British Journal of Psychotherapy最新文献

Psychotherapy with suicidal and self-harming young people is complex, as this population group is difficult to engage in treatment and their internal reactions may remain concealed, leading to impulsive suicide attempts or abandonment of treatment. The resulting countertransference reactions of confusion, guilt and shame are most distressing and often cause psychotherapists to avoid treating this population group. Safety concerns increase when self-destructive patients abandon therapy, or their condition worsens despite the therapist's best efforts. The vicissitudes of the adolescent developmental process suggest that, in some cases, withholding information, rejection of the therapist's caring interventions, and abrupt termination of treatment arise from the need for separation and independence and are ego syntonic and therefore suicide protecting. In other cases, the risk for suicide may be increased because of the transference experience of hostile abandonment. A negative therapeutic reaction (NTR) is a disturbing development in the course of psychotherapy that has not been adequately explained in the treatment of suicidal young people. This article is a consideration of whether these negative reactions associated with abrupt, unplanned terminations, in the treatment of self-destructive young people, should appropriately be thought of as an NTR or as a developmental stage in separation.

In clinical practice, there is a well-established developmental path from beginner to post-qualification and on to some form of expertise or mastery. In this paper, I explore whether the outline of a similar pathway could be mapped out for analytic supervision. For the clinician, a key element in becoming more competent and skilled is the capacity to reflect on one's work and learn from experience. To do that the clinician learns to develop a form of internal conversation which orients them to the work. I argue that an important developmental step for the supervisor is to acquire a similar capacity, which I call the supervisor's internal monologue. In this paper, I illustrate what I mean by the supervisor's internal monologue and discuss some of its functions and characteristics.

In this paper, the author looks at some central psychoanalytic themes through the lens of literature. In literary criticism, it is clear that we construct a meaning with the help of certain formal principles. In literature, we also know that fiction differs from documentary or scientific prose. The literary critic thinks that, specifically in fiction, one may find new formal principles and, through that, new perspectives on reality. With the help of these literary constructs, the author looks at character, transference, therapeutic change and truth/reality in psychoanalysis. The argument is elaborated in relation to a clinical example.

This paper addresses the conditions for the development of creativity and the possible obstacles along the way. It explores conscious and unconscious mechanisms which either impede or support this process. Creativity is seen as a special case of relationships between internal and external objects, with some aspects being more consistent and others being more fluid throughout an individual's life. This paper is based on the clinical experience of psychodynamic work with clients whose psychological predicaments related to creativity impoverished different areas of their lives. The non-exhaustive list of factors to be considered when working with those clients includes a blocked epistemophilic instinct, excessively repressed aggression, and strong negative projections. A harsh superego opposing a weak ‘internal supporter’ combined with an internalised negative parental attitude to their own creativity constitutes a powerful unconscious force which prevents it from blossoming. A high level of basic anxiety, a low degree of omnipotence, and the release of endorphins in response to suffering contribute to these difficulties. Insufficient capacity to sublimate emotions and an inability to free associate prevent clients from finding the links between ideas born in the mind and their expression that could be accessed by others.

The Balint group, a time-tested and efficacious resource for fortifying resilience among helping professionals, is explored in depth in this article through a case vignette. Despite its demonstrated efficacy in assisting professionals handling challenging cases, the Balint method's adoption remains inexplicably limited. We hypothesize that this restraint is due to a deficient understanding of the method's mechanics, operational processes and outcomes. In response, we offer a contemporary interpretation anchored in the theoretical framework of mentalization, aligning with current psychotherapeutic standards. The article underscores the Balint group's remarkable utility, akin to other mentalization-based therapeutic methods, in navigating intricate cases, emotionally demanding situations and circumstances that exceed the expertise and experience of the professional. By highlighting this, we hope to broaden the acceptance of the method, enable systematic assessment of its effectiveness and augment training for group leaders and participant commitment. This endeavour represents both a nod to the research-centric approach originally espoused by Mihály Bálint and an embrace of the growing emphasis on evidence-based methodology in medicine and psychotherapy. Ultimately, we aim to illuminate the potential of the Balint group and promote its extensive application in support of helping professionals.

People experiencing homelessness are subject to entrenched health inequalities and obstacles to accessing care. Numerous studies have highlighted that structural and organisational obstacles result in people experiencing homelessness living with unmet healthcare needs. Over time, this is associated with a reduced life expectancy compared with the national average in the UK. Although combating health inequalities has become a mandate for many healthcare providers, attempts to improve parity and access for people experiencing homelessness has stalled. This article utilises a case study method to highlight instances of psycho-social exclusion that homeless patients can be subject to and examples where healthcare staff can collude in this exclusion. The article concludes with highlighting the benefits of psychologically informed staff consultation, which creates reflective spaces to gain a better understanding of people experiencing multiple disadvantage and exclusion. In addition, staff consultation allows space to process feelings that are stoked in professionals who struggle to comprehend why it is difficult for some people to accept offers of care.

Supervisees who have experienced disturbing therapeutic incidents that undermined their professional self-experiences need a supervisory environment of sameness and solidarity to process and learn from these lived experiences. To create such an environment, supervisors need to minimize the sense of safety asymmetry between themselves and their supervisees by awakening to the ‘dark,’ ominous truths of professional life. This process is facilitated by summoning memories of therapeutic experiences of failure, vulnerability and frustration at having insufficient time to achieve wished-for therapeutic goals. Awakening to these truths inspires a dark experiential mode that helps the supervisor share the supervisee's destiny and existential anxiety. Despite the contradiction between the dark and the playful, experiential modes, both are essential for creatively understanding the supervisee's disturbing therapeutic experiences and learning from them. Moreover, when these modes are interwoven, they enrich and strengthen the supervisory process by diversifying the supervisory dyad's ways of perceiving the unfolding therapeutic interaction and of coping with supervisory challenges.