Providing therapy to children and families in foster care: a systemic-relational approach

Foster care is a system created to protect children from an unsafe home environment yet multiple foster home placements, conflictual or nonexistent relationships between foster parents and birth parents, long, drawn out court battles, and living in an on-going state of not knowing when or if they will be going home are just some of the challenges many children in care are expected to manage. This paper presents a guide for therapists working with families involved in foster care. Utilizing ideas from the postmodern therapies and structural family therapy, suggestions will be provided about who needs to talk to whom about what, when to have these necessary conversations, and how to talk to people in a way that mobilizes adults to take action for the children, with the goal of minimizing postplacement trauma, strengthening and repairing relational bonds, and moving children out of foster care and into permanent homes as quickly as possible.     

Trauma‐Informed Programs Based in Schools: Linking Concepts to Practices and Assessing the Evidence

When children experience stress and adversity in their homes and communities, schools become a critically important setting in which to intervene and foster their resilience. Changing practices within schools so that vulnerable and traumatized children are better understood and more compassionately served is a goal shared by many school professionals, yet schools remain poorly equipped to address the needs of these children. Any number of school‐based programs have the potential to benefit children with an elevated risk for academic difficulties and mental health disorders, although questions remain as to which programs are most promising, effective, and sustainable. Questions also remain about which programs best serve diverse populations and which have potential to reach the largest number of children, including those who do not outwardly manifest behaviors consistent with an underlying disorder but nonetheless require support. In this review, we take stock of existing programs used in schools to address the social, emotional, and academic needs of children with trauma histories. We summarize components of a various trauma‐focused programs, categorized as: (a) individual and group‐based approaches, (b) classroom‐based approaches, and (c) school‐wide approaches. For each category, we review and comment on the state and quality of research findings and provide illustrative examples from the literature to show how programs address trauma in the school context. Findings of the review suggest that empirical evidence currently favors individual and group‐based approaches, although classroom‐based and school‐wide programs may be better positioned for integration, access to services, and sustainability. Implications and recommendations center on future research, practice, and policy.     

“Weathering the storm:” Mothers’ and fathers’ experiences of parenting a preterm infant

Parenting preterm infants is a unique experience distinct from parenting full-term infants, characterized by a delayed transition to parenthood and limited caregiving opportunities. This study explored mothers’ and fathers’ lived experiences of parenting during infancy in the context of preterm birth. Semistructured qualitative interviews were conducted with 13 parents (6 fathers, 7 mothers) of preterm infants. Data were analyzed using interpretative phenomenological analysis. Four superordinate themes emerged: (a) An unnatural disaster: The traumatic nature of preterm birth, (b) The immediate aftermath: Disconnected and displaced, (c) Breaking the ice: Moving from frozen to melted, and (d) Aftershocks: Transitioning home. Both parents experienced preterm birth as traumatic. Similarities and differences in mothers’ and fathers’ experiences were identified. Preterm birth posed challenges for nurturant and social caregiving and resulted in anxiety, hypervigilance, and overprotective parenting behavior. The results highlight the need for trauma-informed care and further research developing and testing empirically based interventions.     

Trauma,resilience and healthy and unhealthy forms of dissociation

This paper outlines the difference between healthy and unhealthy forms of dissociation following, and in response to, traumatic experience, in particular the experience of refugees, calling on 30 years’ experience in working with refugees in voluntary and public sectors, including 20 years at the Refugee Therapy Centre, London. It differentiates dissociation from repression, and looks at some of the specific traumatic experiences associated with refugees’ displacement and situation, particularly relating to loss. Four key characteristics of resilience are described: ‘psychic space’, ‘sense of self’, and the use of a ‘listening other’ and ‘healthy dissociation/resiliency’. Two vignettes are given to illustrate the difference between healthy and unhealthy dissociation.     

Enlightenment and individuation: syncretism,synchronicity and beyond

This paper opens with a personal introduction to the topic of syncretism within the context of a comparison of enlightenment associated with Eastern religious traditions and individuation as experienced through Jungian analysis. A brief exploration of the recent scholarly revival of interest in syncretism follows. Some close parallels with Jungian theory are highlighted, especially in the work of Timothy Light. Applications to the syncretic trends in Tang culture along the Silk Road(s) suggest deeper patterns of interconnectedness lie at the heart of these trends. A complex systems view highlights similarities between syncretic connections and non‐local aspects of synchronistic field events. The final section attempts to extend this approach to innovation in general terms through the recently articulated concept of the ‘adjacent possible’ from the writing of Stuart Kauffman. From this, the notion of a collective pre‐conscious dimension to the psyche is extrapolated. The unifying thread of acausal emergent forms provides a potential synthetic network for these phenomena.     

Posttraumatic stress disorder and psychosocial functioning within two samples of MVA survivors

To examine criterion F variables of PTSD, the psychosocial functioning of two samples of motor vehicle accident (MVA) survivors was investigated. Within each sample, comparisons between MVA survivors with and without PTSD were conducted on four psychosocial functioning indices at three time points. In addition, the relationships between specific PTSD symptom clusters and psychosocial functioning indices were examined. The study revealed that, in general, MVA survivors with PTSD evidenced poorer psychosocial functioning than did survivors without PTSD. The emotional numbing symptoms of PTSD emerged as the most consistent predictors of the psychosocial functioning indices. The implications of these findings to the comprehensive treatment of PTSD are discussed.     

Dissociative Collusion: Reconnecting Clients with Histories of Trauma in Couple Therapy

This paper introduces the concept of “dissociative collusion” as a helpful theoretical and clinical tool for understanding and working with clients with histories of trauma in couple therapy. The paper describes ways to diagnose and treat dissociative collusion based on the integration of an object relations approach, a relational approach, and a narrative approach. Dissociative collusion, a unique version of the well‐documented “couple collusion,” describes relational unconscious dynamics where split‐off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes a part of the shared unconscious and is reenacted in destructive ways. The dissociative collusion concept is especially relevant to couple therapists who work with clients with histories of trauma, who frequently use dissociation as a primary defense mechanism. We suggest that the challenge and goal for couple therapy with this population are to help them reconnect and better oscillate between dissociated self‐other configurations. A case of couple therapy of a wife who had been a victim of childhood sexual abuse and her husband who displayed frequent use of dissociative defenses is presented.     

Narcissus locked in the past: Vulnerable narcissism and the negative views of the past

We examined how the perception of past events might contribute to the understanding of vulnerable narcissism. Across seven samples (N_Grand = 1271), we investigated the association between vulnerable narcissism and individual differences in negative view of the past as well as how both were associated with basic personality traits, intrapersonal (i.e., affect, life satisfaction, and self-esteem) and interpersonal (i.e., anger, and hostility) outcomes, and memory biases of immediate life events and early life traumas. We found that vulnerable narcissism was reliably correlated with a negative view of the past. Additionally, both variables showed similar personality profiles (e.g., high neuroticism) and overlapped in explaining various outcomes, including self-esteem, anger, hostility, recalled traumas, and a negative memory bias.     

Physical activity to address multimorbidity among survivors of sexual violence: A comprehensive narrative review

BackgroundSexual Violence (SV) is highly prevalent and experienced by women and men throughout the United States and world. Survivors of SV often experience poor mental and physical health, and poor health-related quality of life. Studies have explored the associations between SV survivorship and maladaptive health behaviors, but few have examined SV and health promoting activities such as exercise.PurposeThe aim of this narrative review is to describe available peer-reviewed literature regarding SV and physical activity and provide recommendations for future research. Specifically, this review aimed to identify information relevant for promoting and designing exercise interventions that can integrate into clinical treatments for adult survivors of SV.MethodsA search of electronic databases identified 18 articles on SV and exercise behavior.ResultsFour of these studies were exercise interventions, 10 were observational studies, and 4 were qualitative interviews. Results broadly indicate that levels of physical activity among survivors of SV is unclear. Findings from trials indicate exercise may have a positive impact on mental health in survivors of SV. Qualitative interviews found survivors often enjoyed exercising and identified several health benefits, suggesting exercise interventions may be feasible and acceptable in this population. Interviews also identified valuable information about survivors' experiences with exercise.ConclusionsResearch in this area would benefit from: representative samples of adults among populations at high risk for victimization, more consistent and in-depth reporting of SV history and exercise levels, consistent and trauma-informed outcome measurements, and more diverse study designs and interventions. Increased exploration of exercise in this population is warranted given the well-established evidence base indicating the health promoting qualities of exercise for mental and physical health among trauma affected populations.     

Towards a geography of voice-hearing

The social psychiatrists Marius Romme and Sandra Escher argue that boundaries are of critical importance in the therapeutic treatment of so-called ‘auditory verbal hallucinations’ (AVH), or, what is better known as, ‘hearing voices’. Limiting voices to a specific time and place, they argue, helps ‘voice-hearers’ to take back control from their voices. This paper draws inspiration from contemporary debates on sonic geographies to explore what it means for voice-hearers to engage in a complex relationship with their voices. We analyse a range of material and affective spaces to understand what it means for a voice-hearer to transcend, mediate and rework the boundaries between interior and exterior worlds. Besides a detailed conceptual discussion on the geography of voices and voicehearing, we conducted semi-structured interviews with a sample of thirty voice-hearers in North-East and South-East England to gain insight into their voice geographies. The participants move us to appreciate how voice-hearers construe relationships with their voices in complex and ambiguous ways. Some voice-hearers were able to challenge and even change the balance of power, allowing them to be ‘in control’, while others were not. The paper is aimed at introducing voice-hearing to a growing body of work on geographies of the voice.