Some thoughts and responses to The Francis Report

This response to the report by lawyer Robert Francis into the failure of National Health Service (NHS) care in Mid-Staffordshire is fairly positive about its conclusions but points out that without consideration of personal, psychosocial factors in care, on the ward, in the institution things are unlikely to improve, the report leaves much unconsidered. Francis emphasises that patient care is at the very centre of the NHS, this is obvious but so often forgotten. He comments that the unhelpful blame culture still exists. Missing from Francis’ analysis is a psychological perspective – the systemic factors he mentions are administrative not relational. This response is an attempt to redress the balance in thinking about the improvement of care for patients and of the working lives of staff.     

The social side of shame: approach versus withdrawal

ABSTRACT

At present, the consequences and functions of experiences of shame are not yet well understood. Whereas psychology literature typically portrays shame as being bad for social relations, motivating social avoidance and withdrawal, there are recent indications that shame can be reinterpreted as having clear social tendencies in the form of motivating approach and social affiliation. Yet, until now, no research has ever put these alternative interpretations of shame-motivated behaviours directly to the test. The present paper presents such a test by studying the extent to which shame motivates a preference for social withdrawal versus a preference for social approach. Two studies (N?=?148 and N?=?133) using different shame inductions both showed people experiencing shame to prefer to be together with others (social approach) over being alone (social withdrawal). In addition, the preference for a social situation was found to be unique for shame; it was not found for the closely related emotion of guilt. Taken together, these findings provide direct empirical support for the idea that shame can have positive interpersonal consequences.     

The development of a brief group intervention (Dynamic Interpersonal Therapy) for patients with medically unexplained somatic symptoms: a pilot study

The primary aim of this equivalence study was to compare the outcome of a brief group therapeutic intervention, based on the principles of dynamic interpersonal therapy (DIT) with an intervention based on cognitive behavioural therapy (CBT) in patients suffering from medically unexplained somatic symptoms (MUSS). Participants were 89 patients (aged 18 to 62) who were offered 20 sessions of either DIT or CBT, as central part of a treatment package, consisting of art therapy, psychomotor therapy, social therapy and physical therapy. Measurements were conducted at baseline, 10 weeks and 20 weeks, using self-rating scales measuring the level of anxiety and depression, the severity of medically unexplained symptoms and quality of life. Results showed that CBT and DIT were comparable. The conclusion was that it is recommended to design a larger scale randomised controlled trial to further elaborate the short-term and long-term effects of this novel psychodynamic group therapy for MUSS patients.     

‘Characters’ in psychoanalytic and interpersonal therapy: A comparison

In this paper the author considers how the therapist might listen to the characters talked about by his or her patients. In psychoanalytic therapy the emphasis is on listening to the patient's characters as though they are located in psychic reality and as representatives of the transference relationship, whereas in interpersonal therapy (IPT) the patient's characters are taken as inhabiting the realm of external reality. It is argued that clinical thinking in IPT would be enhanced by taking more account of psychic reality, which will make clearer the quality of external reality in which the patient's characters are located. It is also argued that both therapies share an interest in enabling the patient to find characters which can serve as holograms of previously unexpressed affective experience.     

‘I don't want to be the mother of a paedophile’: the perspectives of mothers whose adolescent sons with learning disabilities sexually offend

The subject of sexual abuse is a major focus of professional and public concern. Sexual abuse of (and by) people with learning disabilities evokes even greater disquieting emotions, and makes severe demands on the social services, and the criminal justice system. The aims of the project were: 1) to determine whether group psychotherapy produced effective outcomes for adolescent boys with learning disabilities who exhibit sexually abusive behaviour, 2) to explore the perspectives of parents and other care-givers, and 3) to document the nature and extent of service support to families. This paper focuses solely on the mothers' perspectives. This was a three-year project with six boys (under 16) receiving group psychotherapy, using both quantitative and qualitative methods. Clinical measures were used to track changes throughout the course of psychotherapy. Semi-structured interviews (taped and transcribed) were held (separately) with the boys, their parents, paid care-givers and the therapists. The mothers tried hard to make sense of, and come to terms with, what was happening to their sons and to themselves, they struggled to reconcile their own confused and often conflicting emotions, and to maintain their own sense of identity. They felt almost totally unsupported by the services, both in the past and present, and could see little hope for the future. There is an urgent need for development of effective and sympathetic services for the parents of boys with learning disabilities who have been abused, and who are now showing abusive behaviour.     

The nature of quality of life in residential care facilities: the case of White older South Africans

This study describes the nature of quality of life (QoL) from the perspective of older South Africans (n?=?41) in residential care facilities (female =?75%; age range 62–95 years). The residents participated in individual in-depth interviews and focus groups. They also set down their narrative reflections on their QoL in journals. Data were analysed by means of interpretative phenomenological analysis. Findings reveal the resident older South Africans regard QoL as a spiritually informed worldview of life events, coping with challenges and being mindful of others. The residents perceived QoL to include proximity and quality and reciprocity with others. QoL among older people is context and people specific.     

The role of teammate relationships,communication and self-efficacy in predicting athlete flow experience

This study aimed at testing a structural model of athlete flow in a sample of South African students. A quantitative, cross-sectional research design was implemented. Participants completed self-report measures at pre-arranged times that were in close proximity to the completion of athletic activity. Student athletes (n = 235) participating in South Africa's two major sports, football and rugby, were surveyed. The instruments utilised in this study included the Short Flow State Scale-2, the Questionnaire on Experience and Assessment of Work, and the Generalised Self-Efficacy Scale. The results indicated positive relationships between the variables and established predictor paths. Teammate relationships and self-efficacy were established to as the best predictors of flow experiences of athletes.     

The stalking of psychotherapists by current or former clients: Beware of the insecurely attached!

Abstract

A survey of psychological therapists who worked in primary care showed that the incidence of psychotherapists being harassed or stalked by their current or former clients was more than twice the national average at 24%. The stalkers 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, especially those with a narcissistic style. All of these are disorders of attachment. This paper discusses the neurobiological development of an insecure attachment and how that manifests during therapy in stalking behaviour. Psychotherapists who are aware of the dynamics within the therapeutic relationship can take preventative steps to inhibit the automatic fear response of a client who is insecurely attached and which may lead to stalking behaviour.

A survey of psychological therapists who worked in primary care showed that the incidence of psychotherapists being harassed or stalked by their current or former clients was more than twice the national average at 24%. The stalkers 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, especially those with a narcissistic style. All of these are disorders of attachment. This paper discusses the neurobiological development of an insecure attachment and how that manifests during therapy in stalking behaviour. Psychotherapists who are aware of the dynamics within the therapeutic relationship can take preventative steps to inhibit the automatic fear response of a client who is insecurely attached and which may lead to stalking behaviour.     

A relationship with Señor de Carácuaro

The present paper explores the issue of personal relationships in the context of pilgrimage. Most literature about pilgrimage in Latin America focuses on the journey, or on the alleged ‘sacred power’ located in the shrine and sought by the pilgrims. I argue that, from the perspective of the participants’ experience, pilgrimage could be understood in terms of personal relationships with particular holy beings, who are perceived as agents. Through the particular case of Marta, a young Purhépecha woman from Lake Pátzcuaro (Mexico), I will examine the modes in which people from this area relate, interact and communicate with saintly beings in the context of pilgrimage; the connection of vows with quotidian experience; and the implications of relationships with saints for people in their everyday lives.