Three Views of Artful Practice in Psychosocial Occupational Therapy

This qualitative study explored artfulness in the psychosocial practice of three occupational therapists through in-depth observation and interviews. Analysis focused on the therapist-client relationship, activity use, self-reflection, and the change process. Each therapist established an interpersonal connection while offering meaningful, engaging activities. In addition, each brought a distinct and unique personal view to treatment. Findings suggest that the art of practice in occupational therapy is constructed by the therapist's integrated balance of substance, form, and vision to achieve a coherent whole, which positively influences the personal views of substance, form, and vision in clients.     

Beyond Hopelessness

Abstract

The researchers conducted a needs assessment survey of practicing school-based occupational therapists to determine the incidence of grief within existing caseloads, current awareness of the issue, related concerns, and willingness or resistance to address grief in the intervention environment. The survey was administered to a representative sample of 150 school-based therapists throughout the state of Ohio. Fifty-six therapists responded with usable data.

The results suggest that the students who are currently on occupational therapy (OT) caseloads face a large number of grief issues. Although a majority of therapists reported addressing grief issues, only a small percentage typically do so for a variety of reasons. The school therapists offered a number of explanations for the limited follow-through on this issue. These findings support the profession's recent efforts to further establish occupational therapy as a well-recognized and respected provider of interventions to address the mental health and psychosocial needs of children in school settings.     

Being ordinary in extraordinary places: Reflective practice of the total situation in a total institution

This paper examines a ‘Foulkesian type’ Balint group for psychiatry trainees set in a high secure forensic hospital. Within a Balint group, group processes and dynamics are not examined. Deviation from this format is construed as resistance, and destructively getting in the way of the primary task.

This paper reports on a case‐based reflective practice group operating on a more Foulkesian group analytic model and argues that the revised principles of method proposed here – paying attention to context; group processes; and creating an atmosphere where group curative factors are in play – can help trainees to sustain an emotional reservoir for their patients. Further, these principles do not get in the way of the primary task but can add to an understanding of the individual transference and counter‐transference issues, and can place these in context within the organization and society. This is particularly important in total institutions such as forensic units.

Clinical material from this group is used to support this claim.     

The Psychology of the persecutor — With reference to Costa Gavras's film Music Box

This paper is based on the author's interpretation of the film Music Box by Costa Gavras. The external and internal preconditions in the development of a persecutor are discussed in an attempt to understand the process from a socio-psychological as well as psychoanalytic viewpoint. During crises of a social nature, earlier coping strategies lose their validity, resulting in a narcissistic blow to the individual's ego. Earlier repressed primitive aspects of the personality are reactivated. When the individual is exposed to a totalitarian ideology which promises salvation from anxiety, paranoid processes become anchored and may dominate.

The protagonist in the film is approached as a case-study. By reviewing his present and past actions, the process by which the young man became a persecutor is exemplified as well as the long-term effects upon his object relations.     

The embodied analyst: from Freud and Reich to relationality

This paper presents the impact of clinical supervision on once-weekly psychoanalytically-informed training psychotherapy. The development of Oedipus complex theory is presented, culminating in Britton's work on the triangular space that opens up by working through the complex. The geometry of psychic space is described to highlight the importance of supervision, especially when training in therapy. The theme of spiders and cobwebs emerging from the clinical material provides a powerful metaphor for the tensions in psychic space. In the course of this training, the trainee therapist was at times less able to benefit fully from supervision, and thus the third position partially collapsed. Vignettes from anonymised clinical work are presented in the three ‘phases’ of this therapeutic process, illustrating the impact of the presence – and relative absence – of supervision.     

Critical Issues in Causation and Treatment of Autism: Why Fads Continue to Flourish

The increasing incidence of autism and the lack of specific answers regarding causation have given rise to unproven educational interventions and medical treatments. Parents of a newly diagnosed child can easily fall prey to interventions that promise cures. These interventions may be harmful and, thus, pose one of the critical issues in special education today. This article will discuss some of the suspect interventions that have been popularized through the media (i.e., celebrities, journalists, and professional organizations). The authors argue that using the scientific method is clearly the antidote for pseudoscience; the need for accurate research-based decision making is apparent.     

Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base

For many years psychoanalytic and psychodynamic therapies have been considered to lack a credible evidence-base and have consistently failed to appear in lists of ‘empirically supported treatments’. This study systematically reviews the research evaluating the efficacy and effectiveness of psychodynamic psychotherapy for children and young people. The researchers identified 34 separate studies that met criteria for inclusion, including nine randomised controlled trials. While many of the studies reported are limited by sample size and lack of control groups, the review indicates that there is increasing evidence to suggest the effectiveness of psychoanalytic psychotherapy for children and adolescents. The article aims to provide as complete a picture as possible of the existing evidence base, thereby enabling more refined questions to be asked regarding the nature of the current evidence and gaps requiring further exploration.     

Revisiting ‘What works for whom?’: A qualitative framework for evaluating clinical effectiveness in child psychotherapy

This paper describes a framework for evaluating the effectiveness of child psychotherapy used by child psychotherapists in an inner city Child and Adolescent Mental Health Service (CAMHS). The Hopes and Expectations for Treatment Approach (HETA) involves using the assessment for psychotherapy that normally precedes treatment to derive a baseline from which to generate a set of hopes/expectations as regards the effects of the treatment on the part of parents and the psychotherapist, to be revisited one year after the start of the psychotherapy and/or at its completion. The Strength and Difficulties Questionnaire, for parents and schools, was also administered before and after the treatment. The characteristics of the first 30 children referred for psychotherapy over a particular time period are described. Of the first 15 children in this group to complete one year of individual psychotherapy, all showed change or significant change in the areas concerning parents' and therapists' hopes at the end-of-year review, as rated by parents and psychotherapists. A case of a child with conduct disorder is used to describe how the assessment generated a psychoanalytic formulation, how the therapist's understanding was fed back to the parents, and how the parents' and therapist's hopes and expectations were derived and recorded. This case illustrates powerfully the impact of trauma in the parents' backgrounds on the internal world of the child, and how the method provides a useful bridge between parent and child work. Feedback from the psychotherapists, the parents and the referrers using the framework is reviewed, and in conclusion the paper argues for the framework's value in promoting good practice in the treatment and management of complex cases and in enhancing awareness of the nature and scope of the psychotherapy process.     

Conceptualizations of Social Class in Afrtican American Women:

This article addresses the multiple definitions of social class in African American people and how the therapist's understanding of these definitions is important in therapeutic interventions with African American women. The article discusses: (a) the traditional ways in which social class has been defined in social science and the limits of these conceptualizations; (b) the multiple definitions of class within the African American community; and (c) treatment concerns for African American women based on class issues. Clinicians working with African American and other women who vary by class should be able to assess how class variables influence their therapeutic interventions with these women.     

Fostering Feminist Principles in Our Community

SUMMARY

In a recent focus group discussion at the Feminist Therapy Institute conference participants outlined a vision for a future community based on feminist principles. It is built on five critical ideals, including more equitable distribution of resources, genuine respect for human diversity and varying world views, caring and compassionate members, increased connections and collaborations, and political/personal empowerment. While the challenges inherent to such vision must be acknowledged, greater attention will be placed on ways in which we can begin to foster environments and micro communities that are conducive to feminist practice and ideology.