Search

Unseen Suffering - Therapy for Traumatized Refugee Children In March 2015 the psychological counselling service (Psychologische Familien- und Lebensberatung) of Caritas Ulm initiated a psychotherapy project for traumatized minor refugees. Besides individual and group therapy, networking and qualification of qualified personnel and volunteers, in autumn 2015 we started offering our services on-site in a large collective accommodation for asylum seekers in Ulm. This was mainly because - in contrast to unaccompanied, mostly adolescent, minor refugees - our services appeared to reach children only by chance. In our opinion this is mostly due to the fact that children's suffering is often far less noticed. This paper describes our first year's project work, followed by reports on the use of psychodrama groups with refugee children and on the therapeutic work in a collective accommodation for asylum seekers.

Functional analytic group therapy (FAGT) is based on the idea that, in effective group therapy, the problems clients seek treatment for actually happen in the interaction with other group members, which allows the therapist to assess the problems and do therapeutic work on them in vivo. This paper proposes a logical framework that describes interpersonal sequences in which functional analytic principles help harness natural exchanges among group members for effective therapy. The sequences typically start when group interaction poses difficulties to which the client responds with clinically relevant behavior, either his or her usual problem behavior or improved target behavior. Effective exchanges in the group naturally weaken the problem behavior and reinforce target behavior. The group is an ineffective agent when it reinforces problem behavior or weakens target behavior. The FAGT therapist continuously assesses and, when needed, improves group interaction patterns by weakening ineffective group patterns and shaping effective exchanges in the group. The article provides examples of these logical sequences and offers recommendations about making groups more therapeutically effective.

In this article I offer some technical suggestions for psychoanalytic work with anorexic patients. Although focused on an outpatient setting, certain parts of the article will also have utility for inpatient work. As an outpatient therapist working with an anorexic patient, especially in the acute stages of the illness, there are case management demands that need immediate attention. The setting up the particular frame is required to augment the therapeutic work. The most urgent pressure felt by the clinician is the precariousness of the patient’s physical health. This can be experienced as if there is a gun to the head of the therapist. This deathly force must be carefully and constantly grappled with, and particularly so in the most symptomatic stages of the illness. The clinician must work with a patient who might die at any time, yet an anorexic patient cannot be managed the way a suicidal patient would be. The question of technique in this situation is a complex one. Above all, the patient mu...

Various professional standards underscore the importance of providing effective services to all people, including those from diverse religious backgrounds. Yet despite these standards, studies have repeatedly found that most social workers receive little training in navigating this aspect of diversity during their graduate educations. To address this lack of training, the present article discusses a concept that is foundational for effective service provision with spiritual clients from diverse religious backgrounds—spiritual competence. More specifically, this article outlines what spiritual competence is and why it is important in therapeutic work, and then offers a number of strategies for developing spiritual competence. As such, this article helps equip practitioners to provide more ethical, effective services in a nation characterized by increasing religious diversity.

This paper looks at violence and sadism in child and adolescent patients. Psychoanalytic and developmental ideas are brought together to make sense of these children’s presentations and the clinical challenges of therapeutic work with them. Differences are outlined between cold and hotter forms of aggression. The contribution of Glasser and his concept of the core complex is central to the paper, as is an understanding of addictive processes often seen in aggression, including sexual aggression.

ObjectivesTo compare preoperative staging, multidisciplinary team-assessment, and treatment in patients with screening detected and non-screening detected colorectal cancer.MethodsData on patient and tumour characteristics, staging, multidisciplinary team-assessment and treatment in patients with screening and non-screening detected colorectal cancer from 2008 to 2012 were collected from the Stockholm–Gotland screening register and the Swedish Colorectal Cancer Registry.ResultsThe screening group had a higher proportion of stage I disease (41 vs. 15%; p ConclusionsScreening detected cancer patients were staged and multidisciplinary team assessed more extensively than patients with non-screening detected cancers. Staging and multidisciplinary team assessment prior to endoscopic resection was less complete compared with surgical resection. Extensive surgical and (neo)adjuvant treatment was given in stage I disease. Participation in screening reduced the risk of emergency surgery for colorectal cancer.

This article analyzes the links between the conception of the body and of sexuality found in Freud and Merleau-Ponty. The French philosopher refers to Freud in various of his works, and performs a reading of Freud through which he rescues the meaning that the latter gives to sexuality as he integrates it into the totality of the person, without making it into a blind or merely instinctive force. As a consequence of this integration, the notions of the unconscious and of instinct or drive are interpreted in the light of the meaning or signification that they have in the person's behavior. Merleau-Ponty's notion of pre-reflective knowledge plays a decisive role in this understanding of meaning. In the same way, it allows important contemporary analysts to use these studies in their therapeutic work and also in psychological studies.

Introduction: Equine-assisted activities and therapies (EAAT) have gained prominence as a viable therapeutic approach for a range of mental health and developmental problems, yet is not widely known and not conventionally provided within the social work educational curriculum. Thus, the purpose of this study is to provide a review of various certification bodies available to social workers in order to bring EAATs into their therapeutic work. Methods: A multi-stage process, including consultation with experts in the field and an online search was undertaken to locate certification programs for mental health professionals. Results: Seven certification organizations were identified; programs varied with respect to mental health pre-requisites, type of certification, training components, and cost. Discussion: There has been substantial growth in EAAT for children with mental health and developmental problems, and there are a range of certification types to select from. Factors to consider when choosin...

The Building Blocks supervisory team is committed to providing and maintaining a safe environment for therapists to reflectively process their work with underserved and high-risk families. Therapists regularly meet with supervisors in group and in one-on-one meetings. In the nonjudgmental and supportive environment of the supervision, therapists give detailed descriptions of their work and share video recordings of their sessions. The therapists feel safe to express their feelings, concerns, fears, and conflicts about doing this demanding work. In the safe supervision space, ruptures that might arise between therapists or between supervisor and therapist are processed and repaired, resulting in deeper communication and stronger relational bonds. Good communication in the supervision group and in individual supervisory relationships promotes mentalization, which has a direct impact on the therapeutic work with underserved and high-risk families, who need so much. Feeling cared for, the therapists c...

Every time new applications of information and communication technologies (ICTs) are developed for psychological care. This article aims to favor the implementation of technological applications in daily practice. To do so, some advantages of the use of technologies are pointed out and the impact of technology on the alliance of therapeutic work is reviewed. Secondly, some technological resources available for psychological work are pointed out, as well a classification of such technologies. This is followed by a review of the possible risks of the application of treatments mediated by technologies. Finally, the results in terms of effectiveness are indicated. All in all, the conclusion is that ICTs are tools whose effectiveness has been proven and they can be a complement to traditional care.

This chapter examines the specific difficulties Imprisonment for Public Protection (IPP) prisoners share, including hopelessness and the near enough impossibility of proving they are no longer a risk to others. When the Criminal Justice Act of 2003 introduced IPP, the objective was to shield the public from serious sexual and violent offenders in England and Wales. It was designed so those who posed a significant risk of causing serious harm to the public could be detained in prison until they no longer posed such a risk. Originally, the government estimated that IPP would lead to 900 extra offenders entering the prison system but IPP numbers grew rapidly, with many in jail well past their minimum terms. IPPs have proved difficult to understand and leave victims and their families uncertain about how and when an offender will be released. IPPs lead to inconsistent sentencing.

In this penultimate chapter, we address elaborate forms of mental navigation, which involves the subtlest capacities of the human mind. First, we deal with epistemic navigation, i.e. the encounter with the inner world of others (or of oneself). We show in particular that intersubjectivity, the condition of the richest social relationships, such as love or therapeutic relationships, requires complex nesting of worlds and refined explorations of the inner worlds of others (or ourselves). We then approach aesthetic navigation as a dialogue between the inner world of a subject and the worlds opened by an artwork. We also show that science, despite its apparent austerity, builds on navigation in possible worlds and can thus offer a stimulating model for therapeutic work. Finally, we suggest that more specific attention to the inner world could enrich the exploration of spiritual life in care.

Ethical questions arising in the course of therapeutic work mobilise the psychotherapist’s superego in helpful and hindering ways. The therapist’s task of maintaining the therapeutic relationship on an ethical footing often proves complex and uncertain. In this chapter I offer a triangulating model with three reference points – ethical principles, the analytic framework and the defining features of the psychoanalytic model – to assist the therapist to create a mental space in which to think through the conflicts of interests at stake between, and within, therapist and patient and to hold the necessary uncertainty about the ‘rightness’ and ‘wrongness’ of the outcomes of ethical thought.

Some years back I was asked to do some pro bono work with war refugees. For various reasons, St. Louis had become a destination for refugees, and since the last several years had seen quite a few wars, there was a lot of work to be done. At first, I mostly conducted diagnostic assessments that were used for legal purposes, such as determining if someone had to learn English before applying for citizenship, or had a psychiatric diagnosis that might militate against being deported. Eventually, I worked for a clinical agency to do therapeutic work. I had been working as an analyst and psychiatrist off the bureaucratic grid, so to speak, for several years before then, and filling out forms and questionnaires as a way of documenting the need for treatment and its progress was a new experience for me, or at least one I hadn’t had in a long time; rather, 20 years ago I had to do things like this, but nowhere near as much paperwork went into it then as now.

Recent investigations have elucidated the influence of the Strong Black Woman (SBW) Schema on the mental health and treatment seeking behaviors of Black women in the United States. However, the SBW schematic characteristics that produce depression have yet to be identified. The current study fills this void in the literature through a quantitative examination of how characteristics of the SBW Schema relate to depressive symptomology. Analyses were based on 194 participants, including college students (n = 98) and community members (n = 96), ranging in age from 18 to 82 years-old (M = 37.53, SD = 19.88). As hypothesized, various manifestations of self-silencing were found to significantly mediate the relationship between the perceived obligation to manifest strength (a SBW characteristic) and depressive symptomatology. The present study advances the idea that depressive symptoms are related to endorsement of the SBW Schema and highlights self-silencing as a mechanism by which this relationship occurs. These results offer evidence and clarification of the impact of the SBW Schema on Black women’s mental health and identify specific points of intervention for mental health practitioners conducting therapeutic work with Black women. We provide recommendations for future research to avoid pathologizing strength and we discuss the implications and potential benefits of integrating a Womanist theoretical perspective into counseling for Black women, a population that has historically underutilized mental health resources.

This chapter traces the role of shame in traumatic disorders and disorders of attachment should be a potentially fruitful area for further study. Under ordinary conditions of peace, this chapter suggests that shame is one of the primary regulators of social relations. Fear is the primary regulator only in circumstances where social structures for maintaining peace have broken down and social relations are ruled by violence. Developmentally, shame appears in the second year of life. Properly speaking no toddler is autonomous; rather, one might formulate the toddler's developmental task as learning to regulate body, affect, desire, and will in attunement with others. Originating in the primary attachment relationship, shame generalizes to become an emotion that serves to regulate peer relationships, social hierarchy, and all the basic forms of social life. According to Lewis addressing shame directly in the psychotherapy relationship facilitates therapeutic work, by normalizing shame reactions and by giving patients a relational framework for containing and understanding them.

This chapter presents the question of the particularity of psychoanalysis and regulation by briefly reviewing the current status of registration procedures for psychotherapists in Japan. It considers the position of the “dead person” in Japanese Buddhism, which provides an analogy for the position of psychoanalysis in Japan as it faces the prospect of state regulation. The chapter deals with some reflections on the transmission of psychoanalysis. The members of the Japan Psychoanalytic Society who are psychiatrists are actually quite indifferent to the issue of the state regulation of psychoanalysis; they are already regulated as medical doctors and this is not at all inconvenient to them. Psychoanalysis is expected to provide such a vocabulary, and it is still one of the reference points of the broader psychotherapeutic community. The pressing issue now is the state regulation of clinical psychology rather than psychoanalysis as such, and it is this that will have major consequences for therapeutic work of any kind.

In this chapter, the authors begins by outlining some of the key ideas and practices of narrative therapy and then consider what opportunities narrative therapy may offer in therapeutic work with adults with intellectual disabilities. They provide a brief overview of the key theoretical ideas and practices in narrative therapy. Narrative therapy was initially developed by Michael White and David Epston and has evolved from a synthesis of diverse influences. The ideas of various social sciences theorists and poststructuralist philosophers, in particular Foucault, have been instrumental in the development of narrative theory. Narrative therapy's challenge of dominant discourses and taken-for-granted realities makes it an appealing approach for therapeutic work with people who collectively have been marginalized and stigmatized like few others. The authors conclude by addressing some questions that the reader might have about using this approach and offer some personal reflections on the effects of incorporating narrative therapy into our own work.

This chapter argues that therapists and other refugee workers, under the imperceptible influence of the refugee-trauma discourse, tend to feel that they cannot work effectively with this group of clients unless they have some privileged knowledge. Therapists and refugee workers are exposed to the wider societal narratives about refugees that address not only the psychological plight of the fleeing people but also a host of other aspects of the whole mosaic that contains the refugee condition. The simplification that the "refugee-trauma" discourse offers can do violence to an already multifaceted and multidimensional field such as the refugee situation. The denial of complexity may deprive therapeutic work in these contexts from accessing the totality of psychological functions and abilities of refugees. Ultimately, human beings have the capacity to process internally and within their families and communities painful events and experiences, and to transform them into potentially growthful potentialities.

The idea of writing a book on the Winnicott squiggle game in therapeutic work with children has been in my mind for a long time and is rooted in many experiences. One such is the realisation, still surprising to me even after so many years, that the squiggle game does indeed enable us in most cases to make contact with a child with particular ease. In most cases, if the child takes up my suggestion, an intense dialogue develops in one way or another, which gives an insight into his or her inner situation. And even in cases where the child is consciously very reserved and in which the talk emerging from the squiggle game seems to be unproductive, the pictures offer a chance to start talking about precisely why he or she shows such reserve.

This chapter describes the therapeutic work and a psychodynamic framework and draws on predominantly from the work of Dr Donald Winnicott. It illustrates that it can have a profound effect if someone is interested in one's baby and his development; even with the most traumatised mothers, it can be a helpful way to facilitate their bonding process. First, the psychoanalyst Winnicott introduced the concept of the "holding environment", which is helpful in parent–infant psychotherapy because it encapsulates the experience of being physically and emotionally supported by the carer. The second useful concept in psychotherapy is that of "containment", introduced by the psychoanalyst Wilfred Bion. Third, other indispensable therapeutic ideas are drawn from the work of the researcher and clinician Daniel Stern. Amina had fled Somalia with her male cousin as a result of the political unrest. Adroa was a well-groomed baby who was looked after physically, but he was quite clearly rather neglected psychologically.

This chapter focuses on individual therapy with adults, outlining what preoccupied attachment looks like in general and in the consulting room, highlighting difficulties that commonly arise in therapy, and proposing aims and a specific focus for therapeutic work with preoccupied clients. It uses the masculine pronoun when describing anxiously attached individuals and the feminine pronoun in relation to therapists. The unifying factors among this spectrum of self-experience are the core anxiety of being abandoned and patterns of defence aimed at preventing separation; all else stems from this. From childhood on, attachment-eliciting behaviours are resorted to in order to attract the care and attention of others and hold on to them once their attention has been captured. Coercive helplessness, angry protest, and even illness are found to be effective in preventing desertion. A distinctive feature of psychotherapy with preoccupied clients concerns boundaries. Anxiously attached clients may arrive early and often overstay session times.

This book delivers comprehensive insight into therapeutic relationships with refugees and asylum seekers and the complexities and barriers practitioners often experience. The guide is made up of fo...

Presentamos la experiencia de un Taller de Arteterapia breve, realizado con un grupo de mujeres con afecciones dermatológicas, llevado a cabo en el Hospital General Universitario Reina Sofía de Murcia. Centraremos la atención en una de las pacientes, reconociendo la importancia de las relaciones grupales para su terapia. El objetivo principal del taller fue establecer un vínculo entre las emociones y vivencias de las pacientes y su propio cuerpo, más específicamente su afección de piel. Así, lo personal, lo familiar y lo social se constituyen como base en la que se inscriben esas emociones y vivencias. Las relaciones de pareja y su condición de madres son guías del trabajo terapéutico llevado a cabo.

En este artículo pretendemos buscar los aspectos que confluyen en el ámbito de la musicoterapia y el arteterapia, comenzando por su definición y orígenes y siguiendo con los modelos teóricos más importantes. Al analizar los trabajos de investigación elaborados a partir de proyectos en los que se combina la práctica de las dos disciplinas, observamos la necesidad de una mayor interdisciplinareidad. Esto daría lugar a un mayor enriquecimiento de las sesiones y por tanto, del trabajo terapéutico, lo que revertiría en una mejora de la calidad de la intervención.

This paper describes and discusses the creation and development of a therapeutic service set up in an inner city primary school over the period of 10 years. It explores this emotional well-being model and how it acts as an anchor for the children, staff and parents.Case examples illustrate the authors’ work in a multidisciplinary team and focuses specifically on Bion’s theory of ‘container-contained.’ The authors underline how the therapeutic interventions need to be held in the containing vessel of the school’s robust thinking and understanding of the therapeutic process and how the therapeutic work impacts on the well-being of the children as they work on their experiences within the school and outside community.

This paper derives from a longer dissertation submitted for an MA in Psychoanalytic Observational Studies. Aspects of thinking about silence and significant contributions to the psychoanalytic and psychological research history are discussed in depth as a prologue to the discussion of a case in which the parents of twins were seen by the author in an attempt to encourage more listening as well as talking between the father and mother and with their children. Silence is seen as a significant internal sounding board through which the individual may listen to what others say, to himself, and to enable the birth to new thoughts. The review in depth of the literature on silence is applied to therapeutic work undertaken by the author with a couple one of whose twins was in psychotherapy. The author connects the significance of the absence of silence and the absence of toleration of silence in the couple with absence of the experience of being taken in, contained, and of the experience of being heard and listene...

Including couple treatment in psychoanalysis has required the setting of new parameters beyond the classical psychoanalytical setting, in which the treatment is individual. This article aims to define the clinical criteria for, and benefits of, recommending couple treatment rather than individual psychoanalysis or psychotherapy, and to identify the challenges and demands that this has entailed for psychoanalysis, from the standpoint of the analysis itself and also that of the therapeutic relationship. Couple therapy is a very complex endeavor since a host of factors must be borne in mind. The present paper discusses the specific features of these factors and how they influence the diverse mechanisms in the analytical relationship. A clinical vignette is included in order to demonstrate the mechanisms that influence therapeutic work in couple psychoanalytic treatment.

The aim of this paper is to broaden the understanding of the process of shaping the social maladjustment from the systemic, relational and communication perspective and to discuss the various impacts of therapeutic methods on the prevention of the problem and coping with it when fully developed. Author presents important issues such as potential of family and education environment to create bonds and ties with children and adolescents, bonds-making behavior modelling and communication, the role of the teacher as the provider of socialization and personality patterns, therapeutic dialogue as special container for their internal conflicts and support for development of identity process. Author shows general meta-perspective on the social maladjustment prevention that takes into account personalistic approach perspective, attachment theory, positive motivation to change and axiological dimension of the children and adolescents bonds, ties and relationships with the social world. Also author shows general, practical model of therapeutic work in school environment that aims at prevention of social maladjustment.

The organization of health care provision to navy sheep crews is a priority issue for all studies related to navy medicine. The current state of navy forces, the concepts of the deployment of navy forces, and their further development reinforce the topicality of the scientific investigations of medical services in navy ships. The analysis of medical services in the waterborne ships of the Northern Fleet uncovered a number of problems. Morbidity parameters suggest the inadequacy of diagnostics and in-depth medical examinations of ship crews. This necessitates a broader outlook on the professional training of navy medical specialists at all of its levels. The fundament of health care provision to navy forces must be constituted by preventive and therapeutic work accounting of all factors and conditions that may make impacts on its organization.

In the experience of Saint Alban, therapeutic work is a major focus of institutional psychotherapy. What is the place today of work in the therapeutic projects led by caregivers? The principle of reality concerning our society clashes with the importance which the caregiving team attaches to work as a principle of reintegration. New opportunities for sociability and integration must be designed and bridges must be co-constructed by nurses and patients towards associations and activities in the community.

This paper focuses on one example of the potential benefits of offering Pre-Therapy in a psychiatric setting. The paper focuses on the very beginning phase of therapeutic work taking place with one...

This article offers another perspective on the positioning of psychodynamic therapeutic work with parents and children.

In the course of treating a serious illness, a person is faced with questions related not only to the medical side of treatment, but also with the realizing the sense of the events. This is equally true for both oncology adults and for children. The paper researches the disease representation in children who suffer from severe diseases. General psychological aspects of the disease situation and the understanding of patient children and the ability to use these concepts in practical psychological help are considered. The study hypothesizes, first of all, the semantic structure of representation in this group of children having specific characteristics that distinguish them from healthy children. Secondly, data representation having a therapeutic potential can be used as a psychological tool. Mediating function of the psychological tools mentioned is justified in this paper from the perspective of cultural historical approach and the concept of mental health levels. The experimental study was conducted in the specialized pediatric clinics in Moscow, Russia. Control group include students of one of Moscow schools. The study included organization of the experimental situation, criteria for obtaining data, comparative analysis and evaluation. The hypothesis is confirmed. The characteristic structure of disease representations in patient children reflecting some vector of the disease course is outlined. This makes the study an important practical value as the results may provide a solution to practical issues of medical psychology in assisting patient children. The research offers further studying the semantic sphere of patient children.

The devastation, chaos, and horror that characterize combat reveal aspects of the human condition that most individuals, and much of society, would rather remain unseen. And the reality of killing renders most individuals viscerally and existentially uncomfortable, and thus is often turned away from. Civilian psychotherapists are not immune to this. This article explores how civilian therapists’ subjectivities manifest in therapeutic work with service members who have killed or think they may have killed in combat. The experiences of previous generations of psychotherapists as well as findings from interviews with current-day clinicians point to significant ways in which the distressing and dissonant reverberations of killing in combat are manifest in the dyad between civilian therapists and service members.

Psychotherapists concentrate on the experiencing of their clients and carefully separate their therapeutic work from direct interfering into the lives of their clients. This is essential because it...

In an attempt to pinpoint what has formatively affected our therapeutic work, we were again and again confronted with our patients’ suffering, along with senses of frustration in facing it. As we pondered the persistent nature of suffering, we came to believe that sadomasochistic relations mark not only extreme cases of suffering and abuse, but are also prevalent in daily life and are characterized by pleasure of pain, domination, and special splitting. The shared process enabled us to broaden the various appearances of the sadomasochistic relations, as we were able to identify them along our cowriting, our therapeutic relationships (transference/countertransference), and our fantasized relations with former theoretical writers. This acknowledgment allowed our unbridled and pleasurable writing as well as the separate subjectivity of each of us.

Revisions to the posttraumatic stress disorder (PTSD) diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) clarify that secondary exposure can lead to the development of impairing symptoms requiring treatment. Historically known as secondary traumatic stress (STS), this reaction occurs through repeatedly hearing the details of traumatic events experienced by others. Professionals who work therapeutically with trauma victims may be at particular risk for this exposure. This meta-analysis of 38 published studies examines 17 risk factors for STS among professionals indirectly exposed to trauma through their therapeutic work with trauma victims. Small significant effect sizes were found for trauma caseload volume (r = .16), caseload frequency (r = .12), caseload ratio (r = .19), and having a personal trauma history (r = .19). Small negative effect sizes were found for work support (r = -.17) and social support (r = -.26). Demographic variables appear to be less implicated although more work is needed that examines the role of gender in the context of particular personal traumas. Caseload frequency and personal trauma effect sizes were moderated by year of publication. Future work should examine the measurement of STS and associated impairment, understudied risk factors, and effective interventions.

This chapter examines the principles and major methods of play in therapeutic work and, for diagnostic purposes. It looks at the evidence for the value of play approaches as interventions. "Play therapy may be directive in form, that is, the therapist may assume responsibility and direction for the child, or it may be nondirective: the therapist may leave responsibility and direction to the child". Although the child is the source of session content, the client-centered play session differs in many ways from the kind of open play engaged in by children in a totally unstructured and unsupervised setting. An observer viewing a play therapy situation in which the child "calls the shots" and the therapist responds with reflective statements might interpret the scene erroneously as a void filled by the child. C. Brady and W. Friedrich relate play therapy to Piaget's three developmental stages of play and postulate therapeutic cognitive-developmental benefits.