Prevalence of auditory verbal hallucinations in a general population: A group comparison study

The present study was specifically designed to investigate the prevalence of auditory verbal hallucinations (AVH) in the general population, and sought to compare similarities and differences regarding socio‐demographics, mental health and severe life events between individuals who have never experienced AVH with those who had. The study also aimed to compare those who sought professional help for their experience of AVH with those who had not sought help. Through a postal questionnaire, 2,533 participants ages 18 and over from a national survey completed the Launay‐Slade Hallucinations Scale and other measures examining AVH characteristics and other areas related to AVH. In total, 7.3% of the sample reported a life‐time prevalence of AVH. Those with AVH were more likely to be single and unemployed, reported higher levels of depression and anxiety, and experienced a higher number of severe life events compared with those without AVH. Only 16% of those who experienced AVH in the general population sought professional help for these experiences. Compared to those who did not seek professional help, participants that had were more likely to experience AVH with a negative content, experience them on a daily basis, undergo negative reactions when experiencing AVH, and resist AVH. In conclusion, the prevalence of AVH was found to be relatively high. The results also revealed higher levels of reduced mental health for individuals who sought professional help, followed by those who did not, compared with those who had never experienced AVH.     

Milieu therapy for neglected children: Treatment in a caring relationship

The central thesis of this paper is that treatment of neglected children can better take place in a caring relationship than in psychotherapy or analysis. In order to create the basis for this idea, Part 1 introduces a milieu therapy for neglected children, developed by the author. In Part 2 of the article, it is proposed that treatment in a caring relationship is in line with the child's dependence on a caring person. It is also argued that the traditional distinction between problems in the child's environment and internal psychological difficulties seems imprecise. Instead, it is proposed that a problem has both an external and an internal aspect. This supports the idea that it may be possible to solve problems that are traditionally considered internal through environmental strategies, for example milieu therapy. The article is hypothesis-generating and builds upon clinical experience inspired by works of, among others, Erikson, Bowlby, Winnicott, and Fonagy and collaborators. Part 1 of the article is the first presentation in English of the main points of the author's books on milieu therapy. The ideas in Part 2 are published here for the first time.     

Ethical Considerations of Screening and Early Intervention for Clinical High-Risk Psychosis

Research on individuals at clinical high risk for psychological and physical disorders has grown exponentially in recent years, with a variety of new screening tools and early intervention techniques being implemented. One recent example is Attenuated Psychosis Syndrome, a diagnosis for individuals who are at clinical high risk for psychosis, which was recently included in Section III of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Given the focus on prevention at early stages, at-risk individuals will continue to be a topic of significance not only in psychosis research but also in other illnesses. This document provides a comprehensive summary of the ethical dilemmas that clinicians or researchers may encounter in this domain, and possible actions consistent with the current Canadian Code of Ethics for Psychologists. We use clinical high risk for psychosis and the Canadian Code of Ethics for Psychologists as a way to illuminate these ethical issues; however, application to other jurisdictions and disciplines, as well as other high-risk populations, is also of relevance.     

过度担忧和广泛性焦虑障碍与rCBF关系的SPECT脑显像研究

目的：探查过度担忧者和GAD病人的r CBF变化,更好地了解导致病理性焦虑和GAD的神经病理生理学基础。方法：回顾性分析18例过度担忧者和61例GAD病人SPECT脑显像的结果。GAD患者再按病程分为3个亚组。计算各组患者特定脑区r CBF损伤的百分比及损伤的脑区数。结果：12例（66.7%）过度担忧者可见前额叶、基底节、扣带回、颞叶和枕叶r CBF增加（11例）和/或减少（9例）。58例（95.1%）GAD患者可见r CBF减少,主要累及中和下前额叶、中和下颞叶、前扣带、海马旁回、基底节和丘脑。大多数GAD患者累及的主要脑区等于或大于3个。GAD病人的r CBF损伤和病程之间存在一定的相关性。结论：结果支持GAD患者r CBF的变化是一个与担忧和焦虑等心理和情绪改变密切相关的慢性和渐进的过程。GAD的局部脑功能障碍是病理性焦虑产生的先决条件,并出现在局部脑结构异常之前。     

Experiences of Countertransference: Reports of Clinical Psychology Students

While historically linked with psychoanalysis, countertransference is recognised as an important component of the experience of therapists, regardless of the therapeutic modality. This study considers the implications of this for the training of psychologists. Fifty‐five clinical psychology trainees from four university training programmes completed an anonymous questionnaire that collected written reports of countertransference experiences, ratings of confidence in managing these responses, and supervision in this regard. The reports were analysed using a process of thematic analysis. Several themes emerged including a desire to protect or rescue clients, feeling criticised or controlled by clients, feeling helpless, and feeling disengaged. Trainees varied in their reports of awareness of countertransference and the regularity of supervision in this regard. The majority reported a lack of confidence in managing their responses, and all reported interest in learning about countertransference. The implications for reflective practice in postgraduate psychology training are discussed.     

Entering the Sacred: Using Motivational Interviewing to Address Spirituality in Counseling

Despite the salience of spirituality in the lives of many clients, counselors are often hesitant to explore spiritual issues in counseling, largely out of a valid concern of imposing values on the client. Motivational interviewing provides a framework within which a counselor can both assess spirituality and facilitate client exploration of spiritual issues without fear of imposing values.     

What's not being said? Recollections of nondisclosure in clinical supervision while in training

The aim of this qualitative study was to retrospectively examine nondisclosure in individual supervision while in training. Interviews were conducted with supervisees two years post-qualification. Specific nondisclosures were examined and reasons for these nondisclosures were explored. Six in-depth semi-structured interviews were conducted and data analysis drew on Consensual Qualitative Research. The findings revealed four categories relating to: (i) the nature of the difficulty; (ii) reasons for nondisclosure; (iii) the supervisory relationship; and (iv) facilitative factors. The quality of the supervisory relationship was a significant element in nondisclosure. A key recommendation was that role induction for supervisees should be incorporated into training programmes to assist supervisees in learning how to use supervision more effectively. Limitations of the study and further research are provided in light of current findings.     

Not starting psychotherapy is more often initiated by the therapist than the patient

The phenomenon of not starting psychotherapy is seldom investigated. The present study of psychotherapy in the Swedish mental health services differentiates between patients applying for and being offered psychotherapy but choosing not to start (n = 69), patients recommended to receive no treatment, another type of treatment or treatment at another clinic (n = 133), and therapy starters (n = 1294). After the initial assessment, nearly twice as many patients did not start based on the therapist’s decision than on the patient’s. Cases of not starting psychotherapy decided by the therapist were more frequent among patients whose occupational status was less stable, presented a danger to others, had lower levels of initial therapeutic alliance, and by therapists with lower levels of psychotherapy training and those at less structured and more unstable clinics. Patients choosing not to start therapy had lower levels of mental ill-health than both starters and therapist-initiated nonstarters. The most frequently presented reason for a patient-initiated decision to not start therapy was “patient wished another treatment or therapist,” whereas the most common therapist-initiated reason was “recommended or referred to another treatment or clinic”.