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No current psychotherapeutic intervention is designed to enhance job retention in employees with moderate–severe recurrent depression. The aim of this study is to test the feasibility of a new, interdisciplinary work-focused relational group cognitive behavioural therapy (CBT) treatment programme for moderate–severe depression.

The programme was based on a theoretical integration of occupational stress, psychological, social/interpersonal and bio-medical theories. It consisted of up to four 1:1 psychotherapy sessions; 12 work-focused, full-day, weekly CBT sessions facilitated by a cognitive behavioural therapist and occupational therapist; and up to four optional 1:1 sessions with an occupational therapist. Depression severity (primary outcome) and a range of secondary outcomes were assessed before (first CBT session) and after (twelfth CBT session) therapy using validated instruments.

Eight women (26–49 years) with moderate–severe depression participated. Five were on antidepressant medication. While there was no statistically significant change in Hamilton Depression Rating Scale depression scores after therapy (n = 5; p = 0.313), Beck Depression Inventory-II depression scores significantly decreased after therapy (n = 8; –20.0 median change, p = 0.016; 6/8 responses, 7/8 minimal clinically important differences, two remissions). There were significant improvements in the secondary outcomes of overall psychological distress, coping self-efficacy, health-related quality of life and interpersonal difficulties after therapy. All clients in work at the start of therapy remained in work at the end of therapy. The intervention was safe and had 100% retention.

A major limitation was recruitment shortfall, resulting in a small sample of middle-aged women, which reduces representativeness and increases the possibility of methodological weaknesses in terms of the statistical analysis. A definitive trial would need much larger samples to improve statistical power and increase confidence in the findings. Another major limitation was that two of the authors were involved in delivering the intervention such that its generalisability is uncertain.

This novel programme was evaluated and implemented in the real world of clinical practice. It showed promising immediate positive outcomes in terms of depressive symptoms, interpersonal difficulties and job retention that warrant further exploration in a longer-term definitive study.

Empirical studies focused on enhancing job retention in employees with moderate–severe recurrent depression are lacking, so this study was highly relevant to a potentially marginalised community.

While limited by a recruitment shortfall, missing data and client heterogeneity, this study showed promising immediate positive outcomes for the new programme in terms of depressive symptoms, interpersonal difficulties and job retention that warrant exploration in a definitive study.

This paper aims to provide a living tribute to the leading autoethnographer, Alec Grant.

Alec provided Jerome with a list of names of people he might approach to write a tribute on his behalf.

The accounts describe the influence that Alec has had both as an educator and as a trusted colleague for the people approached.

While this is a living tribute, it is about one man and could, therefore, be described as a case study. Some people wonder what can be learned from a single case study. Read on and find out.

Alec has carved out a path for himself. In many senses, he chose “The Road Less Travelled”. He has never shied away from challenging “The System” and defending the rights of the marginalized and socially excluded. It is not a road for the faint-hearted.

For systems to change, radical thinkers need to show the way. “Change keeps us safe” (Stuart Bell).

Alec was a well-known and highly respected cognitive behavioural academic practitioner and the author of key textbooks in the field. He then decided to reinvent himself as an autoethnographer. This has brought him into contact with a much more diverse group of people. It has also brought him home to himself.

Here, this study aims to report a case study of the initial design and programme theory of an interdisciplinary work-focused relational group cognitive behaviour therapy (CBT) treatment programme for moderate-severe depression using realist methods.

This case study shows how the authors designed the intervention using component analysis of existing literature and focus groups of frontline practitioners and former service users and mind-mapping analysis to establish its operational logic and evaluated the theory underpinning the intervention using realist synthesis and evaluation to establish its conceptual logic.

An iterative hybrid approach of literature review, component analysis, focus group discussion and realist methods established the initial design and programme theory for the new intervention. The intervention focused on three areas of therapy, three inter-dependent outcomes, in a group format, with opportunities created for peer interaction. The main theoretical principles most likely to promote efficacy were to accelerate and optimise activation of one or more of six hypothesised mechanisms: realise, reflect, regulate, resolve, relate and retain/resume in the context of skilfully facilitated group psychotherapy.

This study outlines a methodological approach based on the layered ontology of critical realist philosophy, applied to a successful example, which will be useful during the early stages of the design and development of new group-based psychotherapeutic interventions.

By adopting the critical realist approach, the authors identified underlying mechanisms of change in relational group CBT. The theoretically integrated approach involving service users and practitioners from different professional backgrounds was unique and meant that the treatment programme was multi-modal rather than informed by a single therapeutic or theoretical approach.

Closing the treatment gap in depression is vital to prevent people from losing their jobs. Delivering group-based interventions at work could reach more employees than delivering 1:1 interventions in a clinical setting. This study aims to redesign a Treatment Programme to make it more acceptable and accessible for employees with depression.

A mixed-methods exploratory sequential design with a high level of stakeholder consultation was used to redesign an interdisciplinary Work-focussed Relational Group CBT Treatment Programme for moderate-severe depression. Qualitative data from focus groups and quantitative data from a small feasibility study were integrated to develop the new Training (and Staff Support) Programme (TSSP), which was fully specified and manualised in line with the Template for Intervention Description and Replication (TIDieR) for future delivery.

Focus groups identified a need for improved acceptability and accessibility of the tertiary preventative Work-focussed Relational Group CBT Treatment Programme. This programme was, therefore, simplified for delivery by peer facilitators at the worksite as an intervention for all employees rather than an indicated/targeted intervention for only those with symptoms/risk of depression. The TSSP comprised a compulsory trauma-informed educational/experiential workshop over four days plus optional open-ended, peer-led base groups set up and run by volunteer peer facilitators.

The focus groups comprised a convenience sample who knew the researchers as a colleague or therapist, so there is a risk of selection or relationship bias. They were not involved in the data analysis which undermines the element of co-production and increases the risk of analytic or confirmation bias.

Delivering the new intervention in a group format will require peer facilitators to acquire skills in co-facilitation using a structured-directive leadership style and an awareness of the potential side effects of group-based interventions.

The worksite TSSP provides a democratic learning space and empowers employees to stay at work by self-managing their symptoms and by challenging the interpersonal dynamics and organisational structures that might precipitate and perpetuate depression.

This intervention is fully specified and manualised with an explicit programme theory, unlike most universal worksite-based CBT programmes.

Alongside the ubiquitous computer games apparently the marketing success of the 1992 toy season was a series of 25 year old puppets who had featured in a repeat showing of the orginal ITV series on BBC — Thunderbirds — more than 70 franchises have been sold to sell goods marked with the International Rescue logo and it is alleged that these products are even bigger than the previous smash marketing hit the Teenage Mutant Ninja turtles, saving thousands of jobs and making substantial profits for the British toy industry. The characters are licensed for right‐owners ITC (originally the international marketing arm of ATV, the ITV company which put out the programme, and now an independent company, ATV having long since lost its ITV franchise) by Copyright Promotions, Europe's largest licensing company (‘Thunderbirds are go to save the toy industry’ Sunday Telegraph 15/11/92).

Indefinite immigration detention causes well-documented harms to mental health, and international condemnation and resistance leave it undisrupted. Health care is non-independent from immigration control, compromising clinical ethics. Attempts to establish protected, independent clinical review and subvert the system via advocacy and political engagement have had limited success.

The purpose of this study is to examine the following: how indefinite detention for deterrence (exemplified by Australia) injures asylum-seekers; how international legal authorities confirm Australia’s cruel, inhuman and degrading treatment; how detention compromises health-care ethics and hurts health professionals; to weigh arguments for and against boycotting immigration detention; and to discover how health professionals might address these harms, achieving significant change.

Secondary data analyses and ethical argumentation were employed.

Australian Governments fully understand and accept policy-based injuries. They purposefully dispense cruel, inhuman and degrading treatment and intend suffering that causes measurable harms for arriving asylum-seekers exercising their right under Australian law. Health professionals are ethically conflicted, not wanting to abandon patients yet constrained. Indefinite detention prevents them from alleviating sufferings and invites collusion, potentially strengthening harms; thwarts scientific inquiry and evidence-based interventions; and endangers their health whether they resist, leave or remain. Governments have primary responsibility for detained asylum-seekers’ health care. Health professional organisations should negotiate the minimum requirements for their members’ participation to ensure independence, and prevent conflicts of interest and inadvertent collaboration with and enabling systemic harms.

Australia’s aggressive approach may become normalised, without its illegality being determined. Health professional colleges uniting over conditions of participation would foreground ethics and pressure governments internationally over this contagious and inexcusable policy.

IN a recent Money programme on BBC TV Sir Monty Finniston was seen advocating the need for greater investment in industry as opposed to money being sent abroad to be invested either in Japanese industry or American real estate.

THE sudden death, at a comparatively early age, of Mr. Franklin Trengrouse Barrett, of the Fulham Public Libraries, removes from the ranks of librarians, one of the most promising, highly‐trained, and best‐loved of those younger men whose work is making itself so strongly felt in this country. His death came as a severe shock to most of his friends, and particularly to his father, Mr. Francis T. Barrett, the universally‐esteemed City Librarian of Glasgow, who was quite unprepared for such a sudden and bitter bereavement. To him, as to Mrs. Franklin Barrett, a lady well‐known and much respected by London librarians, I am sure the deepest sympathy of all librarians and other colleagues will go forth. The sad event has already produced a great many messages of sympathy from many kind friends, and for these, and other efforts of consolation and comfort, the family are deeply grateful.

THE sixteenth annual report of the National Advisory Committee for Aeronautics for the year ending June 30, 1930, the report for the year 1930 of the National Physical Laboratory, coupled with a visit to the latter establishment, between them give a comprehensive picture of the work that is being done in the two countries. Summaries have already appeared in AIRCRAFT ENGINEERING of all the published reports issued by the N.A.C.A. and the A.R.C., while a survey of the ground covered and an indication of future progress appears in the volumes referred to; so that there is little need here to go over what is now past history.