A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.     

It is never the right time: How to help a mother to separate from her young child

In this paper I have described a short-psychotherapy treatment with a mother, a 3-year-old girl, and occasionally a father, over the difficulty in separating and settling down at nursery. The mother's unresolved mourning for the early miscarriage of her second baby was one important factor. She held on to the company and comfort provided by the little girl, who had become the vessel of maternal projections. Filled with Poppy's projections, the mother had also felt unable to withstand and process them. Mr Green was a conflictual element in the family, rather than a supportive husband and father, and Poppy's care and problems were left with the mother. Nine sessions unblocked the situation and allowed Poppy to settle down at a private nursery.     

Suicide and masochism: The evolving relationship between guilt,suffering, self-attack and suicide

Masochism is a complex and intriguing phenomenon. Self-attack may serve many purposes. Some patients suffer through harsh self-criticism, bodily harm, or even tormenting thoughts of death, without actually killing themselves. Some of these patients ultimately may go on to die by suicide, but for many, the self-torturing aspect may exist independently in acute or chronic forms. This paper addresses the complex relationship between masochism and suicide as two separate yet interconnected phenomena.     

A pre-suicide state in an adolescent female 1

Abstract

During a pre-suicide state, the enactment of a suicide fantasy is the motive force. The nature and function of a suicide fantasy is explored in this paper in the context of the impact of puberty on the female body image and against the background of the pre-Oedipal and Oedipal father's relationship with his daughter. Case material from the analysis of an adolescent girl is presented to illustrate the crucial role of the father, in the transference, prior to a suicide attempt.

La force motrice qui sous-tend l'état pré-suicidaire est la mise en acte d'un fantasme suicidaire. Cet article explore la nature et la fonction du fantasme suicidaire dans le contexte de l'impact, chez une adolescente, de la puberté sur son image du corps avec, en toile de fond, la relation que le père, pré?dipien et ?dipien, entretient avec sa fille. Un matériel clinique extrait de l'analyse d'une adolescente est présentée afin d'illustrer le rôle crucial du père au sein du transfert avant la tentative de suicide.

Mots-clés: État pré-suicidaire, fantasme suicidaire, puberté et image du corps chez la fille, père pré?dipien et ?dipien, transfert, contre-transfert

Riassunto: Durante lo stato pre-suicidio, il motivo forza è la messa in atto di una fantasia di suicidio. Nell'articolo viene esplorata la natura e la funzione della fantasia di suicidio considerando l'impatto della pubertà sull'immagine del corpo femminile e sullo sfondo di una relazione pre-edipica ed edipica del padre con sua figlia. Viene presentato il materiale dall'analisi di una adolescente per illustrare il ruolo cruciale del padre, nel transfert, precedente al tentato suicidio.

Parole chiave: stato pre-suicidio, fantasia di suicidio, immagine corporale femminile e della pubertà, padre pre-edipico ed edipico, transfert, contro-transfert

Während eines prä-suiziden Zustands, ist das Ausagieren einer Suizidphantasie die motivierende Kraft. Die Eigenschaft und Funktion einer Suizidphantasie wird in diesem Artikel im Zusammenhang mit dem Einfluss der Pubertät auf das weibliche Körperbild und mit dem Hintergrund der prä-ödiplaen und ödipalen Beziehung des Vaters zu seiner Tochter exploriert. Es wird Fallmaterial aus der Analyse eines adoleszenten Mädchens vorgestellt, um die wichtige Rolle des Vaters in der Übertragung vor einem Suizidversuch zu illustrieren.

Keywords: Prä-suizider Zustand, Suizidphantasie, Pubertät und das weibliche Körperbild, prä-ödiplaer und ödipaler Vater, Übertragung, Gegenübertragung     

Quality-of-life assessment in HIV-infected psychiatric outpatients: Perceived health,functional status,symptoms, and preferences for cardiopulmonary resuscitation

Abstract

The current study had two purposes: (1) to describe the reliability and validity of a measure of quality of life (QOL) in HIV-infected psychiatric outpatients, and (2) to predict cardiopulmonary resuscitation (CPR) preferences from disease stage, depression, and other QOL factors. We studied 63 patients, who were seen in one year at an HIV/AIDS psychiatry clinic. The results provide evidence for the validity of our instrument as a measure of health status in an HIV-infected psychiatric population. Overall symptoms were the strongest associates of functional limitations. disability, and perceived health, but depression was also significantly associated with all measures of QOL. Twenty-two patients (35.5%) would not have wanted to be revived if their heart stopped beating the day of the study. Disease stage and poor mental health were independent predictors of this preference, but severity of depression, social support, fatigue, perceived health, functional limitations, and life satisfaction were not.     

Suicide ideation and depression in university students in Botswana

The study aimed at exploring suicide ideation and its relationship to depression in university students in Botswana. Data were collected from 122 undergraduate students (68.9% females, 31.1% males) with a mean age of 20.02 years. Depressive symptoms were measured with an adapted version of Beck's Depression Inventory-II. In total, 47.5% of the respondents reported suicide ideation, 28.7% reported previous suicide attempts, and the mean depression score was 19.14. Suicide ideation correlated strongly with total depression scores. The level of depression severity was linearly related to suicide ideation but 14.3% of respondents who scored at the level of minimal depression and 53.8% of those who scored at the level of mild depression had also contemplated suicide. The level of education of respondents’ mothers had an inverse relationship with suicide ideation and with depression in that those whose mothers had a tertiary level education were less likely to engage in suicide ideation and had significantly lower depression scores. The results are discussed from within the specific social ecological context of Botswana.     

Tate Modern: Jung modern

Abstract

This paper describes how a counsellor in education has to take on and respond to a number of transferences in the clinical work in addition to holding onto a number of centres within the institution and personally. It takes a close look at one student presentation and speaks to the quality of the emotional and psychological impact on the counsellor. It argues for the need to be both thoughtfully containing and thoughtfully penetrating in the clinical work despite the bombardment of conscious and unconscious material. Over all, the paper states how important it is for the counsellor to stay in touch with his/her own feelings, thereby effectively maintaining the depressive position, though this is painful given the current predominance of suicide and serious suicidal intentions among adolescents and young adults.     

A Burden to Others: A Common Source of Distress for the Terminally Ill

Recent research into the desire for death among people with terminal illness has begun to recognize the importance of “feeling oneself a burden to others” as a factor in suicidal behaviour. In this study, 69 patients with advanced cancer underwent semi‐structured interviews. The sense of self‐perceived burden was found to be a common experience, reported by 39.1% of participants as a minimal or mild concern and by 38% as a moderate to extreme concern. The sense of burden showed a low correlation with physical symptoms (r = 0.02–0.24) and higher correlations with psychological problems (r = 0.35–0.39) and existential issues (r = 0.45–0.49). Comparisons of participants with high or low levels of self‐perceived burden showed the importance of this factor for overall quality of life. In summary, self‐perceived burden is an important but underestimated dimension of social cognition in the medically ill.     

The relationship between emotional clarity and suicidal ideation among trauma-exposed adolescents in inpatient psychiatric care: does distress tolerance matter?

ABSTRACT

The present investigation examined associations between low emotional clarity (the extent to which individuals are confused about the specific emotions they are experiencing) and suicidal ideation in a diverse sample of trauma-exposed inpatient adolescents, as well as the moderating role of distress tolerance (DT) in this association. Participants (N = 50; 52.0% female; M = 15.1 years, SD = .51; 44% White) completed measures of emotion dysregulation, posttraumatic stress disorder (PTSD), and suicidal ideation/attempts, as well as a behavioral measure of DT. Controlling for age, gender, presence of mood disorder, and past history of attempts, results revealed a significant interaction between DT and low emotional clarity in relation to suicidal ideation. Specifically, lower emotional clarity was related to suicidal ideation at higher, but not lower, levels of DT. Findings suggest that presence of suicidal ideation among traumatized youth with low emotion clarity is most likely when these emotional deficits are coupled with a high tolerance for cognitive/psychological distress. Given that the ability to withstand distress is arguably a key factor in transitioning individuals from ideation to lethal suicidal behavior, attention to the presence of this construct in the context of clinical practice may be warranted.     

Queering Black Homophobia: Black Theology as a Sexual Discourse of Transformation

Abstract

This article explores black homophobia as a co-constitutive phenomenon which harbors the fear of the loss of a black archetypal identity that can be understood as (hetero)normative. Using a method of queering black homophobia from a hetero non-normative viewpoint, an exploration of the authenticity of a liberation viewpoint that is multivocal, multidimensional, and offering an interpretation that is inclusive of identities that trouble the waters of black hetero-patriarchal hegemony will be in question as it relates to the role of the Hamitic hypothesis and those interpretations that conflate evil, sexual perversion, and human degeneration within blackness.