Response to ‘Containment lost’ by Andrew Briggs

This is a response to Andrew Briggs’ paper presented to the ACP Conference in June 2017. Briggs’ paper, sobering, pessimistic and challenging, looks at the emotional pressures on child psychotherapists in Child and Adolescent Mental Health Services (CAMHS) as a result of the imposition of the internal market in the NHS. He posits that this has caused the loss of organisational containment, not just for child psychotherapists, but for all those clinicians who work in CAMHS. Briggs writes that this loss of containment is evident in clinicians’ experience of meaninglessness in their work and that this meaninglessness may lead to the despair of the death instinct. For Briggs, this goes along with the loss of professional identity as a once favoured discipline. He compares this fall from grace to Satan’s as described in Milton’s Paradise Lost. If, as he suggests, there has been a strong sense of being the favoured discipline, then maybe a dependence had grown in the profession whereby this loss now feels like a terrible abandonment. The author of this response sees hope amidst the despondency being forced upon workers in the NHS and makes the case for us to engage and resist in a number of practical ways.     

Do Community Characteristics Relate to Young Adult College Students’ Credit Card Debt? The Hypothesized Role of Collective Institutional Efficacy

This study examines the extent of emergent, outstanding credit card debt among young adult college students and investigates whether any associations existed between this credit card debt and the characteristics of the communities in which these students grew up or lived. Using data (N = 748) from a longitudinal survey and merging community characteristics measured at the zip code level, we confirmed that a community's unemployment rate, average total debt, average credit score, and number of bank branch offices were associated with a young adult college student's acquisition and accumulation of credit card debt. For example, a community's higher unemployment rate and lower number of bank branches were associated with a young adult college student's greater accumulated debt. Community characteristics had the strongest associations with credit card debt, especially after controlling for individual characteristics (i.e., a young adult college student's race and financial independence) and familial characteristics (i.e., their parents’ income and parents’ discussions of financial matters while growing up at home). The findings may help to understand the unique roles that communities play in shaping children and young adults’ financial capability, and how communities can be better capacitated to support the financial goals of their residents.     

‘Her Majesty the Baby’: narcissistic states in babies and young children

This article considers narcissistic states in babies and young children with some reference to the myth of Narcissus in Ovid’s Metamorphosis. The object-seeking character of babies from the beginning of life is elaborated in connection with selected research from mother–baby interaction. This forms the backdrop to a discussion of withdrawal into illusions of self-sufficiency and denial of dependence in adverse circumstances. Two clinical cases are discussed in some depth. One boy whose superiority, self-reliance and pseudo maturity is prompted by anxieties around separation as he approaches starting school is considered within the parameters of ordinary transient narcissism. The lengthy psychotherapy of another child, who developed entrenched narcissistic defences as a response to traumatic, abusive and neglectful experiences in early life, and who needed considerable help, is described in greater detail. Some links are made with difficulties associated with the emergence from narcissistic functioning and encountering the pain of separation and loss.     

The impact of conflict of interest on trust in science

Conflicts of interest have an erosive effect on trust in science, damaging first the attitude of the public toward scientists and their research, but also weakening the trusting interdependence of scientists. Disclosure is recognized as the key tool for management of conflicts, but rules with sanctions must be improved, new techniques for avoidance of financial conflicts by alternative funding of evaluative research must be sought, and there must be new thinking about institutional conflicts of interest. Our profession is education, and both the public and research professionals of all ages would benefit from greater understanding of how science should and does work. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

A STAFF MANAGEMENT SYSTEM FOR MAINTAINING IMPROVEMENTS IN CONTINENCE WITH ELDERLY NURSING HOME RESIDENTS

We developed a staff management system for maintaining treatment gains achieved on a specialized continence unit located in a geriatric nursing home. Geriatric assistants learned to use a prompted voiding procedure to maintain improved dryness for 4 elderly residents. The staff management system included self-monitoring and recording of prompted voiding activities and supervisory monitoring and feedback based on group performance of these activities. Results show that the system was effective in maintaining prompted voiding activities with corresponding maintenance of improved patient continence. However, a gradual decline in staff performance was noted 4 to 5 months after the initiation of the system. During a subsequent phase of the study, provision of individual feedback restored staff performance to previous levels. Results are discussed in relation to the practicality of prompted voiding interventions in nursing home environments and the applicability of staff management systems in this setting.     

Pushing the frontiers of multicultural training in community psychology

Suarez-Balcazar, Durlak, and Smith (1994) have provided the field with important baseline information regarding multicultural training practices in community psychology. This report can serve as a catalyst in our quest to place an understanding of human diversity, in particular, ethnic-cultural diversity, at the heart of community psychology. To do so, we need to move beyond the teaching of culturally sensitive research and practice to a reconceptualization of the knowledge base and methods of community psychology, to an examination of the conflicts engendered by the inclusion of multiple voices, and to the implementation of institutional arrangements that can support such a challenging task in constructive ways.