Tag Archives: research

On Loss and Mourning….

Kew gardens

Excellent read…well worth the time to absorb…

EXCERPT:  In The Long Goodbye(public library), her magnificent memoir of grieving her mother’s death, Meghan O’Rourke crafts a masterwork of remembrance and reflection woven of extraordinary emotional intelligence. A poet, essayist, literary critic, and one of the youngest editors the New Yorker has ever had, she tells a story that is deeply personal in its details yet richly resonant in its larger humanity, making tangible the messy and often ineffable complexities that anyone who has ever lost a loved one knows all too intimately, all too anguishingly. What makes her writing — her mind, really — particularly enchanting is that she brings to this paralyzingly difficult subject a poet’s emotional precision, an essayist’s intellectual expansiveness, and a voracious reader’s gift for apt, exquisitely placed allusions to such luminaries of language and life as Whitman, Longfellow, Tennyson, Swift, and Dickinson (“the supreme poet of grief”).

LINK:

http://www.brainpickings.org/index.php/2014/06/09/meghan-o-rourke-the-long-goodbye/

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Angry and Stressed People ‘may risk heart attacks’

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   Here’s a short article talking of some research that may be helpful to talk about with patients and clients

“Having a hot temper may increase your risk of having a heart attack or stroke, according to researchers.

…[R]age often precedes an attack and may be the trigger, say the US researchers who trawled medical literature.They identified a dangerous period of about two hours following an outburst when people were at heightened risk.

…[E]xperts know that chronic stress can contribute to heart disease, partly because it can raise blood pressure but also because people may deal with stress in unhealthy ways – by smoking or drinking too much alcohol, for example.”

See the link:       http://www.bbc.com/news/health-26416153

 

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What Actually Happens While You Sleep and How It Affects Your Every Waking Moment

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“…sleep remains one of the most poorly understood human biological functions, despite some recent strides in understanding the “social jetlag” of our internal clocks and the relationship between dreaming and depression. In Dreamland: Adventures in the Strange Science of Sleep (public library), journalist David K. Randall — who stumbled upon the idea after crashing violently into a wall while sleepwalking — explores “the largest overlooked part of your life and how it affects you even if you don’t have a sleep problem.” From gender differences to how come some people snore and others don’t to why we dream, he dives deep into this mysterious third of human existence to illuminate what happens when night falls and how it impacts every aspect of our days.”

See link:  http://www.brainpickings.org/index.php/2012/08/21/dreamland-science-of-sleep-david-randall/

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Child Psychotherapy

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This is a review published in a British journal a while back, speaking to the question of efficacy in child psychotherapy – and ultimately, therapeutic change.  

Weisz, J.R. & Kazdin, A.E. (Eds.). (2010). Evidence-Based Psychotherapies for Children and Adolescents. Second Edition. New York and London: Guilford Press. 

 Conversations about the efficacy of child psychotherapy frequently, if not always, return to the question of the ‘mechanisms of change’ inherent in the process.  How does child psychotherapy change the individual’s behavior?  Why does this particular therapy work, and another therapy does not? How is the effectiveness of a therapy – in the real world experience of therapists – to be measured, taking into account the developmental factors of age, maturity, language ability, environmental factors, and the child’s capacity to form a relationship with the therapist. One must further consider the training and education of the therapist, as well as the therapist’s personality with all its proclivities, the therapist’s theoretical orientation and consequent preferences, along with the impact of those preferences on the clinical approach.  The challenges of understanding this process and of the persistent questions raised for the clinician as well as for the researcher continue to perplex, and to aid or hinder the determination of what we measure.

In the context of these challenges, funding sources continue to ask for the evidence – and the current volume under review attempts to shed further light on these questions, the methods, and the results of a considerable body of research – research carried out in varied settings and different methods.  The aim is not only to highlight the evident progress in researching evidence- based psychotherapies, but also to help researchers in their efforts at developing treatment programs and determining paths of further research. 

The book begins by examining the foundations of child and adolescent psychotherapy research by first setting the context – the historical perspectives, ethical issues in the research of children and adolescent treatment, offering a sound look at the developmental issues that need to be accounted for in both practice and research.  This section is followed by looking more particularly at the discrete problems or disorders and the treatments utilized for those disorders, e.g., antisocial disorders, autism, children with attention deficit or hyperactivity disorders, anorexia and substance abuse.  Interestingly, the editors have included several unique treatment approaches (and the research on those approaches), such as the Oregon Model of parent management training, and cognitive-behavioral models for treating several recalcitrant disorders, as well as the use of narrative therapies.    

In the third section of the book, the editors provide examples that illustrate the difficulties and the attempts at implementing treatment in several settings with different populations.  That is, how might clinicians make use of the ‘science’ in measurement of evidence-based psychotherapies, so strenuously investigated now by the researchers – namely, the ‘science to service’ issue.  How are the challenges to be addressed within the contexts of children in poverty, of cultural differences in the populations of children needing psychotherapeutic help, of the need for more critical programs of parent intervention? 

The editors emphasize their perspective in the final chapter on the need for clinicians to attend to the research on what some skeptics (in the clinical world) may refer to as “manual-guided treatments,” – those treatments having a prescriptive nature – and the consequent questions about the relevancy of the research to their particular clinical settings and populations.  It is noted that clinicians engaged in the ‘actual practice in mental health service settings’ do indeed need to recognize the usefulness of the research – in order to build the types of treatment and a base of evidence that will support their continued clinical work. 

The thread that runs through the book however, remains that of the challenges created in our attempts to tease out the mechanisms of change as a result of our psychotherapeutic work.  Perhaps the clinicians and the researchers in this field need to keep Rilke’s comment in mind:  “…for at bottom, and just in the deepest and most important things, we are unutterably alone, and for one person to be able to advise or even help another, a lot must happen, a lot must go well, a whole constellation of things must come right in order once to succeed.” 

 Rilke, R.M. (1934) Letters To A Young Poet. New York and London: W.W. Norton & Co. 

 Rudy Oldeschulte        roldeschulte@gmail.com

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Why Books and Movies Are Better the Second Time

 

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http://www.livescience.com/18526-books-movies-rereading.html

New research reveals why people like to reread books, re-watch movies and generally repeat the same experiences over and over again. It’s not addictive or ritualistic behavior, but rather a conscious effort to probe deeper layers of significance in the revisited material, while also reflecting on one’s own growth through the lens of the familiar book, movie or place. See link above….

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Review of Child Psychotherapy and Research: New Approaches, Emerging Findings, Nick Midgley, et. al. (Eds) (2009). Routledge, Taylor and Francis Group. London and New York.

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Review of Child Psychotherapy and Research: New Approaches, Emerging Findings, Nick Midgley, et. al. (Eds) (2009).  Routledge, Taylor and Francis Group. London and New York.  (Published in Bulletin of the Association of Child Psychotherapists, Issue No. 212, July 2010.)

   Particularly good compilation of essays on the research in child psychotherapy, addressing the skepticism about effectiveness of our work – and applicable to the whole range of child and adolescent work. The primary editor is with the Anna Freud Centre in London. 

REVIEW: 

    The challenge has been laid down – by policy makers, funders, and the ‘scientific’ community – to measure and to quantify and qualify the effectiveness of child psychotherapy.  Skepticism has been expressed about the benefits of child psychotherapy, despite its rather obviously good results for many children, adolescents, and families; those benefits being attested to each day from the consulting rooms of therapists.  Understanding – and explaining that understanding of the mechanisms of change and the processes leading to that change – have been attempted since early on in Freud’s writings. This is noted by Nick Midgley and his colleagues in this excellent collection of papers. One of the goals of this volume is the delineation of the research methods or approaches to determining the effectiveness of child psychotherapy. An equally important goal is that of examining the developmental processes that allow a child or adolescent to come to the needed change; what promotes resilience and adaptability in children? What furthers our knowledge of how children and adolescents experience, and in turn deal with, adversity or psychological disorder?  How do these qualities of resilience or adaptability augment the process of therapeutic change?

             The challenge may seem daunting, given that coincident with our search for more applicable methodologies for research, we must also contend with the complex developmental processes occurring in a child – and that this knowledge base is being expanded each day by new research into the physical and mental spheres of the child.  Complicating the picture even further is that the authors’ contributions in this volume utilize different theoretical frameworks to explain their findings – often contrasting or conflicting perspectives. 

             The editors embrace this challenge with a collection of papers designed to offer us a full spectrum that examines what child psychotherapy research is, how it is studied, how the effectiveness of child psychotherapy may be evaluated, and how interdisciplinary research affords us the best opportunity for creating connections – connections that will be relevant to clinical endeavors.  A “pluralistic and pragmatic approach” is stated as the ‘spirit’ of this book  – and this is certainly what this book offers us – and it does so in a marvelously spirited fashion with accessible chapters from a wide variety of clinical and theoretical perspectives. 

    Critical evaluation of our understanding of these processes of change in psychotherapy provides us with our greatest challenge in child psychotherapy.  This requirement is well described in the first chapter by Peter Fonagy.  He posits that our quest to “persuade policymakers and funders” with “evidence” for our work, and its methodology, will only result from further research into systematizing our knowledge of mental processes and integrating our work with the ever-developing science of mind.  Michael Rustin echoes Montaigne’s question: Que sais-je? What do child psychotherapists know? Rustin states that we know quite a lot – that our clinical work has evolved as a result of our research into mental processes of the child and of psychotherapy.  He writes that this research promises the further elaboration of meaningful clinical and systematic application of developing models of theory and methodology.  Historical influences on our current clinical and research work is persuasively described.  At the same time, Rustin acknowledges the complexity of understanding individual people, suggesting that there may be no “code book” to which we as child psychotherapists can turn.  Rather, a ‘branching tree’ of classifications may be best visualized, the branches of which have resulted from our continued cross-fertilization in research and clinical efforts with different populations of children, be they within the autistic spectrum, the depressed or anxious children, deprived or abused children, or in parent-infant disturbances.  Thus, the conversation and debate about research methodology will continue to be explored on several fronts. 

     The first two chapters set the stage upon which the process of child psychotherapy can be studied and effectively measured within different actual work settings, and in which the clinical relevance may be utilized by other child psychotherapists. The psychotherapeutic process is elucidated in descriptions of research projects with children in temporary foster care, in the collection and organization of child psychotherapy data, utilizing unique methodologies such as the Child Psychotherapy Q Set (CPQ) to examine the process of interaction between child and therapist.  Diabetic children and the importance of developing insight for diabetic control is yet another illustration of the projects undertaken, as are the outcome studies that examine how we conceptualize the change process in child work. 

    The next section of this volume details the evaluation of the existing outcome studies.  The long term consequences, as well as the evaluative techniques that can be incorporated into our daily practice are described. Illustrations are given of working with adopted children and those in foster care, childhood depression, and the long-term follow–up study of children (now adults) that received psychoanalytic treatment when young. A fascinating framework for evaluation is described using the Hopes and Expectation Treatment Approach (HETA) – this approach examining the “interrelationships between understanding psychopathology, developmental level, and appropriate intervention,” with a view to improving practice.  

    The final section focuses on the collaboration of unique perspectives in looking at the issue of effectiveness in child psychotherapy: studies of the complexity of the therapeutic encounter with autistic children, clinical understanding of risk and dangerous behaviour in children, attachment in maltreated children, and the linkage to be drawn from social neuroscience research into the theory of therapeutic action. 

      As will be evident to readers, there is food palatable for every appetite in this collection. Clinicians and researches will gain insight into different methodologies and practical approaches to the challenges presented.  This is a work that was carefully and diligently brought together by the editors – and well worth the effort in study. 

Rudy Oldeschulte

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