Mandatory personal therapy: does the evidence justify the practice? In debate

ABSTRACT

The article addresses the question of whether the practice of mandatory personal therapy, followed by several training organisations, is justified by existing research and evidence. In doing so, it discusses some implications of this training requirement from an ethical and ideological standpoint, raising questions of import for training organisations and highlighting avenues for further research.     

Psychometric evaluation of the eating disorder inventory (edi) in a clinical group

Abstract

This study examined the psychometric properties of the Eating Disorder Inventory (EDI) with a clinical sample of 79 female clients seen at an outpatient eating disorder program. The means and standard deviations for the bulimia nervosa subgroup in this study (n = 48) compared favorably with the bulimia group in the EDI Manual Supplement (1986) on all eight subscales, except Drive for Thinness. The present non-student sample had significantly lower scores on this particular subscale than did the norm group (mostly students). Another difference was that the local bulimic subgroup had significantly higher present and minimum weights (as a percentage of the expected average weight according to height). The EDI subscales also displayed respectable internal consistency reliability with this sample. In contrast to previous research, however, only five factors were found in a factor analysis rather than eight corresponding to the original subscales for the EDI. Differences between bulimic and a not-otherwise-specified (NOS) diagnostic groups were also found on both the EDI Ineffectiveness and Bulimia subscales (NOS had lower scores). The results of this study are discussed in terms of the importance of undertaking local standardization of tests in clinical settings.     

Women's views about intimate examinations and sexually inappropriate practices by their general practitioners

Abstract

The aim of this survey of 472 adult women was to assess women patients' feelings about intimate examinations and their perceptions and experiences of sexually inappropriate medical practice. Two-thirds of women preferred a women doctor for intimate examinations. Slightly more than two-thirds found intimate examinations embarrassing and stressful, and strongly expressed the need for information and on-task, health-related comments during these examinations. General personal comments or non-medical touching were not particularly welcomed, even for the purpose of comforting the patient. There was a range of views about patients' personal relationships with doctors, with the lines between acceptable and unacceptable behaviour somewhat ambiguous. A small but significant number of women perceived that they had been sexually harassed (5%) or abused (3%) by a doctor, with this experience more common for non-English speaking women. Results were discussed in terms of implications for improved doctor practice, particularly during intimate examinations and with vulnerable patients.     

Computer-Assisted Therapies: Examination of Therapist-Level Barriers to Their Use

Despite enthusiasm in the field for their potential ease of dissemination, little work has examined whether practicing clinicians are willing and able to use computer-assisted therapies (i.e., computerized treatments designed to be administered with therapist support). For therapists to use these tools, they require access to computer equipment, the skills needed to use the equipment, and willingness to adopt the technology in treatment. This study examined these three factors using survey data from a national sample of mental health clinicians (N = 1,067). Respondents reported on their access to technology and computer fluency, in addition to completing the Computer-Assisted Therapy Attitudes Scale (CATAS), a measure of therapist attitudes designed for this study. Overall, the majority of therapists (90.7%) reported access to at least one computer at work and self-reported computer fluency levels were high. On average, therapists held positive attitudes towards computer-assisted therapies, although expressed concern that these technologies might damage rapport and did not feel that these technologies would improve treatment outcomes. Predictors of positive attitudes included greater general openness toward new treatments, greater comfort with computers, and easier access to technology at work (all ps < .01). Results suggested that, on the whole, therapists may be likely to integrate computer-assisted therapies into their clinical practice. However, therapists vary both in their ability and willingness to use these tools. Implications for the dissemination of computer-assisted therapies are discussed.     

Voices of African Traditional Healers: Cultural Context and Implications for the Practice of Counselling in Sub-Saharan Africa

The healing paradigm implicit in many sub-Saharan African cultures is embedded in African cosmology, and thus the recognition of this is essential for understanding Traditional African Healing practices and implementing collaborative counselling practices. To this end, this article focuses on the cultural importance, or voice, of traditional healers in sub-Saharan Africa. The current article uses an ethnographic approach to analyse systematically the cultural context of indigenous healing practices in sub-Saharan Africa. The anthropological importance of Traditional Healing practitioners, the context of healing, and the changing legal and ethical status of Traditional Healers are addressed as pivotal in furthering the development of this crucial, yet under utilized resource. The authors propose that such cultural understanding is highly relevant to the work of professional counselors.     

The evolution of the primates: Anglicanism,primacy and conciliarity

Contemporary debate about the relationship between civil and religious law, highlighted by the Archbishop of Canterbury's 2008 lecture on ‘Civil and Religious Law in England’, prompts a reassessment of the place of ius divinum in the understanding of the nature of law. This article questions the assumption of modernity that there is no place for divine law, and briefly surveys the different role played by divine law in Judaism, Islam and Christianity. It examines the contrasting Christian perspectives of Aquinas and Duns Scotus, which leads to a critique of the relationship between personal welfare and the common good. Since, in the context of post-modernism, questions related to divine law are once again being addressed, the article criticises aspects of a fundamentalist approach to it in both Islam and Christianity. It argues that, from a Christian perspective, the personal truth of Jesus Christ embodies the place where the divine freedom comes into relation with human freedom. It concludes that in reflecting on a common praxis for humanity, it is this embodied relationship which provides the basic perspective for practitioners of canon law to contribute in a significant way to the debate now gathering momentum.     

Learning and teaching (briefly)

This paper was given as the Annual Ellen Noonan Counselling Lecture on July 2012 and retains some of the spoken style of the lecture. It uses examples of Ellen Noonan’s work to examine aspects of the process of teaching and learning psychodynamic practice. The difficulties of how to embed theoretical knowledge with its clinical application are discussed and the question of what are the key skills of the self-reflective practitioner is raised with reference to whether, and how, they can be taught or learnt. It is suggested that part of this process consists in helping students, and their teachers, to be more comfortable with not knowing, a concept that is both counter intuitive and counter cultural. From this aspects of contemporary therapeutic practice, with specific reference to psychodynamic short-term therapy, are addressed. The paper looks at the ambivalence felt by many psychodynamic clinicians towards working within a short-term paradigm in current workplace settings and how this might be addressed. The paper discusses the intrinsic qualities of a psychodynamic short-term approach and its relation to contemporary therapeutic modalities. It is suggested that the increasing managerial culture, leading to the ascendance of protocol driven, manualised and structured therapies, represents an attack on the relational and must be challenged.     

‘I download my prayer schedule’: exploring the technological mediation of Islamic religious practice at work

The practice of daily prayers in Islam and how observances such as Ramadan fall each year follow specific solar or lunar calendars different from the Gregorian calendar of UK work places. Identifying the time for daily prayers and finding a place to practise is a skilled activity requiring ways to ascertain the correct (and changing) time and a place in which prayer can take place. In the absence of traditional mediation such as the call to prayer broadcast from a local mosque, new, often technologically innovative, approaches are being adopted. This paper reports on a study of how Muslims practise and negotiate the difficulties of performing daily prayers in a UK university. Though technological mediation is a significant aspect of daily prayers, it is but one part of a complex practice which often involves multiple technologies and multiple ways of working.     

Using Stories in Dynamically Oriented Clinical Social Work

Abstract

This paper uses concepts from discourse analysis to understand the meaning making functions of narrative in clinical treatment and to describe the interactive processes through which these functions are achieved. “Negotiative” and “heuristic” narrative processes are described as they occur in ordinary conversation. The relevance of these concepts to clinical practice is then explored using case material.     

Failure to Mentalize: Defect or Defense?

ABSTRACT

The author reviews current thinking on the phenomena of failure to mentalize and provides an alternative to the structural defect point of view. Also included are some clinical implications of this alternative viewpoint.