Existential themes in the treatment of people at suicide risk. Understandings and practices of specialist healthcare professionals

ABSTRACT

This qualitative study focuses on the ways in which existential themes were understood and addressed in therapeutic relationships with patients who had attempted suicide. Health care professionals (HCP) from Norway specialist healthcare participated in focus groups. The interviews were transcribed and analysed by systematic text-condensation through a four-step procedure. We found that the HCPs emphasised the context-specific functions of their departments. They considered these conversations essential but demanding. They indicated existential themes of hope/hopelessness, loneliness, meaning, life/death, shame, religion and suicide. The HCPs’ understandings of themes deemed to be existential and how they should be addressed were primarily based on clinical experience. This appeared to exacerbate the pressure on their personal involvement, leading to the question of whether patients’ existential needs are tackled or instead disappear into a conversational vacuum. The study suggests that HCPs' professional competence of existential themes pertaining to patients at suicide risk needs to be strengthened.     

Redefining dementia care barriers for ethnic minorities: the religion–culture distinction

Barriers to healthcare services experienced by black and minority ethnic (BME) persons with dementia are labelled as “cultural” in existing research. This is a promising shift from an ethno-centric approach to dementia care provision, yet very little research is dedicated to specifically how religion – as distinct from culture – influences healthcare practice. Further consideration of the religion–culture distinction is required; religion and culture are two distinct entities, which inevitably interlink. Cultural themes such as “God's will”, “Religious Ritual” and “Religious Duty”, warrant re-categorisation as “religious”. Sensitivity to the nuances between cultural and religious themes will provide clearer knowledge of how and why BME persons with dementia experience barriers to accessing care services. Further research is needed with regard to the role of religion specifically on dementia care access for BME persons to aim to improve care provision for this underrepresented demographic.     

Number perseveration in healthy subjects: Does prolonged stimulus exposure influence performance on a serial addition task?

Perseverative behavior characterizes mainly patients with severe psychopathology, but it can also be observed in healthy individuals. The aim of the reported experiment was to investigate a serial addition task that elicits strong perseverative behavior in normal subjects by examining the significance of perseveration in the final step of this addition task (Gardner, 1971) as a function of time availability. The classical serial addition task, which was used in the experiment, consisted of 4 consecutive digit decreases in the added numbers following a constant digit (1,000 + 40 + 1,000 + 30 + 1,000 + 20 + 1,000 + 10) and required an additive calculation. The main questions were how and if color and time variations could influence perseverative responses in this task and whether memory performance and relevant mathematical knowledge of the participants could have an effect on responses. The sample of subjects participating in the experiment consisted of 300 healthy university students (112 male, 188 female) ranging from 17 to 40 years of age. They were divided in 5 groups of 60 subjects each. A memory digit span and spatial test were administered and relevant scores were taken for each subject of the 5 groups. Obtained results suggest the presence of a strong perseverative error in the final step of the presentation of digits for the large majority of subjects and for all 5 conditions. It seems that time and color changes and the memory span of the participants have no detectable effect on performance on this specific serial addition task.     

Costs and Benefits in Item-Method Directed Forgetting: Differential Effects of Encoding and Retrieval

This study examined how encoding and retrieval factors affected directed forgetting costs and benefits in an item-method procedure. Experiment 1 used a typical item-method procedure and revealed a levels-of-processing effect in overall recall. However, the deep encoding condition showed a smaller directed forgetting effect than the shallow encoding conditions. More importantly, “remember” (R) words were selectively rehearsed as indicated by greater recall from the primacy portion of the list and more apt to be recalled before “forget” (F) words. Experiment 2 showed that a deep encoding operation reduced directed forgetting costs and that directed forgetting benefits occurred only when R words were recalled before F words. These findings supported the hypotheses that encoding manipulation affected directed forgetting costs and that directed forgetting benefits were associated with output order bias. Results were discussed in terms of mechanisms that produce item-method directed forgetting.     

Extending the Knapsack: Using the White Privilege Analysis to Examine Conferred Advantage and Disadvantage

This article describes a self-awareness activity that utilizes a directed reading on privilege and a small-group discussion format to examine unearned disadvantage and unearned advantage in one’s life. This exercise can help clinicians to better understand systemic and individual sources of power and privilege in society. Beginning with my previous work on white privilege, students can extend this analysis to other domains of privilege, including, for example, gender, class, sexuality, age, nationality, and physical ability, to name a few. The primary goals of this reflective exercise are to help clinicians understand how clients’ lives are influenced by societal disadvantages and advantages, to encourage a new understanding of oneself, and to increase empathy towards clients.     

My Recency,Our Primacy: How Social Connection Influences Evaluations of Sequences

Individuals have many life experiences (e.g., work and vacations) that consist of a series of interconnected episodes (i.e., temporal sequences). Assessments of such experiences are integral to daily life in that they facilitate future planning and behaviors for individuals. Therefore, these experiences often culminate in evaluations of their global affect. Past work has shown that retrospective, affective evaluations of these sequences generally exhibit an “end effect,” whereby a sequence's end intensity—but not its start intensity—is disproportionately weighted. Yet, researchers have largely investigated experiences that occur alone. In contrast, many real‐world experiences vary in their extent of social connection to others (e.g., working in an office with others versus alone in a cubicle). The present work fills this gap by showing the moderating role of social connection on how episodes are weighted in global affective ratings. Five studies involving two autobiographical experiences spanning several days each (workweek and spring break) and two brief simulated experiences show that high social connection leads to greater (lesser) weighting of the first (last) episode. To our knowledge, we are the first to demonstrate that these effects persist across different forms of social connection (i.e., interpersonal interaction versus semantic priming tasks) and are supported regardless of whether social connection occurs at encoding or retrieval of an experience. Copyright © 2015 John Wiley & Sons, Ltd.     

Classification of Planning and Violent Behaviours in Serial Homicide: A Cross‐National Comparison Between South Africa and the US

Recent literature suggests that different ‘styles’ of homicide will most appropriately be reflected in the different types of behaviours committed by offenders during the crime. In the last few years, there has been a move to standardise classification systems of single homicides and establish their cross‐national generalisability. Literature on serial homicide to date has mostly centred on homicides occurring in the US. However, national differences due to factors such as culture, national identity, political, and socio‐economic circumstances may decrease the applicability of these models or certain aspects thereof in other countries and thus must be evaluated. The present study tested the applicability in the South African context of a recently developed US‐based serial homicide crime scene classification framework. Specifically, this study compared the thematic differentiation in planning and violent behaviours that the offenders engage in and how this differentiation compares with that in the US. The sample consisted of 25 homicides that were in total responsible for the murder of 267 victims. Results indicated that overall, the framework is useful and applicable in the South African sample, but important environmental and contextual constraints must be taken into account. Copyright © 2014 John Wiley & Sons, Ltd.     

South African Serial Homicide: Consistency in Victim Types and Crime Scene Actions Across Series

Key to understanding the significance of behavioural evidence for linkage purposes is in establishing how consistently an offender displays the same or similar behaviours across their series. There have however to date been very few studies aiming at identifying salient components of offending behaviour that can be used reliably for linking individual crimes as part of a single series. In addition, studies that have been conducted have all dealt with serial homicide in the Western world and have been based on small samples of cases from each country. Some of the recent literature has started to disentangle some of these salient features, notably the victim, violence levels, control, and planning. The current study focused on evaluating the consistency of these features across series, using a sample of serial homicides from South Africa consisting of 30 offenders with a total of 283 victims and 235 crime scenes. Results indicate that the level of interaction with the victim may be influential to the stability or instability of offending patterns across the series. How offenders approach planning in their offence also showed a certain degree of consistency, with patterns of violence being the least consistent across the series of all components tested. Copyright © 2014 John Wiley & Sons, Ltd.     

Linking Crimes Using Behavioural Clues: Current Levels of Linking Accuracy and Strategies for Moving Forward

The number of published studies examining crime linkage analysis has grown rapidly over the last decade, to the point where a special issue of this journal has recently been dedicated to the topic. Many of these studies have used a particular measure (the area under the receiver operating characteristic curve, or the AUC) to quantify the degree to which it is possible to link crimes. This article reviews studies that have utilised the AUC and examines how good we are currently at linking crimes (within the context of these research studies) and what factors impact linking accuracy. The results of the review suggest that, in the majority of cases, moderate levels of linking accuracy are achieved. Of the various factors that have been examined that might impact linking accuracy, the three factors that appear to have the most significant impact are crime type, behavioural domain, and jurisdiction. We discuss how generalisable these results are to naturalistic investigative settings. We also highlight some of the important limitations of the linking studies that we reviewed and offer up some strategies for moving this area of research forward. Copyright © 2013 John Wiley & Sons, Ltd.     

Care Versus Control: The Identity Dilemmas of UK Homelessness Professionals Working in a Contract Culture

UK voluntary and community sector organizations (VCOs) play a key role in caring for homeless people. However, there are widespread concerns about the impact of increasing government contracting on the quality of their services. This paper examines understandings of homelessness and identities as homelessness professionals, as expressed by VCO professionals. By so doing, it considers how ‘partnership working’ enables or undermines their capacities to care. The paper uses 24 in‐depth interviews and four focus groups with London‐based homelessness professionals. Professionals expressed deep tensions in their experience of their role. On one hand, they reported a deep ethical commitment to care and to develop quality supporting relationships to respond to their clients' complex needs. On the other, their capacity to care was undermined by their dependence on statutory resources and the controls this involved over the way VCOs delivered care. Professionals had to adjust to statutory monitoring frameworks and hard performance targets, which detached them from the human and intimate encounter with their clients and constrained their person‐centred caring interventions. The findings highlight the contradictory nature of contemporary systems of ‘joined up’ welfare that neglect the very human and complex nature of the issues that they were originally created to address. Copyright © 2013 John Wiley & Sons, Ltd.