This paper provides a clinical practice overview of the challenges that can arise when working with dangerous and severe personality‐disordered patients in a high secure…
This paper provides a clinical practice overview of the challenges that can arise when working with dangerous and severe personality‐disordered patients in a high secure hospital. Poor engagement and treatment readiness, mistrust, paranoia and dominant interpersonal styles are all clinical features that affect treatment delivery. The paper discusses the impact of these features, and suggests how clinicians can engage effectively with individuals who have personality disorders in regard to therapy in general.
This paper has been written following an influential therapeutic encounter that we experienced while working with an emotionally distressed woman. The barriers that can…
This paper has been written following an influential therapeutic encounter that we experienced while working with an emotionally distressed woman. The barriers that can get in the way of providing a structured therapeutic approach are discussed. The paper focuses on dialectical behaviour therapy as a treatment model, and discusses how the concept of ‘dialectics’ provide an over‐riding context for case conceptualisation (Linehan, 1993). The dialectical dilemmas and powerful dynamics that can be enacted between individuals, teams and patients in their endeavours to cope with distress will be illustrated. The dialectical philosophy is described and elaborated upon, providing a framework for the synthesis of clinical interpersonal encounters and metaphorical concepts of a therapy seesaw. The paper discusses how these ideas can guide us in our work with emotionally distressed individuals.
This paper describes and analyses our experiences as lecturer practitioners working in the personality disorder service at Rampton High Secure Hospital. This service is an…
This paper describes and analyses our experiences as lecturer practitioners working in the personality disorder service at Rampton High Secure Hospital. This service is an NHS Beacon site and hosts one of the pilot projects that are part of the Home Office and Department of Health initiative concerned with the assessment and treatment of people deemed to be dangerous because of the severity of their personality disorder. The paper focuses on the development of a competency‐based diploma/degree programme that is integrated with service priorities and clinical care pathways. The factors that shaped the evolution of this programme are outlined, supplemented by a critical commentary on how the course team experienced and made sense of the complex dynamics of the implementation process. Also discussed is the way our experience of facilitating dialectical behaviour therapy (DBT) group work influenced and helped us understand our work with students. Being active in service delivery ensured the course content developed from and reflected the realities of clinical practice. These issues are discussed with reference to the concept of parallel processes (Hawkins & Shohet, 2000) and by comparing the clients' experience of DBT groups with the students' experience of the competency programme.
The UK government proposals for services for individuals considered to be dangerous with a severe personality disorder (DSPD) are developing. The complex task of balancing…
The UK government proposals for services for individuals considered to be dangerous with a severe personality disorder (DSPD) are developing. The complex task of balancing safety and therapeutic change in DSPD services will rest largely upon the skills, knowledge and practice of the staff group. As a result, one challenge for DSPD services is to provide sufficient training and support to staff, in order to ensure that adequate resources are available to assist them in processing their emotional reactions to their work. As part of this, clinical supervision systems need to be developed to offer professional support and learning, enabling individual practitioners to develop knowledge and competence and assume responsibility for their own practice (DoH, 1993). Among the service developments at Rampton Hospital an innovative multi‐professional supervision strategy has been introduced for all staff working in the unit. This paper describes the evolving supervision framework, including a new tool, the ‘Supervision Matrix’, and implementation guidelines, and describes how this supervision framework will be evaluated.
“It is generally accepted that the food industry must be scientifically based to cope with the problems, particularly of public health, which arise as new processes of growing, manufacturing, packaging and preserving food depart even further from traditional ways.”
There is growing evidence of the efficacy and effectiveness of targeted parenting programmes but the evidence for universal parenting programmes is much less developed…
There is growing evidence of the efficacy and effectiveness of targeted parenting programmes but the evidence for universal parenting programmes is much less developed. The purpose of this paper is to evaluate the effectiveness of Parent Gym, a parenting programme delivered in schools.
In this paper a quasi-experimental design was utilised. Parents were recruited to the Parent Gym programme comprising six two-hour weekly sessions. Parents completed measures of their parenting efficacy, parenting satisfaction, interest in parenting and mental well-being at pre- and post-course. Comparative data were derived from a retrospectively-defined randomly selected group of non-participant parents at two time points, equivalent to the length of the Parent Gym course.
Changes in the Parent Gym group were compared with the comparison group using repeated measures mixed 2×2 ANOVAs, which accounted for the potential effect of demographic characteristics (parent gender, ethnicity, parent age, parent education level and single parent status), and their potential interaction with group membership. Parenting satisfaction showed a significantly greater increase for the Parent Gym group with a large effect size (d=0.80). Regarding parenting efficacy, there was a significant time × group interaction indicating efficacy scores increased in the Parent Gym group but decreased in the comparison group (d=1.93). Mental well-being also improved for the Parent Gym group from below the national norm before the course (d=−0.26) to significantly greater than the national norm at post-course (d=0.29).
A limitation of the present study is the absence of data on outcomes for children. Second, the administration of the research at local level, primarily the distribution and collection of the measures and return to the research team for analysis, is a potential source of data loss: both pre- and post-programme data were available on 55 per cent of Parent Gym parents, similar to other community studies. Third, the present study did not include a longer term follow-up after the programme ended. Future research is required to examine the sustainability of effects produced from community implemented programmes.
Findings from the present study indicate that a universal programme, Parent Gym, was effective in aiding the positive development of aspects of parenting behaviour, namely parents’ self-efficacy, parenting satisfaction and mental well-being, when delivered in community settings. This demonstrates its potential as part of a regular service delivery option of evidence-based support for parents.
Successful parenting requires both the development of parenting skills and a positive relationship between parent and child. Parents vary in the resources (e.g. family) available to develop positively. Evidence-based parenting programmes have an important role in aiding parenting development, both those targeted at parents with most challenges and those (universal) aimed across the population. This study demonstrated that the universal Parent Gym programme is effective across a wide range of parents and has the potential to be a positive social resource for community delivery.
This is the first rigorous study of Parent Gym. It adds to the limited evidence about parenting programmes delivered outside of trials, as part of normal service delivery. With this evidence, parent choice of a suitable evidence-based programme is increased.
The purpose of this paper is to examine the determinants of bank interest rate spread in Sub-Saharan African countries, which were categorized into macro-specific…
The purpose of this paper is to examine the determinants of bank interest rate spread in Sub-Saharan African countries, which were categorized into macro-specific, bank-specific and institutional variables.
The authors used fixed effects estimations to analyze the data. The data were drawn from a pool of 20 Sub-Saharan African countries for a period of ten years spanning 2003–2012. The countries were categorized into low-income, lower middle-income and upper middle-income countries based on World Bank income classifications.
The results show that inflation has a negative and significant effect on interest rate spread, while operating costs and bank concentration have a positive and significant effect on interest rate spread. Similarly, government effectiveness, rule of law and political stability are negatively related to the interest rate spread.
The paper provides evidence that interest rate spread is determined by both bank-specific, macro-economic and institutional variables. The paper also indicates that the income status of a country is important in explaining the variations in the interest rate spread across the region. Therefore, the policy makers should design policies that take into account the variables in order to help in planning by all economic agents, including banks.
The paper uses data from Sub-Saharan Africa and introduces institutional variables in the model, which have been found to be critical in the context.
In the hotel industry, exceptional service failure recovery is a key determinant of customer satisfaction and loyalty. Western‐based hotel corporations should adapt their failure recovery training programs for their properties in China. Adjustments are necessary because of differences in cognitive processing. Modifications are also required due to various Chinese cultural characteristics.