To know or not to know: an application of Bion’s K and –K to child treatment1

The authors discuss an application of Bion’s conceptualisation of thinking and non-thinking states (K and –K links) to the treatment of a nine-year-old girl. The authors consider Bion’s interrelated concepts such as K and –K, container/contained, maternal reverie, and the development of thinking through alpha function to be highly applicable to child treatment. The afore-mentioned conceptual elements are used to elucidate case material over two consecutive hours. A K link is established between therapist and patient, the fragility of which link is then demonstrated by its deterioration into a –K link. Complex issues about knowing and not knowing are central in this girl’s clinical presentation. She was conceived through in vitro fertilisation (IVF), and subsequently diagnosed with cerebral palsy. The authors consider the emotional impact of this origin story and how the parents relate to it. The authors discuss how parents sometimes cope with perceived losses by wishing to shield or protect their children. This can have repercussions for children’s efforts to know (K) and not to know (?K). The fear that emotional knowledge will be too painful to bear can interfere with ‘learning from experience’. Bion’s premise that the purpose of analysis is the growth of the mind is synonymous with the child analyst’s goal of fostering development and understanding impediments to development.     

Counselling,autism and the problem of empathy

The experiences of disabled people suggest that ableism insidiously and invasively impacts upon the practice of counselling and related therapies. This article critiques a particular account of psychotherapy with a child with the label of autism to illustrate how ableism can disrupt the process of empathy and negate the therapeutic experience. In so doing the article highlights the inherent difficulties in traversing different epistemic positions to make sufficiently informed readings of counternormative expressions of being. General principles of counselling practice are then proposed to support practitioners with providing effective therapy for all clients.     

Exploring Expressive Sandwork as a Form of Psychosocial Care: A Case Study of a Vulnerable Adolescent

This paper explores the use of expressive sandwork as a form of psychological support for a youth with psychosocial vulnerability. A case study, which emanated from a community outreach project, is briefly described of a male black participant, from a low socioeconomic background, who is currently in correctional services care. The participant engaged with sandplay over five weekly sessions, lasting approximately an hour each. The data obtained during these sessions were thematically analyzed and the findings suggest that expressive sandwork enabled this individual to become more aware of his emotional wellbeing and foster a sense of hope. Expressive sandwork offers a form of short-term psychological support in circumstances where limited or no help is available.     

Recording supervision: Educational,therapeutic, and enhances the supervisory working alliance?

Aims: To explore the impact of listening to an audio‐recording of their latest supervision session on supervisees. Method: Participants recorded a supervision session, listened to it and were interviewed about this experience of listening to it within seven days of listening to the recording. The phenomenological interviews informed by the researcher's knowledge were analysed using grounded theory. Participants: Fifteen participants with 0–20 years’ experience, representing person‐centred, CBT, psychodynamic and integrative approaches, and qualifications ranging from student to doctorate formed the theoretical sample. Findings: Listening to the audio‐recording allowed participants to re‐experience their thoughts and emotions. Participants recalled and re‐experienced events which had been forgotten, unnoticed or (arguably) repressed. This re‐experiencing was usually less emotive than in real‐time; but suppressed emotions could be more intense. As participants integrated both these noticed and unnoticed events, they were able to accept what had been unacceptable, gaining self‐awareness, which was potentially therapeutic. Noticing what had been unnoticed permitted insights into many aspects of therapy and supervision, which was more than just ‘reflection‐on‐action’. Conclusion: Listening to an audio‐recording of the latest supervision may be educational for any supervisee; it may be therapeutic by facilitating challenge of maladaptive beliefs and behaviours; and it also seems to strengthen the supervisory working alliance.     

Therapeutic outcomes in the Welsh Government's school‐based counselling strategy: An evaluation

Aims: The purpose of this study was to evaluate the outcomes of school‐based counselling, as delivered in the Welsh Government's School‐based Counselling Strategy, for reducing psychological distress in young people aged 11–18. Method: The study used a quantitative cohort design, comparing levels of distress on either the Young Person's CORE (YP‐CORE) or the Strengths and Difficulties Questionnaire (SDQ) from baseline to endpoint. Data were available on 3613 episodes of counselling, across 42 datasets. Meta‐analytical procedures were used to identify the mean effect size and predictors of outcomes. Results: Within each dataset, counselling was associated with significant reductions in psychological distress, with a mean effect size (d) of 0.93(95% CI = 0.89–0.97) using a fixed effects model and 1.09 (95% CI = 0.97–1.22) using a random effects model. Datasets using the YP‐CORE had larger effect sizes than those using the SDQ, and datasets with more complete response rates had lower outcomes than those with poorer response rates. Conclusion: The results confirm that school‐based counselling, as delivered in the UK, is associated with significant reductions in psychological distress, comparable to adult counselling and psychotherapy services.     

Dependency and perfectionism: Short-term dynamic group psychotherapy for university students

Abstract

This paper is based on the authors' experiences of conducting short-term psychodynamic group therapy with university students. The therapy groups focus on common problems among the members, i.e. perfectionism, procrastination, and fear of graduation. Working on their dependency and on their inadequate separation from parental figures typically helps the students cope more creatively with their academic problems. The paper explores technical questions and possible advantages in working within a short time frame using a group analytic approach.     

Linking Metaphor and Dreams in Clinical Practice

Abstract

This paper is an attempt to weave together selected aspects from the theoretical domains of metaphor and dreams. With respect to dreams, the paper draws on theorists who argue for the continuity hypothesis of dreaming. Of particular interest is the symbolic value that may be placed on the manifest dream. Establishing the significance of the manifest dream is an important step toward linking its imagery with our daytime figurative language in a meaningful way. Further, the notion that dreams symbolically capture our self-state lends support to the idea that there may be thematic correspondence between our dreams and metaphors. This may be most apparent when we compare dominant metaphors with recurring dreams.     

The Effectiveness of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in a Frontline Service Setting

The goal of the current study was to test the generalizability of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) in a frontline service setting. Twenty‐nine patients who presented to treatment clinics with problematic worry were provided CBT for GAD. Among the intent‐to‐treat sample, there were no significant changes in worry or depression from pre‐ to posttreatment. Treatment completers showed significant pre‐ to posttreatment reductions on measures of worry and depression. The magnitude of change was smaller than has been reported in randomized control trials (RCTs). Although the frontline service setting differed from RCT settings in multiple ways, treatment completers nonetheless achieved moderate to large decreases in self‐reported worry and depression.     

Intraclass Correlation Associated with Therapists: Estimates and Applications in Planning Psychotherapy Research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.     

Cognitive Behaviour Therapy to Improve Mood in People with Epilepsy: A Randomised Controlled Trial

This study compared a 9-week individualised Cognitive Behaviour Therapy (CBT) programme for people with epilepsy (PWE), with a wait-list control. Fifty-nine PWE were randomised and 45 (75%) completed post-treatment outcomes. People with lower quality of life (QoL), particularly for cognitive functioning, were more likely to drop out. Analyses based on treatment completers demonstrated significant improvements on the Neurological Depressive Disorders Inventory for Epilepsy (p = .045) and Hospital Anxiety Depression Scale-Depression subscale (p = .048). Importantly, CBT significantly reduced the likelihood of clinical depressive symptoms (p = .014) and suicidal ideation (p = .005). Improvements were not observed for anxiety, QoL or maintained overtime for depression. Results suggest that CBT was effective, however, and could be improved to increase patient retention and long-term outcomes.