Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base

For many years psychoanalytic and psychodynamic therapies have been considered to lack a credible evidence-base and have consistently failed to appear in lists of ‘empirically supported treatments’. This study systematically reviews the research evaluating the efficacy and effectiveness of psychodynamic psychotherapy for children and young people. The researchers identified 34 separate studies that met criteria for inclusion, including nine randomised controlled trials. While many of the studies reported are limited by sample size and lack of control groups, the review indicates that there is increasing evidence to suggest the effectiveness of psychoanalytic psychotherapy for children and adolescents. The article aims to provide as complete a picture as possible of the existing evidence base, thereby enabling more refined questions to be asked regarding the nature of the current evidence and gaps requiring further exploration.     

Conceptualizations of Social Class in Afrtican American Women:

This article addresses the multiple definitions of social class in African American people and how the therapist's understanding of these definitions is important in therapeutic interventions with African American women. The article discusses: (a) the traditional ways in which social class has been defined in social science and the limits of these conceptualizations; (b) the multiple definitions of class within the African American community; and (c) treatment concerns for African American women based on class issues. Clinicians working with African American and other women who vary by class should be able to assess how class variables influence their therapeutic interventions with these women.     

Fostering Feminist Principles in Our Community

SUMMARY

In a recent focus group discussion at the Feminist Therapy Institute conference participants outlined a vision for a future community based on feminist principles. It is built on five critical ideals, including more equitable distribution of resources, genuine respect for human diversity and varying world views, caring and compassionate members, increased connections and collaborations, and political/personal empowerment. While the challenges inherent to such vision must be acknowledged, greater attention will be placed on ways in which we can begin to foster environments and micro communities that are conducive to feminist practice and ideology.     

Mandatory personal therapy: does the evidence justify the practice? In debate

ABSTRACT

The article addresses the question of whether the practice of mandatory personal therapy, followed by several training organisations, is justified by existing research and evidence. In doing so, it discusses some implications of this training requirement from an ethical and ideological standpoint, raising questions of import for training organisations and highlighting avenues for further research.     

Women's views about intimate examinations and sexually inappropriate practices by their general practitioners

Abstract

The aim of this survey of 472 adult women was to assess women patients' feelings about intimate examinations and their perceptions and experiences of sexually inappropriate medical practice. Two-thirds of women preferred a women doctor for intimate examinations. Slightly more than two-thirds found intimate examinations embarrassing and stressful, and strongly expressed the need for information and on-task, health-related comments during these examinations. General personal comments or non-medical touching were not particularly welcomed, even for the purpose of comforting the patient. There was a range of views about patients' personal relationships with doctors, with the lines between acceptable and unacceptable behaviour somewhat ambiguous. A small but significant number of women perceived that they had been sexually harassed (5%) or abused (3%) by a doctor, with this experience more common for non-English speaking women. Results were discussed in terms of implications for improved doctor practice, particularly during intimate examinations and with vulnerable patients.     

Voices of African Traditional Healers: Cultural Context and Implications for the Practice of Counselling in Sub-Saharan Africa

The healing paradigm implicit in many sub-Saharan African cultures is embedded in African cosmology, and thus the recognition of this is essential for understanding Traditional African Healing practices and implementing collaborative counselling practices. To this end, this article focuses on the cultural importance, or voice, of traditional healers in sub-Saharan Africa. The current article uses an ethnographic approach to analyse systematically the cultural context of indigenous healing practices in sub-Saharan Africa. The anthropological importance of Traditional Healing practitioners, the context of healing, and the changing legal and ethical status of Traditional Healers are addressed as pivotal in furthering the development of this crucial, yet under utilized resource. The authors propose that such cultural understanding is highly relevant to the work of professional counselors.     

Learning and teaching (briefly)

This paper was given as the Annual Ellen Noonan Counselling Lecture on July 2012 and retains some of the spoken style of the lecture. It uses examples of Ellen Noonan’s work to examine aspects of the process of teaching and learning psychodynamic practice. The difficulties of how to embed theoretical knowledge with its clinical application are discussed and the question of what are the key skills of the self-reflective practitioner is raised with reference to whether, and how, they can be taught or learnt. It is suggested that part of this process consists in helping students, and their teachers, to be more comfortable with not knowing, a concept that is both counter intuitive and counter cultural. From this aspects of contemporary therapeutic practice, with specific reference to psychodynamic short-term therapy, are addressed. The paper looks at the ambivalence felt by many psychodynamic clinicians towards working within a short-term paradigm in current workplace settings and how this might be addressed. The paper discusses the intrinsic qualities of a psychodynamic short-term approach and its relation to contemporary therapeutic modalities. It is suggested that the increasing managerial culture, leading to the ascendance of protocol driven, manualised and structured therapies, represents an attack on the relational and must be challenged.     

ADHD Assessment

Abstract

This study examined effects of negative versus positive symptom formats on the assessment and subsequent classification of ADHD in children in public schools. Symptoms associated with the disorder based on the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) were presented to parents and teachers of referred children according to both types of formats. Informants were then asked to indicate whether the symptoms described the child's behavior over the last six months. Overall, the negatively phrased symptoms appeared to generate response bias which resulted in an increased percentage of children meeting the DSM-IV criteria for ADHD. Additionally, the decision reliability or classification agreement between the two formats was low, suggesting the possibility of confirmation bias in the assessment process. Implications for practice and future research are discussed.     

Clinical Supervision and Professional Development Using Clients from Literature,Popular Fiction,and Entertainment Media

Abstract

The use of clinical supervision is central to mental health work. In this article, the authors propose using practice cases drawn from characters found in literature, popular fiction, biographies, television, and movies as one method for clinical supervision and professional development in the mental health skill areas of client assessment, case conceptualization, diagnosis, and treatment planning. The method is illustrated with clinical formulations pertaining to four practice clients: Scarlett O'Hara; Maya Angelou's Marguerite Johnson; the fairytale character, Hansel; and the Wicked Queen of Disney's Snow White and the Seven Dwarfs. Applications and limitations of the method are discussed.     

Materials used to support cognitive behavioural therapy for depression: a survey of therapists’ clinical practice and views

ABSTRACT

Use of supporting materials in cognitive behavioural therapy (CBT) is widely advocated, and homework increases effectiveness. The study aimed to identify materials most frequently used by CBT therapists to support CBT for depression, and those perceived clinically most effective. Questionnaires were sent to 3665 accredited CBT therapists asking about their use of resources commonly described in CBT manuals, and their views on effectiveness. Of 3665 approached by post/email, 994 (27%) responded. Another 33 completed the questionnaire via the study website. 818/1027 (80%) of respondents were accredited practitioners who deliver one-to-one therapy. Symptom measures, lists of problems/goals, activity schedules, behavioural activation diaries/plans, and case formulation worksheets were used “frequently” or “very frequently” by over 85% of respondents. Sleep diaries and computerised CBT were used least. Most resources were used within and between sessions. Activity schedules, behavioural activation diaries/plans, case formulation worksheets, thought records, and resources to support the identification of conditional beliefs were regarded as most effective. Symptom measures, sleep diaries, and computerised/online materials were considered only moderately effective. Therapists use a wide range of materials to support individual CBT. For delivering CBT, technology-enabled approaches should incorporate a range of materials to enable therapists to tailor treatment effectively.