Quantitative and qualitative analysis of a set of goal attainment forms in primary care mental health services

Aims: The aim of this paper is to present an attempt to collate the results of the client‐completed Goal Attainment Form (GAF) and to explore the usefulness of analysing the data in this way. The GAF is used primarily to add qualitative idiosyncratic data to the quantitative data collected by the CORE‐OM (Clinical Outcomes for Routine Evaluation Outcome Measure) questionnaire. Method: A sample of 477 completed GAF were used during short‐term therapy through primary care mental health services to investigate potential correlations in various different aspects between the GAF and the CORE outcome measure (CORE‐OM). The themes from these forms were qualitatively analysed to compare how clients describe their experience of therapy with clinical perspectives. Results: The results reveal several significant correlations. Themes used by clients to describe their problems and benefits of therapy were different from clinicians' perspectives. Discussion and recommendations: Several suggestions and recommendations are offered regarding evaluation, therapy and primary care short‐term therapy services.     

We have travelled a long distance and sorted out the mess in the drawers: Metaphors for moving towards the end in psychotherapy

Aim: To explore the process of ending in psychotherapy, in particular how clients and therapists draw on their notions of client improvements and prepare for the upcoming end. Data: The data comes from an intensive process‐outcome study at the University of Oslo, Norway. The study includes audio‐recording from all sessions and separate post‐therapy interviews with clients and therapists. Twelve psychotherapy dyads were selected because they had reached a ‘good enough’ ending. Therapy duration ranged from 7–43 months. The number of sessions ranged from 10–67. Method and analysis: A hermeneutical‐phenomenological approach analysed and combined the observational and reflexive data. The analysis was carried out using a method for systematic text condensation and through reflexive dialogues with the material and between the researchers. Findings and discussion: The language of improvement towards the end of treatment seemed packed with metaphors conveying growth in both affective and relational management. Metaphors based on travel (how they have moved); cleaning (how they have cleaned up and sorted out things); sensing (how the clients have grown stronger, got their heads above water and see things differently); and the clients’ feeling of having received something (gifts or tools) are widely used. Such metaphors are created in the interaction with a mutual sensitivity to their capacity to confirm and regulate affect towards the end. In this sense, the metaphors celebrate accomplishments in a way that exceeds therapy, and the client can keep them to use afterwards.     

The NICE guidelines are misleading,unscientific, and potentially impede good psychological care and help

NICE guidelines have been given the authority to determine what psychological therapies can be provided within the UK National Health Service. This also has implications for private practice. The guidelines are based on a medical model and consider psychotherapy as analogous to a drug. Psychological thinking is discouraged by this approach. A large amount of psychotherapy research evidence is ignored by NICE, particularly the persistent finding that differences in effectiveness between therapies are minimal and elusive. Differences between the skills of therapists are a more significant factor. Practice-based evidence, and learning from the patient's feedback (both conscious and unconscious) may be a better approach. For most forms of psychological distress, none of the main psychological therapies studied in randomized controlled trials can be considered to be clinically effective, even though they facilitate some degree of statistically significant change.     

Making room: Developing reflective capacity through group analytic psychotherapy – in the analyst and in the group. Part one

Abstract

This paper is in two parts. This, the first part, traces the inter-related development of trainee group analyst and training group during the first nine months of the group's life. The influence that personal group analytic psychotherapy, supervision and theoretical learning have on the trainee are also considered in relation to the development of the group and its members, many of whom suffer from narcissistic and borderline disorders. The metaphor of ‘making room’ is used to explore the efforts of analyst and group to contain the chaotic, confused and unbounded projective identifications of its members. In this way, amidst the crowded turbulence of the group, a space begins to open up in which, slowly and painfully, the capacity for reflection may emerge.     

Time's wingèd chariot: Short-term psychotherapy in later life

Abstract

This paper is concerned with the appropriateness of short-term psychodynamic psychotherapy with older adults, a client group which has historically been neglected in psychotherapeutic practice. Drawing on the case study of a fourteen-session therapy with a woman in her seventies, it is argued that brief exploratory work can be of particular value to people nearing the end of their lives. The nearness of death gives a special urgency and motivation to the work and a time-limited therapeutic contract mirrors the reality of having only a short time left. Making psychotherapy available to older people also represents an important valuing and validation of their experience.     

The meaning of boundaries and barriers in the development of cultural identity and between cultures

Abstract

In this paper I shall argue that, although currently in the world of psychotherapy and counselling allusions to culture and cross-cultural work are becoming increasingly frequent, the issues are often talked about in simplistic ways. I shall unpack some of the complexities in the notions of culture and identity to show that they are not the monolithic self-evident natural categories that they are often taken to be. I will do this primarily by focusing on the function of cultural difference rather than the usual procedure of focusing on the differences in the contents of cultures. Although the subject matter of this paper is not drawn directly from the clinical sphere, the contention is that it is pertinent to it none the less.     

Aspects of the Early Life Histories of Social Workers in Private Practice

Abstract

From 1993 until 1999 the author undertook a qualitative doctoral research project into the transition of New Zealand social workers from salaried agency employment to private practice (van Heugten, 1999). This private practice was almost exclusively in psychotherapy and coun seling. During semi-structured interviews in which a range of topics was covered, respondents were asked what part they thought their life history had played in their decision to become social workers and to become pri vate practitioners. Respondents talked about their parents' political per spectives, their own educational experiences, religion and spirituality, and immigrant status. Many respondents disclosed traumatic early life experi ences. Analysis of narratives revealed the prevalence of a perception of be ing outsiders; of viewing and responding to significant situations differently from other people. Whilst respondents struggled with a perva sive sense of personal and occupational marginalization, they also recognized that their capacity to adopt an outsider perspective made a positive contribution to their practice as social workers and as psychotherapists or counselors.     

The Therapeutic Process with Children with Learning Disorders

Abstract

Clinicians who work with children and adolescents with learning disorders must be aware of the relationship between the learning disorder and the psychopathology the children present. This article offers a conceptual framework, based on psychoanalytic self psychology, to understand the modifications that are necessary in the treatment of this population. The author suggests that, in contrast to other approaches, it is not possible to conceptualize the treatment of these children as having a beginning, a middle, and an end. Rather, the therapeutic process is open-ended and conceived as occurring during a series of moments. The moments may be categorized as concordant, complementary, or disjunctive. During concordant moments a holding environment is created; during complementary moments the transference and countertransference is addressed; and during disjunctive moments the ruptures that inevitably occur during treatment are dealt with.