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Abstract: The paper proposes that frameworks typical to metaphysics and art could be used in clinical treatment in somatic and psychiatric contexts to ensure improved care. The concept of the “body electric” of somatic patients which I introduced in previous work is developed further and paired with the “mind electric” of psychiatric patients. Both are defined as a patient's personally generated metaphysical possibility of being healthy‐within‐illness which is experientially actualized. Both concepts are used here to explore the alternative and the serious challenges to treatment approaches focused on clinical categories, disease, provision, and promotion of standardized or “black‐box” therapies. An argument against the idea implied by the hope for such mass treatments and corresponding overreliance on science, namely, that health comes from fixing and regularizing, is developed based on cultural history and the evidenced fact that personally assumed health, just like art and metaphysics, is transgressive of scientific data, and accommodates the untrue, the impossible or the irregular as actual and normal. Because normality is created only with the help of disorder and from within it for chronic patients, clinicians should offer them the metaphysical care they need to produce and actualize their possibility of irregular normality or their body/mind electric. Better treatments can only be provided when scientific advances will be matched with advances in the humanistic competence of clinicians. [ABSTRACT FROM AUTHOR]

Abstract: The physical spaces in which we conduct psychotherapy are an important yet underacknowledged aspect of psychotherapeutic work. Although a few contemporary publications have provided suggestions for the creation of welcoming, comfortable, and efficient practice spaces, considerations of what it means to transform a room into a therapeutic space have remained largely absent from recent literature. This paper reviews the existing literature on this subject and describes the ways in which the therapist's office is intimately tied to several processes of the therapy itself, by way of creating an adaptive environment that is able to meet the needs of both therapist and client over the course of their work together. [ABSTRACT FROM AUTHOR]

abstract This paper reviews the place of the therapeutic community in the mental health field, using a sociological framework to understand some key factors that have shaped the field and its response to this approach to therapy. The therapeutic community treatment method in mental health has been contested over the years. It has challenged conventional professional frameworks, it has dealt with a difficult client group, and it has been hostile to or at least awkward about establishing its evidence base. In this paper I reflect on the 'politics of evidence' in contested fields. I draw on the analysis of 'fields' from the work of French sociologist Pierre Bourdieu, and the analysis of scientific knowledge from an area of the social study of science, 'actor-network theory'. I argue that evidence is not neutral in contested fields, and that the technology of trials is not balanced with a theoretically informed understanding of the phenomena under scrutiny (causality versus meaning). [ABSTRACT FROM AUTHOR]

The aim of this paper is to provide a description of a significant process which takes place during a first psychiatric hospitalization and to shed some light on its context. This process involves a transformation of an individual considered mentally disturbed into a psychiatric patient which affects the person's identity. The ‘person’ becomes a ‘psychiatric patient’. Although it is self-evident that a patient never stops being a person, the context of the first hospitalization merits attention as it is the time when the patient is in most danger of being objectified and depersonalized. The paper describes a study of forty-six patients hospitalized for the first time on a psychiatric ward and their seventy-five parents. Their narratives from the beginning and the end of stay in hospital were compared and the language used during the introductory consultation and discharge consultation analysed. In this process an important role is played by patients' parents. The parents' narratives are seen to change in a direction of acceptance but at the same time a process of stigmatization is apparent. [ABSTRACT FROM AUTHOR]

This paper reviews the current state of the theory and practice of family therapy. It proposes that the field is undergoing a radical metamorphosis in which its theory base is becoming characterised by less ideological ‘purity’, more attention to an evidence base and an integration within other treatment modalities. Like all such metamorphoses, this transformation of family therapy is not without its difficulties. In many ways, professional contexts, professional institutions and training programmes, at least in the UK, do not appear to have made the adjustment to this change. The paper will therefore highlight these contextual issues as a counter-point to the metamorphosis that is in process. [ABSTRACT FROM AUTHOR]

The Integrative Psychotherapy Alliance model brought an interpersonal and systemic perspective to bear on theory, research, and practice on the psychotherapeutic alliance. Questions have been raised about the independence of the theoretical factors in the model and their operationalization in the Individual, Couple, and Family Therapy Alliance Scales. This paper presents results of a confirmatory factor analysis of the scales that delineated at least three distinct interpersonal factors as well as shorter versions of the three scales to facilitate their use in research and practice. The paper also presents the results of a study testing each factor's association with client retention and progress over the first eight sessions in individual and couple therapy. At least two of the interpersonal factors were uniquely associated with progress in individual and couple functioning. Implications of the results for theory, research, practice, and training in individual, couple, and family therapy are elaborated. [ABSTRACT FROM AUTHOR]

This paper 1 is about the psychotherapy of a woman who passed from what Waddell (1998) would term ‘older age’ to ‘later life’, by which latter I mean the inevitable decline into dying and death. However unwelcome these developments may be to the individual, they are none the less activities of the soma, and therefore activities of the self—deintegrates. Much of the work of the psychotherapy centred around the task of enabling the patient to relate to and accept the bodily and emotional correlates of this process, which she tended to want to disown and deny by means of a split between mind and body along the lines of a long-standing internal depressive relationship. Permitting her contact with herself allowed her a much greater sense of internal company and peace, and arguably facilitated an easier process of dying, involving a self reconciled with itself rather than one at odds. Technically, the approach involved a greater concentration on the intrapsychic relationship rather than on the relationship between patient and analyst, and this is briefly discussed in terms of the work of Armando Ferrari who had himself died, shortly before the paper was first presented, and to whom therefore it is in part a homage. [ABSTRACT FROM AUTHOR]

Over the last several decades single session psychotherapy has become a mainstream psychotherapeutic approach. A steadily increasing demand for psychotherapeutic services and a continuous reduction in mental health care resources worldwide are both largely responsible for this development. This paper describes single session psychotherapy and provides a brief review of the relevant literature. Single session psychotherapy delivered in walk-in settings is also discussed. Therapists who are unfamiliar with single session psychotherapy will find that this paper provides a concise introduction to the essential processes and outcomes of this psychotherapeutic approach. [ABSTRACT FROM AUTHOR]

This overview of the March 2003 conference on the U.S. national buprenorphine implementation program is developed to inform the practitioner about the positive experience that has been accumulated worldwide on the use of buprenorphine for office-based practice. The first paper delineates the challenges for American psychiatry in moving buprenorphine forward into general practice. Most psychiatrists are unprepared to work with opiate-dependent patients or to use buprenorphine. The international successes with office-based buprenorphine from France and Australia are presented in the next papers, followed by presentations on several U.S. studies using buprenorphine in the community for detoxification and office-based maintenance. These experiences have thus far confirmed buprenorphine's utility and promise for opiate addiction treatment in the U.S. Finally, two national monitoring programs have been implemented to assess the public health impact of this new treatment opportunity. This opportunity has a three-year window, however, and a critical need will be to attract a sufficient number of physicians into prescribing buprenorphine/naloxone in order to allow our patients increased access to this treatment. [ABSTRACT FROM AUTHOR]

Seldom is the work of philosophers invoked by health professionals when examining aspects of care from a philosophical perspective. Instead, students of health care, especially nurses, have been introduced to ‘philosophies’ which are often superficially examined and poorly understood. This practice fails to develop in students an appreciation of the work of philosophers or to acquire the art of critical thinking. The introduction of models and theories of nursing in the past three decades has alerted nurses to the importance of possessing critical skills in order to identify sound theory and implement good practice. This paper goes beyond mere philosophising and examines aspects of mental health care from the perspectives of one of nineteenth century Europe’s most notable philosophers, Friedrich Nietzsche. It argues that understanding his work can enhance one’s ability to reflect on nursing practice, as well as bringing a new dimension to how we analyse ‘mental health’ problems. His work provides many insights into how we can improve our understanding of the effect of mental illness and mental health care on the individual, and how we conceptualise the process of care. This paper provides an overview of his life’s work, his impact on the history of ideas and develops some of the more provocative implications of his work for mental health care. [ABSTRACT FROM AUTHOR]

Ward community groups have been mostly lost from acute psychiatric in-patient settings in recent years with changes related to care in the community and altered therapeutic expectations. This paper outlines the re-introduction of ward community groups to such a setting and, by using the quantitative measure of patient complaints and qualitative observations, offers evidence for their usefulness as a therapeutic medium, beneficial to the acute psychiatric in-patient ward, and as a container for disturbed states. [ABSTRACT FROM AUTHOR]

This paper 1 considers some of the difficulties that exist in reconciling the ‘treatment’ and the ‘cultural’ aspects of analytic ideas and practice; the extent, for example, to which analysis is both ordinary, and extra-ordinary in more than one way. The implications for this for the place of analysis and analytical psychotherapy in the mental health services is considered along with the ways in which there is a diversity of views about the importance of maintaining the presence of analytic ideas and analytic practice in hospitals and clinics. Some of the limitations of analysis are discussed where analytic ideas and methods move away from their application to patients and patients’ material into the wider world. [ABSTRACT FROM AUTHOR]

There are three lines of argument in defence of coercive treatment of patients with mental disorders: arguments regarding (1) societal interests to protect others, (2) the patients' own health interests, and (3) patient autonomy. In this paper, we analyse these arguments in relation to an idealized case, where a person with a mental disorder claims not to want medical treatment for religious reasons. We also discuss who should decide what in situations where patients with mental disorders deny treatment on seemingly rational grounds. We conclude that, in principle, coercive treatment cannot be defended for the sake of protecting others. While coercive actions can be acceptable in order to protect close family and others, medical treatment is not justified for such reasons but should be given only in the interest of patients. Coercive treatment may be required in order to promote the patient's health interests, but health interests have to waive if they go against the autonomous interests of the patient. We argue that non-autonomous patients can have reasons, rooted in their deeply-set values, to renounce compulsory institutional treatment, and that such reasons should be respected unless it can be assumed that their new predicaments have caused them to change their views. [ABSTRACT FROM AUTHOR]

AIMS: This paper focuses on attitudes towards and use of self-chosen treatment among people prescribed antidepressants and discusses the implications for practitioners involved in medicines management. BACKGROUND: In the wide-ranging debate around the extension of non-medical prescribing in the UK the relationship between complementary and alternative therapies and prescribed medication has received little attention. Research indicates that self-treatment, including use of complementary and alternative therapies is burgeoning, yet there is uncertainty about the degree to which practitioners should be knowledgeable about therapies or be capable of advising clients on their use. Complementary and alternative therapy use is common among people with depression and greater knowledge of their use may be appropriate if health practitioners are to be able to support and inform people with depressive symptoms. METHODS: Qualitative methodology was adopted and 60 people from four primary care practices in the West Midlands, UK were interviewed individually and their self-reported treatment journeys documented. RESULTS: Almost two-thirds of participants had attempted to use self-chosen therapies during their recent illness though few had discussed their use with health service practitioners. Use of a range of self-chosen therapies was supported by a belief that they were natural, combined with a desire to avoid consulting health practitioners. Reasons for non-use of such therapies included confidence in health practitioners and caution about the possibility of drug interactions. CONCLUSIONS: Health practitioners require an awareness that people with mental health problems are using a range of self-chosen treatments and might consider the appropriateness of initiating discussions on self-chosen treatments with clients. This area requires greater debate and if necessary identification of an appropriate knowledge base. RELEVANCE TO CLINICAL PRACTICE: Assessment of common mental health problems should include discussion of patients' previous and current self-treatment. Such discussions will assist in identifying attitudes and beliefs towards health service treatment and provide a basis for selecting appropriate interventions. [ABSTRACT FROM AUTHOR]

The concluding paper in this series provides brief reflections from a range of key individuals involved in the development and interpretation of CORE benchmarks for NHS primary care psychological therapy and counselling services. Michael Barkham firstly reflects on some of the research challenges facing the use of benchmarks derived from practice-based evidence, before acknowledging the potential for such data to help bridge the research-practice gap as we learn the best use of it. Geoff Mothersole considers similar challenges in using real world data, and explores some of the challenges that managers face in using benchmarks for improved service management practice. Barry McInnes increases the magnification in his reflective focus and looks at the juxtaposition of national guideline recommendations from evidence-based practice in contrast to those introduced by the growing practice evidence-base suggesting differential therapist effectiveness. The first of two final strategic reflective perspectives includes Richard Evans's summary of some of the hidden lessons from the benchmarking endeavour to-date, before my own personal concluding summary looking at lessons learned for the on-going strategic development of enhanced support for routine quality evaluation. [ABSTRACT FROM AUTHOR]

Abstract The purpose of the present paper was to investigate the efficacy of augmentation of clomipramine (CMI) by tandospirone in 36 untreated outpatients with major depressive disorder. Twelve patients were treated with CMI and tandospirone (T group), 12 with CMI and diazepam (D group) and 12 with CMI alone (C group) for 6 weeks. No statistically significant differences in the percentage improvement of the Hamilton Depression Rating Scale (17 items; HDRS-17) and the Hamilton Anxiety Rating Scale (14 items; HARS-14) scores were shown among the three treatment groups. However, at 2 weeks, the percentage improvement of HDRS-17 score in the T group tended to be higher than that in the D and C groups, although there was no statistically significant difference among the three treatment groups. No change in plasma prolactin level or adverse events was induced by the addition of tandospirone. These results suggest that 6 weeks of treatment with tandospirone or diazepam was not effective for augmentation of CMI in major depressive disorder patients. However, augmentation of antidepressants by tandospirone administration for a few weeks might induce early expression of antidepressive effects. [ABSTRACT FROM AUTHOR]

This paper describes a family in which bulimia nervosa has been present in four children. Discussion about the possible reasons for the development of bulimia in this family includes the importance of secrecy as a boundary-making function in family systems. [ABSTRACT FROM AUTHOR]

Fairy-tales, like mythologies, can be found all over the world containing the same motif and chains of motifs. In this paper I have presented some theories on the occurrence of this archetypal phenomenon ranging from the old migration theory to Sheldrake's theory of morphogenetic fields. I have then tried to show how fairy-tale-motifs can appear in various ways in analytical therapy, often in hidden forms. We find them in patients' dreams as well as in their fantasies and associations. If the therapist is open to them they will also appear in his or her amplifications. He or she might then take note of the fairy-tale or point it out to the patient; in the latter case it might provide better access to the patient's problems and complexes as fairy-tales have an emotional completeness because of their pictorial character. Finally I have described the favourite fairy-tale of one of my patients and related it to his symptoms, his central complex and his personal ways of experiencing and behaving. This survey of how fairy-tales can be used in therapy with children and with adults far from exhaustive. [ABSTRACT FROM AUTHOR]

Three variations of the multiple baseline design (MBD) have been identified in the behavioral literature: MBD across behaviors, subjects and situations. This anaylsis proposes an important variant of the MBD across behaviors, namely the MBD across exemplars. In this variant, two or more components (exemplars) of the behavior class form the baselines of the design. The implicit rule of the MBD across exemplars can be seen in several published papers in the behavioral literature. The value of recognizing this variant of the MBD across behaviors is its usefulness as an alternative experimental intervention in clinical settings where the possibility of a convincing research design might not otherwise be seen. [ABSTRACT FROM AUTHOR]

This article discusses the much-misunderstood Tarasoff decision that requires psychotherapists to protect third parties from patients' violent acts. Through a normative approach, the paper analyzes four important issues: what to do when potential victims are unknown; what to do about the fact that the patients' potential for violence may be incorrectly perceived; the value of warning potential victims; and, the problem of discharging potentially violent patients from the hospital. The author proposes that the courts adopt a more flexible substantial departure test in most cases that involve psychiatric negligence. [ABSTRACT FROM AUTHOR]

This paper describes a programme for inpatients with severe personality disorders as well as acute exacerbation of Axis II pathology. The goal of the programme was to quickly stabilize participants with respect to self-injurious behaviour and return them to the community. The programme consisted of frequent coordinated cognitive group therapy sessions with supporting written and audiovisual materials. The groups were open-ended and heterogenous, and employed educational and experiential-affective components. An extended group case example is presented in order to illustrate the operation of the programme. The range of typical participants is described, including their diagnoses, treatment plans, and homework assignments. Some comments on the personal and professional difficulties encountered by therapists working with this population ate described as well as some suggestions for alleviating those difficulties. [ABSTRACT FROM AUTHOR]

This article presents information on the application of role playing, as a research technique, in a test of Sarbin's self role congruency theory. The present study attempts to provide further confirmation of Sarbin's congruency theory, in this case within a setting analogous to psychotherapy. It was believed that by using Ss who were playing the roles of therapist and clients it would be possible to obtain information relevant to the effects of self-role congruency and incongruency in the psychotherapeutic interaction. A secondary purpose of the study was to provide data on the validity of pencil and paper tests that purport to measure role-playing aptitude. Forty nine male Ss from various undergraduate classes volunteered to role play either a therapist or a client in a half-hour role-playing session designed to simulate psychotherapy.

Although recent studies indicate greater sustained improvement in psychiatrically hospitalized children when their parents are actively involved in the treatment program, to date no study has examined the direct benefits of group intervention for parents themselves. The present paper describes the impact of an experimental parent-group program on parents' self-esteem, attitudes toward their children, and knowledge regarding childrearing techniques. Overall, supportive group functions are rated by parents as having greater personal relevance and therapeutic impact than educative ones. [ABSTRACT FROM AUTHOR]

The author discusses and comments on Korf and Bosker's paper entitled, `The depressed patient in a biological world: on philosophical and diagnostic strategies'. The author opines that treating mental disorders as being either only biological or strictly psychological, which according to his analysis, renders an objective instead of subjective view. The author opines that such an analysis by clinicians hinder the scope of identifying and developing new treatments.

Focuses on "Reconsidering Schreber: Contemporary Perspectives," a study day held at the Severnside Institute for Psychotherapy in July 2005. Background on how the speakers reappraised Freud's paper "Psychoanalytic Notes on an Autobiographical Account of a Case of Paranoia" which was based on Schreber's "Memoirs of My Nervous Illness"; Highlights of the event.

Focuses on the process of selecting the papers published in the 20th anniversary issue of the journal "British Journal of Psychotherapy." List of articles published in the previous issues of the journal.