Pub Date : 2021-10-02DOI: 10.1080/02668734.2021.1990115
D. di Ceglie
The paper describes three stories of children and adolescents with atypical gender identity development followed in psychotherapy. These cases have already been published, but are revisited here to show how these experiences contributed to the creation of the therapeutic intervention model of the Gender Identity Development Service originally established in 1989 at St George’s Hospital, London. The service transferred to the Tavistock Centre in 1996. The first case shows the gradual recognition of dealing with the development of an atypical gender identity rather than a psychiatric condition. Reflection on this case led to the definition of possible therapeutic goals. The second case illustrates the difference between solid and fluid identities, an important distinction in the decision to consider the possibility of physical intervention. The third case shows the network management model and addresses issues concerning autonomy.
{"title":"Shapes of gender identity: three stories with impact","authors":"D. di Ceglie","doi":"10.1080/02668734.2021.1990115","DOIUrl":"https://doi.org/10.1080/02668734.2021.1990115","url":null,"abstract":"The paper describes three stories of children and adolescents with atypical gender identity development followed in psychotherapy. These cases have already been published, but are revisited here to show how these experiences contributed to the creation of the therapeutic intervention model of the Gender Identity Development Service originally established in 1989 at St George’s Hospital, London. The service transferred to the Tavistock Centre in 1996. The first case shows the gradual recognition of dealing with the development of an atypical gender identity rather than a psychiatric condition. Reflection on this case led to the definition of possible therapeutic goals. The second case illustrates the difference between solid and fluid identities, an important distinction in the decision to consider the possibility of physical intervention. The third case shows the network management model and addresses issues concerning autonomy.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":"35 1","pages":"383 - 395"},"PeriodicalIF":0.8,"publicationDate":"2021-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46275025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-02DOI: 10.1080/02668734.2021.1990990
Judy Trowell
In this paper I reflect on my work with adult patients and the Tavistock based sexually abused girls study. I discuss two young women who came for help with their relationships, but subsequently disclosed having been sexually abused as children. I was particularly interested since contrary to what one might expect, the young woman who seemed to enjoy better relationship with her mother did less well in treatment. These two patients are contrasting and this underlines the importance of focussing on specific aspects of the primary maternal object relationship that are unique to each individual in understanding the ability to benefit from therapy. Important features shared across the two patients such as PTSD, the distortion of time, and the role of the father are considered. The timing of the disclosure is also an issue. Both patients elicit strong countertransference responses that were difficult to manage and the value of supervision was stressed. The author tries to address two questions, why the patient who had a better maternal relationship did not benefit as much, secondly the point in treatment when the disclosure occurred.
{"title":"Trauma and abuse","authors":"Judy Trowell","doi":"10.1080/02668734.2021.1990990","DOIUrl":"https://doi.org/10.1080/02668734.2021.1990990","url":null,"abstract":"In this paper I reflect on my work with adult patients and the Tavistock based sexually abused girls study. I discuss two young women who came for help with their relationships, but subsequently disclosed having been sexually abused as children. I was particularly interested since contrary to what one might expect, the young woman who seemed to enjoy better relationship with her mother did less well in treatment. These two patients are contrasting and this underlines the importance of focussing on specific aspects of the primary maternal object relationship that are unique to each individual in understanding the ability to benefit from therapy. Important features shared across the two patients such as PTSD, the distortion of time, and the role of the father are considered. The timing of the disclosure is also an issue. Both patients elicit strong countertransference responses that were difficult to manage and the value of supervision was stressed. The author tries to address two questions, why the patient who had a better maternal relationship did not benefit as much, secondly the point in treatment when the disclosure occurred.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":"35 1","pages":"335 - 352"},"PeriodicalIF":0.8,"publicationDate":"2021-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48301659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-02DOI: 10.1080/02668734.2021.1999600
P. Cundy
27 September 2020 marked the one-hundredth anniversary of the first patient being seen at the Tavistock Clinic. Over the following year, the Tavistock & Portman NHS Foundation Trust has marked this centenary with a series of events celebrating its history and exploring contemporary issues in relation to identity, relationships and society. This special issue is a collection of papers based on presentations from the centennial celebrations. The authors, most of whom are past and present clinicians of the trust, describe the historical and contemporary work of various departments and services and consider how to draw on this heritage to provide valuable responses to contemporary and future challenges. The Tavistock Clinic was established by Hugh Crichton-Miller, taking its name from its original location at 51 Tavistock Square. Crichton-Miller’s aim was to provide civilians with the kind of treatments that he and other doctors had developed using Freud’s theory of neurosis in the treatment of shell-shocked soldiers during World War 1. So, it seems fitting that the first three papers in this special issue address the subject of trauma. In ‘The Tavistock trauma service centenary lecture’ Jo Stubley describes the history and theoretical developments of clinical work with adult patients in the Tavistock Trauma Service. This service was founded in 1987 in response to the Herald of Free Enterprise Ferry Disaster. Using a psychoanalytic model of trauma developed by Caroline Garland, the unit initially worked with adults who had experienced a single episode trauma, offering a brief intervention of six consultations. However, over time, an increasing number of referrals have been received for people who have experienced chronic, repetitive and sustained traumas. Working with complex trauma has required changes to the original model, and advances in attachment and mentalisation theories and neuroscience have informed developments in the work of the unit. A range of therapeutic interventions, both individual and group, psychotherapeutic, physical and social is now provided. The second paper, by Graham Music, focuses on the developing field of trauma work, and the need to attend to the body. In ‘Being safe and being brave: new thoughts on trauma, and adaptations to technique’, Music describes his work with four young people to illustrate his journey as a trauma therapist, and the development of the techniques that he uses. Much of this requires a focus on the body, initially to develop feelings of safety and facilitate trust. Once this has been achieved the work can move towards emotional expression, again paying
{"title":"Editorial","authors":"P. Cundy","doi":"10.1080/02668734.2021.1999600","DOIUrl":"https://doi.org/10.1080/02668734.2021.1999600","url":null,"abstract":"27 September 2020 marked the one-hundredth anniversary of the first patient being seen at the Tavistock Clinic. Over the following year, the Tavistock & Portman NHS Foundation Trust has marked this centenary with a series of events celebrating its history and exploring contemporary issues in relation to identity, relationships and society. This special issue is a collection of papers based on presentations from the centennial celebrations. The authors, most of whom are past and present clinicians of the trust, describe the historical and contemporary work of various departments and services and consider how to draw on this heritage to provide valuable responses to contemporary and future challenges. The Tavistock Clinic was established by Hugh Crichton-Miller, taking its name from its original location at 51 Tavistock Square. Crichton-Miller’s aim was to provide civilians with the kind of treatments that he and other doctors had developed using Freud’s theory of neurosis in the treatment of shell-shocked soldiers during World War 1. So, it seems fitting that the first three papers in this special issue address the subject of trauma. In ‘The Tavistock trauma service centenary lecture’ Jo Stubley describes the history and theoretical developments of clinical work with adult patients in the Tavistock Trauma Service. This service was founded in 1987 in response to the Herald of Free Enterprise Ferry Disaster. Using a psychoanalytic model of trauma developed by Caroline Garland, the unit initially worked with adults who had experienced a single episode trauma, offering a brief intervention of six consultations. However, over time, an increasing number of referrals have been received for people who have experienced chronic, repetitive and sustained traumas. Working with complex trauma has required changes to the original model, and advances in attachment and mentalisation theories and neuroscience have informed developments in the work of the unit. A range of therapeutic interventions, both individual and group, psychotherapeutic, physical and social is now provided. The second paper, by Graham Music, focuses on the developing field of trauma work, and the need to attend to the body. In ‘Being safe and being brave: new thoughts on trauma, and adaptations to technique’, Music describes his work with four young people to illustrate his journey as a trauma therapist, and the development of the techniques that he uses. Much of this requires a focus on the body, initially to develop feelings of safety and facilitate trust. Once this has been achieved the work can move towards emotional expression, again paying","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":"35 1","pages":"297 - 300"},"PeriodicalIF":0.8,"publicationDate":"2021-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45029754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-02DOI: 10.1080/02668734.2021.1990989
J. Stubley
In celebration of its centenary, The Tavistock and Portman NHS Trust hosted a series of lectures. This paper has evolved from a lecture on trauma work within the Trust shared with Graham Music. The history and theoretical developments of clinical work with adult patients in the Tavistock Trauma Service are outlined.
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Pub Date : 2021-09-14DOI: 10.1080/02668734.2021.1952648
Akiyoshi Okada
Since 1958, the Japanese public health insurance system has covered psychoanalytic psychotherapy. Although it is called ‘standard-type psychoanalytic therapy’, it is essentially psychoanalytic psychotherapy or psychodynamic psychotherapy performed face-to-face once a week. Japan has two psychoanalytical organisations: the Japan Psychoanalytic Society (JPS) and the Japan Psychoanalytical Association (JPA), both established in 1955. Until they separated in 1980, they were one organisation that worked together to secure government approval for medical insurance coverage of psychoanalytic psychotherapy and contributed to training psychiatrists and clinical psychologists in psychoanalytic psychotherapy. Currently, less than 1% of psychiatrists and clinical psychologists in the country have undergone JPA or JPS training. Psychoanalytic psychotherapy provision nationally is difficult because psychoanalytic psychotherapists are concentrated in urban centres. Recent global trends have prompted the demand for evidence-based practice (EBP). To date, the effectiveness of psychoanalytic psychotherapy has not been demonstrated in Japan. Therefore, it is not recognised as an EBP within national measures for public mental health. However, psychoanalytic psychotherapy is essentially an ‘experience-based practice’, even though it is fundamentally different from EBP. Nevertheless, to sustain psychoanalytic psychotherapy as a viable psychotherapy in Japan, it would need to meet EBP standards.
{"title":"The health insurance system and psychoanalytic psychotherapy in Japan: the association with evidence-based practice","authors":"Akiyoshi Okada","doi":"10.1080/02668734.2021.1952648","DOIUrl":"https://doi.org/10.1080/02668734.2021.1952648","url":null,"abstract":"Since 1958, the Japanese public health insurance system has covered psychoanalytic psychotherapy. Although it is called ‘standard-type psychoanalytic therapy’, it is essentially psychoanalytic psychotherapy or psychodynamic psychotherapy performed face-to-face once a week. Japan has two psychoanalytical organisations: the Japan Psychoanalytic Society (JPS) and the Japan Psychoanalytical Association (JPA), both established in 1955. Until they separated in 1980, they were one organisation that worked together to secure government approval for medical insurance coverage of psychoanalytic psychotherapy and contributed to training psychiatrists and clinical psychologists in psychoanalytic psychotherapy. Currently, less than 1% of psychiatrists and clinical psychologists in the country have undergone JPA or JPS training. Psychoanalytic psychotherapy provision nationally is difficult because psychoanalytic psychotherapists are concentrated in urban centres. Recent global trends have prompted the demand for evidence-based practice (EBP). To date, the effectiveness of psychoanalytic psychotherapy has not been demonstrated in Japan. Therefore, it is not recognised as an EBP within national measures for public mental health. However, psychoanalytic psychotherapy is essentially an ‘experience-based practice’, even though it is fundamentally different from EBP. Nevertheless, to sustain psychoanalytic psychotherapy as a viable psychotherapy in Japan, it would need to meet EBP standards.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":"36 1","pages":"288 - 299"},"PeriodicalIF":0.8,"publicationDate":"2021-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48324366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-25DOI: 10.1080/02668734.2021.1958910
A. Salam, Amala Shanker, Malika Verma
Psychoanalysis has been around in India for over a century now, beginning with the works of G.S. Bose in 1910s. However, the popularity, acceptability and accessibility of Psychoanalytic Psychotherapy has had a fluctuating course in the mental health arena of the country. The initial enthusiasm seems to have been circumscribed within the academic community and appears to have taken objections with its ‘foreign origin and roots’. This approach to psychotherapy was seen as alien to the Indian culture and was not welcome warmly as a treatment strategy. However, there have been some recent attempts in making this style of thought and school popular and accessible in clinical settings and there seems to be a slow but gradual increase in the usage of Psychoanalytic thinking in both clinical and non-clinical settings. The paper reviews the history and describes the current state of Psychoanalytic Psychotherapy in India and highlights the difficulties in accessing the therapy within the national health schemes.
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Pub Date : 2021-08-25DOI: 10.1080/02668734.2021.1959390
T. Heinskou, U. Beck
This article argues for the relevance and meaning of mentalizing in leadership and management roles. The relations in organizations are multiple and vulnerable to failure and misunderstandings. A leader has to be both self-aware and aware of others and take into consideration that behind actions there are mental states, emotions and thoughts, wishes and needs. The concept of authority is central in organizational work and in leadership roles. The leader must be able to take relevant action and will be held responsible for it in the organization. In order to act and to understand the consequences it is crucial to have an open mind to oneself and to others. The theory and practice of mentalization can be helpful in understanding the construction of shared meaning in the organization. Reduced capacity to mentalize may be undermining change and the function of the work-group, and thus be inducing irrationality and deadlocks in the organization. Instead of that, mentalizing leadership can stimulate a potential space in the organization for new and non-rigid modes of experiencing.
{"title":"Notes on leadership, management and the role of mentalization","authors":"T. Heinskou, U. Beck","doi":"10.1080/02668734.2021.1959390","DOIUrl":"https://doi.org/10.1080/02668734.2021.1959390","url":null,"abstract":"This article argues for the relevance and meaning of mentalizing in leadership and management roles. The relations in organizations are multiple and vulnerable to failure and misunderstandings. A leader has to be both self-aware and aware of others and take into consideration that behind actions there are mental states, emotions and thoughts, wishes and needs. The concept of authority is central in organizational work and in leadership roles. The leader must be able to take relevant action and will be held responsible for it in the organization. In order to act and to understand the consequences it is crucial to have an open mind to oneself and to others. The theory and practice of mentalization can be helpful in understanding the construction of shared meaning in the organization. Reduced capacity to mentalize may be undermining change and the function of the work-group, and thus be inducing irrationality and deadlocks in the organization. Instead of that, mentalizing leadership can stimulate a potential space in the organization for new and non-rigid modes of experiencing.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":"36 1","pages":"157 - 173"},"PeriodicalIF":0.8,"publicationDate":"2021-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46273672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-03DOI: 10.1080/02668734.2021.1938650
Liam Bierschenk
In this paper, I describe my experience of the aesthetic countertransference in relation to one patient’s artwork in an Art Therapy group as part of a Therapeutic Community for people with a diagnosis of Borderline Personality Disorder within the NHS. The paper discusses how my practice became informed by Mentalization-Based Treatment which places a strong emphasis on clarifying intentional mental states. However, when looking at the artwork I encountered a situation whereby I could not easily put the experience into words. I provide a description of the patient’s overall trajectory within the treatment model, her progress in the Art Therapy group itself, and present a hypothesis for the function of the artwork which the patient produced. I draw upon a model of art therapy I have previously devised combining art psychotherapy theory, art critical theory, mentalization (MBT) and psychoanalytic theory. Drawing on Grotstein’s notion of formulations in the ‘Kleinian-Bionian mode’ I go on to elaborate my concept of the ‘art-psychotherapy object’ being the totality of the triangular relationship (creator/artwork/viewer), in itself unknowable, but the derivatives of which can be understood through the paradigm of transference-countertransference-projective (trans)identification-reverie, and used to explore the dimensions of its planes.
{"title":"Compelling images: a contribution to the theory of aesthetic countertransference","authors":"Liam Bierschenk","doi":"10.1080/02668734.2021.1938650","DOIUrl":"https://doi.org/10.1080/02668734.2021.1938650","url":null,"abstract":"In this paper, I describe my experience of the aesthetic countertransference in relation to one patient’s artwork in an Art Therapy group as part of a Therapeutic Community for people with a diagnosis of Borderline Personality Disorder within the NHS. The paper discusses how my practice became informed by Mentalization-Based Treatment which places a strong emphasis on clarifying intentional mental states. However, when looking at the artwork I encountered a situation whereby I could not easily put the experience into words. I provide a description of the patient’s overall trajectory within the treatment model, her progress in the Art Therapy group itself, and present a hypothesis for the function of the artwork which the patient produced. I draw upon a model of art therapy I have previously devised combining art psychotherapy theory, art critical theory, mentalization (MBT) and psychoanalytic theory. Drawing on Grotstein’s notion of formulations in the ‘Kleinian-Bionian mode’ I go on to elaborate my concept of the ‘art-psychotherapy object’ being the totality of the triangular relationship (creator/artwork/viewer), in itself unknowable, but the derivatives of which can be understood through the paradigm of transference-countertransference-projective (trans)identification-reverie, and used to explore the dimensions of its planes.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":"35 1","pages":"227 - 244"},"PeriodicalIF":0.8,"publicationDate":"2021-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/02668734.2021.1938650","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46225531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-03DOI: 10.1080/02668734.2021.1953116
Andrew White, A. Herbert, Pierise Marshall
The Camden and Islington Personality Disorder Service (PDS) increasingly provides clinical consultation to external services. There is a dearth of research on the experience of clinicians delivering such consultation. Interviews were conducted with clinicians from the PDS, and a semantic Thematic Analysis was conducted on transcripts to answer the question, ‘What is the experience of Personality Disorder Service staff providing input to staff in external services?’ 13 sub-themes under four overarching themes were identified (these latter were: Anxiety, Fragmented Co-working, Task Difficulty, and Positive Outcome). These themes provide an overview of the experience of consulting clinicians. Themes are explored through Kleinian psychoanalytic theory, with reference to Bion’s work on containment and groups. Findings suggest that staff need to retain thinking space to work effectively, to feel safe and recover a sense of competence when it is attacked, highlighting the need for access to structures such as supervision. The responsibility for trying to reduce distress, risk (to self, to and from others) and functional disability of people with a diagnosis of personality disorder cannot belong to one person or service but services need to be able to think together to gain a better understanding and have an agreed cross-service response.
{"title":"Beyond the walls of Camden & Islington personality disorder service: a qualitative study of clinical consultation to external services","authors":"Andrew White, A. Herbert, Pierise Marshall","doi":"10.1080/02668734.2021.1953116","DOIUrl":"https://doi.org/10.1080/02668734.2021.1953116","url":null,"abstract":"The Camden and Islington Personality Disorder Service (PDS) increasingly provides clinical consultation to external services. There is a dearth of research on the experience of clinicians delivering such consultation. Interviews were conducted with clinicians from the PDS, and a semantic Thematic Analysis was conducted on transcripts to answer the question, ‘What is the experience of Personality Disorder Service staff providing input to staff in external services?’ 13 sub-themes under four overarching themes were identified (these latter were: Anxiety, Fragmented Co-working, Task Difficulty, and Positive Outcome). These themes provide an overview of the experience of consulting clinicians. Themes are explored through Kleinian psychoanalytic theory, with reference to Bion’s work on containment and groups. Findings suggest that staff need to retain thinking space to work effectively, to feel safe and recover a sense of competence when it is attacked, highlighting the need for access to structures such as supervision. The responsibility for trying to reduce distress, risk (to self, to and from others) and functional disability of people with a diagnosis of personality disorder cannot belong to one person or service but services need to be able to think together to gain a better understanding and have an agreed cross-service response.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":"35 1","pages":"186 - 207"},"PeriodicalIF":0.8,"publicationDate":"2021-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/02668734.2021.1953116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49232986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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