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Blog

Eric Berne - The Man and His Times

Posted on May 23, 2013 at 7:24 AM Comments comments (0)
Eric Berne – The Man and His Times is a conference Paper delivered at the ITAA Conference, Montreal, 2010 by Ann Heathcote & Marco Mazzetti. Ann Heathcote is writing her doctoral dissertation on the life of Eric Berne. Marco Mazzetti is fascinated with Berne's travels. He says: "According to his biographers (Cheney, 1971; Cranmer, 1971; Jorgensen & Jorgensen, 1984; Stewart, 1992) he travelled a lot, visiting psychiatric institutions in India, Singapore, Fiji, Tahiti, Papua – New Guinea, Thailand, Sri Lanka, Hong Kong, Filipinas, Syria, Lebanon, Guatemala, Turkey, Bulgaria and several other countries. His first article published in a medical journal was entitled “Psychiatry in Syria” and appeared in the American Journal of Psychiatry in 1939 (Berne, 1939).


Client suicide. Online resources for therapists in training

Posted on November 30, 2012 at 4:57 PM Comments comments (99)
The impact of client suicide on therapists in training

(http://epublications.marquette.edu/cgi/viewcontent.cgi?article=1005&context=edu_fac)

 
 
(http://www.socialworker.com/home/Feature_Articles/Field_Placement/Field_Placement%3A_Students_Face_Client_Suicide%3A_A_Painful_Reality/)


Treatment of high-risk clients
An Overview of Dialectical Behaviour Therapy in the Treatment of Borderline Personality Disorder by Barry Kiehn and Michaela Swales(http://www.priory.com/dbt.htm)




Ethics

http://www.psychotherapy.net/interview/thomas-szasz#section-liberty-and-the-practice-of-psychotherapy
 
http://www.psychotherapy.net/article/psychotherapy-insurance
http://www.guardian.co.uk/commentisfree/2010/dec/09/talking-therapy-regulation-judgment  
 
How psychiatry became a damage limitation exercise Darian Leaderhttp://www.guardian.co.uk/commentisfree/2011/jun/21/psychiatric-services-damage-limitation
 

The Myth of Confidentiality Judy C. Roberts, M.A.  http://www.academyprojects.org/lerobe1.htm  
 


Neuroscience resources

Posted on November 30, 2012 at 4:46 PM Comments comments (97)
Here are some excellent free online lectures on neuroscience

Stamford University Human Biology Course (2010) run by Dr. Robert Sapolsky (25 lectures x 1.40 hours) 

Howard Hughes Medical Institute 2008 Holiday Lectures on Science 
Making your Mind. Molecules and Memory. Lectures 1 and 4 "Memories are Made of This” and “Mapping Memory in the Brain” Lecturer: Erik R. Kandel. M.D (2 hours) 

Google Lecture Series "Mindsight: The New Science of Personal Transformation" Lecturer: Daniel J. Siegel, M.D. (1 hour) 

Stress and Memory - Forget it! (Webcast) Lecture delivered by Dr. R. Sapolsky (1h 38min) 

Stamford University "Depression in US" Lecture delivered by Dr. Sapolsky (52min)

And some online articles 

Variation in the human cannabinoid receptor CNR1 gene modulates gaze duration for happy faces by Chakrabarti B and Baron-Cohen S, Molecular Autism 2011, 2:10 (29 June 2011)

The Prefrontal Cortex: Executive and Cognitive Functions by Simon Gerhand, http://brain.oxfordjournals.org/content/122/5/994.full

Reduced Prefrontal Gray Matter Volume and Reduced Autonomic Activity in Antisocial Personality Disorder by Adrian Raine, DPhil; Todd Lencz, Phd; Susan Bihrle, Phd; Lori LaCasse, BA; Patrick Colletti, MD, Arch Gen Psychoatry/Vol 57, Feb 2000

Antisocial Personality Disorder, J. Reid Melory, Ph.D.

An Integrative Theory of Prefrontal Cortex Function, Earl K. Miller and Jonathan D. Cohen Annu. Rev. Neurosci. 2001. 24:167–202

This Column will Change your Life: The Mind Body Connection http://www.guardian.co.uk/lifeandstyle/2012/apr/27/mind-body-connection-oliver-burkeman

Documentaries 

The Human Mind – Part 3 Making friends (48 minutes) (http://topdocumentaryfilms.com/the-human-mind/)   

The Brain: A Secret History by Michael Moseley (http://topdocumentaryfilms.com/brain-secret-history/)    

Psychiatry: An Industry of Death (100 mins) (http://topdocumentaryfilms.com/psychiatry-industry-death/)   
 
In Our Time – Neuroscience (41 mins) (http://www.bbc.co.uk/iplayer/console/b00fbd26)   

I am fish head: Are corporate leaders psychopaths? (1h, 18 min) http://topdocumentaryfilms.com/i-am-fishead-are-corporate-leaders-psychopaths/

On the human project

Posted on November 22, 2012 at 9:40 AM Comments comments (99)
The National Humanities Center is running an interesting online project  "On the human". They ask contributors from scientific and humanistic backgrounds to submit essays on aspects of the human condition, and every thesis put forward is then debated and commented on in a forum. The stated purpose of the project is to "improving our understanding of persons and the quasi-persons who surround us" and to offer an "opportunity to engage experts on questions concerning the meaning and significance, if any, of human life, especially at its edges." 

The list so far:
 
Bateson, Sir PatrickHunting and Science
Biletzki, AnatThe Sacred and the Humane
Churchland, Patricia and Christopher SuhlerControl: Conscious And Otherwise
De Waal, FransMorals Without God?
Gillespie, Michael AllenScience and the Humanities
Krech III, ShepardThe Nature and Culture of Birds
MacKinnon, CatharineAre Women Human?
McCarty, WillardWho Am I Computing?
McLennan, RebeccaWhen Felons Were Human
Rosati, Connie SNarrative and Personal Good
Sandler, RonaldEnhancing Moral Status?
Singer, Peter. Taking Life: Animals
Sterelny, KimThe Evolved Apprentice
Suhler, Christopher and Patricia ChurchlandControl: Conscious And Otherwise

Free New York Times archived articles on mental health

Posted on November 22, 2012 at 8:24 AM Comments comments (99)

Suicide prevention polemic

Posted on November 19, 2012 at 9:08 AM Comments comments (0)
To follow up on my earlier posts on suicide, I three more contributions to the polemic whether suicide is preventable or not. Two were published in the October 1994 of the BMJ, before the Department of Health published its prevention strategy plans. 

Greg Wilkinson contribution to the debate is that better treatment of mental illness is a more appropriate aim. It is "difficult to resist the conclusion that suicide is not morally wrong" and that "suicide may be rational". Although we understand better the suicide risk factors (such as a diagnosis of mental illness including severe depression, Bipolar Affective Disorder, schizophrenia, personality disorder, PTSD, previous suicide attempts, gender etc) we are still finding it difficult to predict suicide. The reasons may be that suicide intent is not constant, many people with whom we associate high risk factors do not commit suicide, and "when an event is as rare as suicide even a predictive factor with high specificity and sensitivity includes too many false positives for practical purposes". 

Wilkinson believes that our resources should be concentrated on treating clients with mental illness "properly".

H. G. Morgan in response argues that prevention is possible if doctors are taught how. Whilst we cannot prevent all suicides, we should try to avoid those suicidal deaths that might be avoided. Morgan believes that this does occur, and yet we may not be able to quantify this effect because the patient lives. In other words it is easier to count the failures to prevent suicide than the success in facilitating someone staying alive. 

Morgan also argues that those who are suicidal remain ambivalent until the end, and that we need to support the part of the patient that wants to live. He also urges us to hold onto the hope that even the worst circumstances can change for the better. The distressed cause to survivors may be "disabling for many years". Risk factors are invaluable tools and all mental health practitioners can be trained to incorporate them in their practice. 

The third article comes from the Psychiatric Times, and raises the question whether there is enough evidence that psychopharmacology (drugs) can help prevent suicide. Leonardo Tondo (et. al) focus on Lithium, a drug used to treat Bipolar Affective Disorder and other psychotropic drugs.

Reviewing the available research Tondo has found that the potential anti-suicidal effect of psychotropic drugs is "strikingly limited" and that in particular there is inconclusive evidence that antidepressants help prevent suicides. Lithium however seems to have a stronger evidence base as many studies support the impression that risk of suicide and suicide attempt is far lower during treatment with this drug. "Neurobiological mechanisms that might be involved in apparent anti-suicidal effects of lithium include decreased impulsivity and hostile or aggressive behavior that may be mediated by enhanced functioning of the central serotonin system." Interestingly though, suicide risk is also lowered significantly when the patient is treated with a placebo. 

The study concludes that "altered suicide risk may be obtained with some modern antipsychotic and anticonvulsant drugs commonly used to treat patients whose illnesses include suicidal ideation. However, such applications, and even use of lithium, require further systematic study for both positive and possible adverse effects on suicidal behaviours."




The clinician-survivor of suicide

Posted on November 19, 2012 at 8:15 AM Comments comments (0)
How are mental health professionals responding to client suicide? "The mental health professional as suicide survivor" by Norman Farberow is a review of the available research on the incidence of patient suicide experienced by clinicians and their reactions. The article also draw's on Farberow's personal experience of losing a client whilst he was leading a survivor therapy group. 

Although the incidence of client suicide amongst mental health professionals is significant (as little as one in four and as high as one in two), this is still an area that is under-researched and therapists in training are ill-prepared for the complexity and depth of feeling and reactions associated with losing a client. 

A clinician's reactions to the loss resemble those of family and friends. They range from shock, denial, numbness, confusion, disbelief, sadness, anger, shame and guilt, but are further complicated by responses that stem from their professional position. Many therapists feel they have failed in their responsibility, they doubt their clinical competency and feel deeply anxious about reprisals such as litigation and criticism from colleagues. They feel depressed ashamed, isolated and judged or rejected by their peers. 

The experience has a profound existential impact and may radically alter the way clinicians work. Many become conservative in record keeping, reluctant to take on clients at risk of suicide and quick to refer or section clients who may not in fact be at high risk. 

Help for the therapist-survivor
Mental health institutions working with clients at risk have detailed protocols about the management and treatment of suicidal risk, however they fail to include any information about the aftermath of such an event and how it may impact the responsible clinician. 

Clinicians get through the event by conducting a thorough "psychological autopsy", going through notes and talking with other colleagues and supervisors. Reading research and testimonies of other clinician-survivors helps normalize the experience of intense feelings associated with grief.

Online suicidology.org has a dedicated page for clinician-survivors and many testimonies. 


Suicide prevention: realistically possible and and always desirable?

Posted on November 16, 2012 at 6:08 PM Comments comments (177)
One in five counsellors, psychologists and psychotherapists and one in two psychiatrist will experience a client's suicide in their career. (Clinicians and suicide loss by Nina Gutin, on www.suicidology.org)

Prediction-prevention culture

How we experience a client's suicide is influenced not only by our own values but also the wider cultural context in which we work. Andrew Reeves (Counselling Suicidal Clients) refers to this as the "prediction-prevention culture" (p.44) 

In the UK several policy documents issued by the Department of Health (Saving our lives: our healthier nation and the National Suicide Prevention Strategy) make reduction and prevention of suicide key principles at the heart of health provision. 

The National Suicide Prevention document states that: "Each suicide represents both an individual tragedy and a loss to society. Suicide can be devastating forfamilies and other ‘survivors’ – economically, psychologically and spiritually. For these reasons the Government has made suicide prevention a health priority." 

As Andrew Reeves points out the policy takes a singular view on suicide and ignores the many shades of grey that become apparent when considering the circumstances around suicide and individual free choice. Some clients are not mentally ill - they have full mental capacity when taking a decision to end their life. They may suffer from a condition that will lead to a progressive loss of function or mental capacity that is incompatible with their sense of self and dignity. 

I think this "allways" approach may constrict and inhibit individual counsellor's willingness to explore alternative statements such as: "suicide should not always be prevented" or "suicide can only be understood ethically by looking at the particular circumstances of a particular individual". 

Counsellors and psychotherapists that work within the National Health System have no choice but to adopt suicide prevention, as it is their contractual duty to follow the protocols of the organisation for which they work. These protocols outline how suicide risk should be assessed, what constitutes suicide risk and what steps neet to be taken with a client who is at risk.

As a consequence of the tenets of the prevention-reduction culture, a counsellor who loses a client through suicide is strongly invited to consider that this reflects a professional failure. 

Is suicide preventable?

It is perhaps understandable that policy makers think in such optimist positivist terms but is this wishful thinking or reality? Can we really predict and prevent suicide? On what basis do policy makers assume that we can? Is this assumption setting counsellors, psychologists, psychotherapists, psychiatrists and social workers up to feel a deep sense of professional failure? 

It is highly unlikely that this question can ever be investigated in a scientific manner simply because one cannot envisage a research in which a control group of suicidal clients is subjected to prediction-prevention. Although we do have statistics to alert us to factors that suggest that a client is at higher risk (male, living alone, unemployment, alcohol or drug misuse, mental illness, access to means), this doesn't mean that we can automatically predict who will carry out a suicide act and when. Reeves suggests that trying to predict suicide is like trying to predict the winner in a horse race. Even with detailed information, it is difficult. 

Suicide statistics are about averages, whereas people processes are highly idiosyncratic and may not neatly fit with the average data. Reeves suggests that even allowing for this, we do have to weigh the facts and ultimately make a decision and, crucially, be prepared to back that decision up and show exactly how we went about considering a course of action. This is because when dealing with suicide there may be no clear right or wrong way. The ethical values we hold sometimes contradict each other. Sometimes we have to prioritise one over another. How we decide in an individual case cannot be dictates solely by statistics - it involves a careful consideration of each individual case in its own right. 

A radical thinker on the subject of suicide prevention, Thomas Szatz goes as far as to suggest that suicide prevention is doomed to fail because: "No one can prevent a person who wants to kill himself from doing so." (Suicide Prohibition p.7) He has a point. Patients who are in high security units manage to take their lives in spite of draconic measures to remove every harmful object or means. It is also known that a high suicide risk period is right after the patient is discharged from the hospital. So sectioning is not necessarily a fool-proof way of stopping someone from committing suicide. If used simply as a means to cover the counsellor's back and avoid the pain and anxiety of holding a suicidal client, it  is a way of handing over the problem to someone else. 

However an aspect not mentioned by Szatz is that some clients are grateful for the containment offered by a psychiatric ward and are willing to temporarily hand over responsibility for their wellbeing to someone else. These are the clients who give consent to be admitted temporarily in a psychiatric hospital. Again a sound decision can only be made by considering the client, their wishes and how they might respond to this type of care. 







The freedom to practice

Posted on October 1, 2012 at 5:56 PM Comments comments (99)
I watched today two interviews posted online by the Online Events team, one with Keith Tudor and another with Anne Stokes. The interviews can be found here: http://www.onlinevents.co.uk/practitioners


Keith Tudor speaks about the importance of challenging dogmatic ideas about practice. It is crucial to consider our philosophical assumptions and make sure they are reflected in our work. Keith is known as one of the architects of the co-creative relational perspective in Transactional Analysis but he also writes extensively on the Person Centred approach. He has also written a book: Freedom to practice

Anne Stokes is a successful practitioner in private practice. She talks about the importance of accepting ourselves as business people as well as practitioners.