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1 – 10 of 114While there is general agreement in the literature regarding the importance of the therapeutic alliance (TA) in psychological interventions with people, the forensic context…
Abstract
Purpose
While there is general agreement in the literature regarding the importance of the therapeutic alliance (TA) in psychological interventions with people, the forensic context raises some unique challenges. The purpose of this paper is to discuss how these challenges are managed within a therapeutic context.
Design/methodology/approach
This paper consists of a literature review examining the following: the significance of the TA in interventions with forensic clients, especially men who have committed a sexual offence and the impact on treatment efficacy and change; therapist characteristics as well as some of the obstacles and challenges present in a correctional setting, which can impact on the TA and; the role of transference and countertransference in relation to these forensic clients.
Findings
Through the literature review, there is a discussion regarding how some of the common obstacles within correctional settings can be overcome, and how certain therapist qualities should be interpreted.
Originality/value
This paper will discuss some of the practical applications of certain recommended therapeutic factors within a correctional setting, challenging some of the common misconceptions and limitations. Furthermore, transference and countertransference, topics which are seldom discussed, will be considered in this paper.
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Madeleine Besson, Philippe Jacquinot, Rémi Jardat and Jean-Luc Moriceau
This article of exploratory research provides a critical perspective on accountability, focusing on three characteristics: transparency, asymmetry and individual agency. An…
Abstract
Purpose
This article of exploratory research provides a critical perspective on accountability, focusing on three characteristics: transparency, asymmetry and individual agency. An experimental method is developed, calling for an ethics of accountability.
Design/methodology/approach
Four entrepreneurs have given accounts of themselves and their projects in life cycle interviews. This article applies Devereux's approach (1967), which allows for opacity (the “unconscious”) to oneself and to others with symmetry between analysts and analysed, and a lack of demarcation between the observer and the observed.
Findings
A tragic entrepreneurial accountability trap of continuous self-justification was discovered, which pertains both to the entrepreneurs and the researchers. Nonetheless, the researchers as inspired by Devereux's method were able to realize a form of accounterability.
Social implications
This article shows that the demands for transparent, asymmetrical and agentive accountability call for ethical reflection. The request for accounts, as resulting in the accounts given and the research conducted into accountability, are all sources of constraints. Differing the accountability situation may lessen the constraints.
Originality/value
This study introduces Devereux's method as an investigative tool in accountability research, opening up new perspectives on communication and analysis. This article shows the researcher as situated both inside and outside of the accountability mechanisms. This article explores a singular form of accountability; that of entrepreneurs who seemingly only account for the future, thereby disconnecting them from others.
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Pádraig Cotter, Sara Hollwey and Alan Carr
The purpose of this paper is to appraise “transference” and “countertransference” when working with people with intellectual disabilities (PWID).
Abstract
Purpose
The purpose of this paper is to appraise “transference” and “countertransference” when working with people with intellectual disabilities (PWID).
Design/methodology/approach
A review of the literature was conducted, followed by a discussion.
Findings
No research articles were found. Potential reasons for this are discussed. Historical influence, complexity of the topic and resistance among professionals may be contributing factors. Despite this, these phenomena are important for several reasons. These include the high levels of trauma these clients experience; the manner in which they have been marginalised by mainstream society; the strong likelihood of PWID evoking difficult countertransference from therapists; and the myriad of coping mechanisms and defences that these clients may employ.
Research limitations/implications
Research is needed to further current understanding of these issues.
Practical implications
An awareness of these issues amongst practitioners and other key members of a PWID’s system is important.
Originality/value
This is the first review and commentary on these issues.
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Adam Polnay, Helen Walker and Christopher Gallacher
Relational dynamics between patients and staff in forensic settings can be complicated and demanding for both sides. Reflective practice groups (RPGs) bring clinicians together to…
Abstract
Purpose
Relational dynamics between patients and staff in forensic settings can be complicated and demanding for both sides. Reflective practice groups (RPGs) bring clinicians together to reflect on these dynamics. To date, evaluation of RPGs has lacked quantitative focus and a suitable quantitative tool. Therefore, a self-report tool was designed. This paper aims to pilot The Relational Aspects of CarE (TRACE) scale with clinicians in a high-secure hospital and investigate its psychometric properties.
Design/methodology/approach
A multi-professional sample of 80 clinicians were recruited, completing TRACE and attitudes to personality disorder questionnaire (APDQ). Exploratory factor analysis (EFA) determined factor structure and internal consistency of TRACE. A subset was selected to measure test–retest reliability. TRACE was cross-validated against the APDQ.
Findings
EFA found five factors underlying the 20 TRACE items: “awareness of common responses,” “discussing and normalising feelings;” “utilising feelings,” “wish to care” and “awareness of complicated affects.” This factor structure is complex, but items clustered logically to key areas originally used to generate items. Internal consistency (α = 0.66, 95% confidence interval (CI) = 0.55–0.76) demonstrated borderline acceptability. TRACE demonstrated good test–retest reliability (intra-class correlation = 0.94, 95% CI = 0.78–0.98) and face validity. TRACE indicated a slight negative correlation with APDQ. A larger data set is needed to substantiate these preliminary findings.
Practical implications
Early indications suggested TRACE was valid and reliable, suitable to measure the effectiveness of reflective practice.
Originality/value
The TRACE was a distinctive measure that filled a methodological gap in the literature.
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Emma Larsson-Thomas, Sukhi Ruprai, Louise Manonga and Tennyson Lee
People with personality disorders often present with interpersonal difficulties which affect their relationship with significant others but also with staff involved in their care…
Abstract
Purpose
People with personality disorders often present with interpersonal difficulties which affect their relationship with significant others but also with staff involved in their care. Administrators work in “frontline positions” where they are required to face challenging situations yet their role has not been studied. This study aims to describe the role and contribution of an administrator in a personality disorder service.
Design/methodology/approach
A mixed-methods design was used. All incoming calls to a specialist personality disorder service over three months were documented. A semi-structured focus group (n = 7) with clinicians working in the service was conducted. The data was analysed using thematic analysis. Clinical vignettes are presented to highlight typical interactions.
Findings
The qualitative results highlighted that the administrator is key in psychological preparations, managing pressure and maintaining clinical boundaries. Traits identified as useful in an administrator working in a personality disorder service are flexibility, consistency and assertiveness. Tensions between administrators and clinicians were related to the role definition of the administrator, boundaries, countertransference and process interaction. The majority of incoming calls were from patients scheduling and cancelling appointments. Only 3% of calls evoked negative feelings in the administrator such as feeling “annoyed” or “drained”.
Practical implications
Results highlight a need for careful selection, training and supervision of staff. A key recommendation is the need for integration and close coordination of the administrator within the clinical team.
Originality/value
This study represents one of the first efforts to explore the contribution of administrators within personality disorder services. It explores the impact of the administrator on the team.
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The purpose of this paper is to explore how supervision is applied in the context of National Health Service services for older adults, with particular regard to the profession of…
Abstract
Purpose
The purpose of this paper is to explore how supervision is applied in the context of National Health Service services for older adults, with particular regard to the profession of clinical psychology and psychotherapy.
Design/methodology/approach
The clinical supervision theories that are considered in this exploration are the Seven-Eyed Model (Hawkins and Shohet, 2012) and the Cyclical Model (Page and Wosket, 2015). The discussion also integrates an overview of psychological dynamics as presented by the existing literature with the author’s reflections on the influence of ageing stereotypes in the therapeutic work with older adults.
Findings
The theoretical models of clinical supervision considered can offer a robust framework and pathway for supervisory work in psychology and psychotherapy for older people. However, this alone seems insufficient and needs to be combined with the supervisor’s knowledge on psychology of ageing as well as their own self-reflection on internalised ageing stereotypes.
Practical implications
The paper suggests a need for health care professionals, providing clinical supervision on older adult therapeutic work, to be familiar with the aspects analysed.
Originality/value
Clinical supervision handbooks overlook aspects related to age as an issue of difference. This paper adds value to the clinical work with older people through a novel attempt to link implications of ageing stereotypes with the therapeutic and supervisory practice.
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There remains a lack of clarity regarding what constitutes “normal” or “complicated” grief within this client group. The purpose of this paper is to identify the factors that…
Abstract
Purpose
There remains a lack of clarity regarding what constitutes “normal” or “complicated” grief within this client group. The purpose of this paper is to identify the factors that complicate grief and considers interventions which would be beneficial.
Design/methodology/approach
The paper draws on previous research by the author and others to comment on some of the issues discussed by Hannah Young in her article.
Findings
Three domains contribute to complicated grief in people with learning disabilities. These are the learning disability itself, environmental factors and the impact of disability on attachment.
Practical implications
A relational approach to support is important in preventing complicated grief. If the grief becomes complicated, a relational psychotherapy is recommended as the preferable intervention.
Originality/value
This paper gives important consideration to practical factors that can lower vulnerability to complicated grief for this client group.
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Shulamith Lala A Straussner and Norma Kolko Phillips
Research has validated the crucial aspect of empathy in effective clinical practice. Empathy requires the identification of the helping professional with the emotional experience…
Abstract
Research has validated the crucial aspect of empathy in effective clinical practice. Empathy requires the identification of the helping professional with the emotional experience of the client. However, in their work with women offenders, clinicians can encounter a number of obstacles to appropriate empathic interventions: the workers may over‐empathize with their clients; the offenders may be resistant to being helped; and there may be institutional and social dynamics that may discourage empathic helping by staff. This paper discusses the concept of empathy and the difficulties encountered by social workers and other clinicians in their efforts to provide appropriate empathic approaches to this population. Effective strategies that will allow for appropriate use of empathy by clinicians working with female offenders are offered.
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Rachael Wheatley and Clare Conway
This discussion paper aims to further explore narcissistic vulnerability as a psychological concept in relation to stalking, adding to the literature base by resurrecting this…
Abstract
Purpose
This discussion paper aims to further explore narcissistic vulnerability as a psychological concept in relation to stalking, adding to the literature base by resurrecting this focus and exploring practical implications of this association through proposing a schema therapy (ST) approach.
Design/methodology/approach
Stalking results from an interaction of circumstances and a vulnerable personality. Understanding the psychology of those who stalk, before and during stalking episodes, is pivotal in helping the person stalking to desist and thus protect victims. Knowing how to most effectively intervene at the earliest opportunity with those stalking is an area receiving renewed attention. Not least due to the improved identification of stalking, but also the continued absence of empirical evidence on effective intervention approaches. This paper sets out to explore the utility of ST with stalking cases.
Findings
Recent research undertaken by Wheatley et al. (2020) with men who had stalked and were detained in prison within the UK highlighted narcissistic vulnerability as a key feature in their personalities. The original study provided support for the linked conceptualisations of narcissistic vulnerability, preoccupied attachment styles and the phenomenon of stalking. This paper extended discussions to explore the utility of ST to address narcissistic vulnerability in stalking cases.
Originality/value
This is an original discussion paper combining research with stalking cases, practitioner specialism, psychological theory and existing empirical literature to argue for the value of ST for addressing stalking.
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Jan Lees, Rex Haigh and Sarah Tucker
The purpose of this paper is to highlight theoretical and clinical similarities between therapeutic communities (TCs) and group analysis (GA).
Abstract
Purpose
The purpose of this paper is to highlight theoretical and clinical similarities between therapeutic communities (TCs) and group analysis (GA).
Design/methodology/approach
Literature review shows comparison of TC and group-analytic concepts with illustrative case material.
Findings
Findings reveal many similarities between TCs and GA, but also significant divergences, particularly in practice.
Practical implications
This paper provides theoretical basis for TC practice, and highlights the need for greater theorising of TC practice.
Social implications
This paper highlights the importance of group-based treatment approaches in mental health.
Originality/value
This is the first paper to review the relevant literature and compare theory and practice in TCs and GA, highlighting their common roots in the Northfields Experiments in the Second World War.
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