Preliminary Evaluation of Sleepwise Program for Children With Sleep Disturbance and Developmental Delay

Sleep disturbances are very prevalent in children with developmental delay. Parental-assisted behavioral strategies have been used effectively in school-aged children; however, multimodal treatment for preschool-aged children is lacking. The current study is a preliminary investigation of the effectiveness of a parent group program called Sleepwise designed for young children with developmental delay and incorporating behavioral, communicative, and sensory strategies. Six parents attended three workshop sessions and implemented individualized treatment plans. Initial results revealed significant posttreatment reductions in child sleep disturbances and behavioral problems, with high treatment acceptability ratings by parents. Outcomes were generally maintained at 1-month follow-up.     

Cognitive mediation of intervention effects on physical exercise: Causal models for the adoption and maintenance stage

Objective: To investigate how the effects of a group-based intervention program (MoVo-LISA) on exercise behaviour were mediated by cognitive variables. Different causal models mapping the short-term (adoption) and long-term (maintenance) intervention effects were tested using path analyses.

Design: N?=?220 in-patients of a rehabilitation clinic were assigned to an usual care or intervention group (quasi-experimental design). Questionnaire-based assessment was conducted at baseline; discharge; and at six weeks, six months and 12 months post discharge.

Measures: The potential mediator variables were outcome expectations, self-efficacy, strength of goal intention (intention strength), self-concordance, action planning and barrier management.

Results: Observed intervention effects on exercise behaviour (p?<?0.05) were mediated by intention strength at the adoption and maintenance stages, by action planning only at the adoption, and by barrier management only at the maintenance stage. Self-efficacy and outcome expectations were only indirectly involved in these mediations by affecting intention strength and self-concordance.

Conclusion: This is the first study to track the cognitive mediation processes of intervention effects on exercise behaviour over a long time-period by differentiating the adoption and maintenance stages of behaviour change. The findings emphasise the importance of deconstructing intervention effects (modifiability vs. predictive power of a mediator) to develop more effective interventions.     

The use of early recollections as a narrative aid in psychotherapy

A narrative framework is put forward for using early recollections as a narrative aid in psychotherapy. According to this framework, early recollections are beginning episodes in the current version of an autobiography or self-narrative which is continuously updated to make sense of current concerns. Inclusion of these episodes in psychotherapy can provide therapists who share an interest in narrative and their clients with a quick way to recognize central themes that are restricting clients’ lives and detect openings to revise them. Revisions regard the form and content of early recollections. Three case examples propose ways of incorporating early recollections in empathic dialogs, including the process of detecting restricting themes and encouraging persons to tell stories in more compassionate voices. Group therapy is proposed as one of the contexts where early recollections can be discussed, but readers are encouraged to extend these ideas to work with individuals and families.     

Narcissism in the modern world

Narcissism has been around since the time of Ovid more than 2000?years ago and the concept has long been a source of study, intrigue, fascination and literature both within and beyond the psychoanalytic community. While Narcissistic Personality Disorder remains a severe and fairly rare clinically diagnosed condition, sub-clinical narcissism or narcissistic traits have reached epidemic proportions with serious consequences. Ever increasing levels of greed, self-obsession, superficial relationships, arrogance and vanity are everywhere apparent and not making us any happier, with common mental health problems on the increase, especially among the young. Seemingly irreversible alterations to family life, technological development – including social media, attitudes to death and dying and celebrity worship, all feature in the rise of our narcissistic society and are interconnected trends. Group greed and grandiosity, as in the world of banking, have led to wide-scale corruption and cover-ups leaving us vulnerable and unable to place our trust in many organisations. Perhaps most sinister of all is our attitude to the planet that supports us, as we play a part in the destruction of much of the environment and many of the species that share the earth with us. Looking at the literature of narcissism, the aim of this paper is to consider ways in which cultural changes have brought about this huge rise in both individual and group egotism. We are seeing many more clients high on the narcissistic spectrum but consideration will be given to the narcissism of the therapist and the impact of the therapist’s narcissism on the client. We live in difficult times and cannot step outside our culture but there are ways of countering our narcissism and helping our clients to do the same. Having compassion for one’s self and recognising how ordinary we really are make for a good start.     

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.     

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.     

Split Self Affairs and Their Treatment

SUMMARY

The Split Self Affair is a long-term serious relationship. The split being played out in the affair reflects an internal split between doing things “right” and the emotional self. Treatment for those involved centers on understanding the origins of the internal split and on reclaiming the neglected emotional self. Long term individual therapy is the treatment of choice, augmented by other modalities.     

The Confluence of Technology and Narrative Approaches in Group Work

Abstract

This article illustrates procedures for using e-journals as a creative and adjunctive approach in group work. Incorporating e-mail based journaling as an ancillary form of group interaction allows members to communicate via written channels, and creates new ways for clients to relate in the group. This article outlines how leaders can use narrative theory to construct e-mail based writing exercises in group settings. Borrowing from established narrative techniques, specific interventions are provided for using interactive e-mails in each group stage. Finally, detailed instructions for establishing encrypted and confidential e-mail communications are provided, and implications and limitations for establishing e-mail based communication systems are overviewed.     

Relationship Between Homework Completion and Outcome in Cognitive Behaviour Therapy

Homework or between‐session learning has long been considered an essential aspect of effective cognitive behaviour therapy. However, it has received relatively less empirical attention than other components of cognitive behaviour therapy. In general, studies have found that homework completion is predictive of outcome in psychotherapy. However, the amount of homework completed by a patient represents only one aspect of this important therapeutic component. This study investigated both the quantity and the quality of homework completed during a 10‐week group cognitive and behavioural treatment program for anxious and depressed patients. It explored the relationship between various aspects of homework completion and outcomes on several different variables. A total of 94 patients were included in the analysis. It was found that both quantity and quality of homework completed predicted outcome on measures of depression, anxiety and quality of life at post‐treatment and at 1‐month follow‐up. The results were strongest for the amount of homework completed, suggesting that clinicians should encourage patients to complete homework even if the homework content is not entirely accurate. The results of this study highlight the importance of homework as a central part of effective cognitive and behavioural treatment.