averaging at just over half the needs shared. A discussion of the results of the analyses identifies some ways in which the needs of hospitalised children and young people may differ, identifying some implications for practice.     

Depth of Field: Using photographs and narratives to explore and reflect on ageing

The learning landscape of the higher education environment is changing, with an increased focus over the past decade on how educators might begin to cultivate reflective skills in health professions students. In addition, changing professional requirements demand that health professionals are adequately prepared to practise in today’s complex healthcare systems, including responding to changing demographics of population ageing. In this educational case study, we will share how we (a group of education, medical and nursing academics) developed ‘Depth of Field: Exploring Ageing’ a digital, consumer-driven, interprofessional reflective learning resource that uses photographs, narrative and small-group work to strengthen reflective capacity in current and/or future health professionals.