Treating Profound Shame States in Men With Antisocial Personality Disorder (ASPD) With Mentalisation-Based Treatment (MBT): A Case Illustration

Shame is a fundamental human affect that plays a central role in social regulation and psychopathology. In some individuals with antisocial personality disorder (ASPD), chronic and pathological shame-shaped by early experiences of abuse, neglect, and attachment disruption-may contribute to difficulties in affect regulation, mentalization, and interpersonal functioning, and is frequently implicated in violent and antisocial behavior. The authors describe a long-term, psychodynamically informed mentalization-based treatment (MBT) group for men with ASPD. The paper focuses on shame as a clinically organizing affect, examining how unmentalized experiences of shame and humiliation may precipitate transient collapses in mentalization, paranoia, and violent acting out. Drawing on detailed clinical material, the authors consider the developmental origins of pathological shame in early attachment relationships and explore the technical challenges of working therapeutically with profound shame states in a group context. It is proposed that addressing both individual and collective experiences of shame within a stable therapeutic group can foster a sense of safety, support the restoration of mentalizing capacity, and reduce vulnerability to violent behavior. The paper aims to extend existing mentalization-based formulations of ASPD by foregrounding shame as a central affective process within long-term group treatment

Exploring the use of single session interventions in child and adolescent mental health services in England: a freedom of information-based study

Objective: We explored the provision of single-session interventions (SSIs) in public child and adolescent mental health service (CAMHS) provision, using freedom of information (FOI) requests to gather data from National Health Service (NHS) trusts. Method: FOI requests were sent to all NHS trusts in England with CAMHS in 2024, seeking information on SSI use, delivery, and implementation. Results: Responses from participating trusts indicated that most trusts did not use SSIs, with varied deployment of SSIs in those that provided them. Some trusts reported plans to expand SSI provision. Conclusion: Although SSIs are used in some CAMHS, variability in practice and reporting suggests a need for further research into decision-making and strategies for the implementation of SSIs in different localities

NICE informed Systemic Therapy

Background: This paper locates the meaning and naming of Systemic Therapy within evidence-based practice. Part of this situated knowledge is informed by our clinical experience within an NHS Trust in North West London. Aims: The paper investigates the evidence base for Systemic Therapy as represented within National Institute for Health and Care Excellence (NICE) guidelines. It also considers the need for competency-based training and examines the implications for how the discipline is described and understood within NHS structures. Methods: The methodology involves a literature review of NICE guidelines and the NHS Long Term Plan. This review addresses five key questions about the status and application of Systemic Therapy within the UK’s NHS context. Results: Findings highlight ongoing confusion about what constitutes Systemic Therapy and the range of models and methods it includes. This lack of clarity presents a barrier to effective implementation and may impede progress toward the aims outlined in the NHS Long Term Plan. Conclusions: We argue for investment in a clinical doctorate in Systemic Therapy, bursaried by the NHS, to support development of a skilled workforce. Clarifying the relationship between NICE frameworks and systemic practice offers an opportunity to improve evidence and healthcare outcomes

Effectiveness and Usability of Artificial Intelligence and/or Machine Learning Enabled Wrist and Ankle Wearables for Physiological and Behavioral Monitoring in Children and Adolescents With Autism Spectrum Disorder: A Systematic Review

Purpose: This review evaluates the performance, feasibility, and acceptability of Artificial Intelligence (AI) and machine learning (ML)–enabled wrist- and ankle-worn wearables for monitoring physiological and behavioral states that help predict difficulties in arousal regulation, emotion modulation, and behavioral control—often manifesting as aggression or self-injury in autistic children and adolescents. Method: A systematic search of peer-reviewed literature was conducted to May 2025 following PRISMA 2020 guidelines and a preregistered PROSPERO protocol (CRD420251068317). Participant characteristics, sensor modalities, study settings, AI/ML approaches, outcome definitions, and feasibility and acceptability measures were examined. Findings were synthesized narratively due to study heterogeneity. Results: Preliminary proof-of-concept data (n = 246; 170 autistic) suggest that AI-enabled models have the potential to anticipate aggression 1–3 min before onset (AUC 0.80–0.87) in specialized psychiatric settings. Under controlled conditions, self-injury and motor stereotypies were detected with 86–96% recall (up to 99% in initial personalized models). Emotional or sensory states were classified with 83–90% accuracy in laboratory contexts. Wrist-worn devices were generally well tolerated. Conclusion: AI-enabled wrist and ankle wearables demonstrate feasibility for anticipating behavioral escalation and detecting emotional states. Short advance-warning windows may support proactive intervention. Although current studies are necessarily small and exploratory, reflecting the early developmental stage of AI-enabled wearable technologies, they collectively provide proof-of-concept accuracy. These preliminary data justify continued research into proactive, sensor-supported behavioral monitoring in autism. Larger, longitudinal, co-designed studies in naturalistic settings are now required to establish reliability, safety, and clinical utility

Developing practice research in mental health: experiences in adult recovery and specialist child and adolescent settings

Purpose: A long-standing agenda in the field of health is developing practice-based evidence, with research driven by applied research questions and led by practitioner experts. The purpose of this paper is to contribute to a growing literature addressing this type of practice research in mental health by presenting the authors’ experiences embedding practice-based evaluation and research activity in an English NHS context. Design/methodology/approach: Efforts in two multidisciplinary settings in a single mental health trust are detailed: a specialist child and adolescent mental health service team and an adult rehabilitation and recovery pathway. This work, developed to inform the meaningful integration of research-based knowledge with care delivery, is described by reference to experiences over a four-year period in which research activity was particularly productive in output compared to other periods. Findings: A reflective account is provided in which conditions that animate practice research activity are considered, particularly collaboration with wider professional networks, including academic colleagues, and the involvement of junior and trainee clinicians. Originality/value: The reflections presented in the paper provide insights into the “doing” of practice research activity in NHS mental health service provision and virtuous cycles of activity to embed this activity in a local context. Though based on experiences from one specific trust, this paper may have the implication of illustrating a prototype for embedding practice research in other settings across similar provider trusts in the UK

Locating Stories: Trauma, Healing, Decolonising—Willakay, Narrative Practice and the Movements of Location, Dislocation and Relocation

In this paper, I use Location, Dislocation and Relocation (LDR) as a narrative and social constructionist approach from which I explore storytelling and meaning-making. It describes LDR as a method to enable the reader to familiarise themselves with this narrative construct. It enables the reader through a clinical description to orientate to the process of LDR in the action of clinical endeavour. I then go on to explore my own stories of LDR and to bring different Indigenous understandings to the process, what location is as a place, what stories are and what type of knowing there is. I explore colonisation and acts of resistance we can use to support something other to emerge. In the process, I introduce descriptions of decolonising as a practice and what that looks like in the clinical example I give. The paper concludes with an invitation to continue to use LDR with each other as a form of story that is full of action and intent

“I think the humanity just gets lost over and over again”: A phenomenological study of the experiences of higher-weight medical students

A growing body of research has found weight stigma to independently drive both morbidity and mortality, regardless of actual weight. This has, however, yet to translate into medical education and practice. Studies have shown doctors to be common sources of weight stigma, which may be driven, in part, by their medical training. Higher-weight doctors may be best placed to understand and support the health needs of higher-weight people. However, significant levels of implicit anti-fat bias towards higher-weight colleagues lingers in the medical profession. Inclusive practices and more holistic education around weight are therefore needed to support and retain higher weight doctors within the workforce, starting within medical schools. This may improve both staff experiences and patient care. This study aims to explore the experiences of higher weight medical students in the UK. This is an interpretive phenomenological study. Three higher-weight medical students (two women, 1 man, all 2nd year medical students, BMI range 31–50 kg/m2) underwent loosely structured interviews over Microsoft Teams. These were audio-recorded. Audio recordings were transcribed verbatim and underwent an interpretive phenomenological analysis. Participants reported logistic and environmental issues, such a lack of provision of larger uniform sizes or narrow small lecture room seat sizes. They also reported negative experiences with peers, teachers, and the general public in relation to their size. Despite this, higher-weight doctors were indeed felt to be important to advocate for higher-weight patients. Negative experiences seemed to stem from wider sociocultural issues and reflect the intersectional nature of weight stigma. To improve matters in the longer term, medical schools should review and update their weight-related teaching, alongside considering the accessibility of their physical environments. Medical schools could consider weight stigma as part of their current efforts to decolonise medical curricula

A feasibility randomised trial of remotely delivered Video Interaction Guidance for parents of children with intellectual disability referred to specialist mental health services

Background: Children with intellectual disability are at a higher risk of presenting with behaviours that challenge. Video Interaction Guidance (VIG) is a brief, personalised, strengths-based therapy that focuses on improving the parent-child relationship and interactions. A strong parent-child relationship may reduce the risk of behaviours that challenge. Access to support is difficult for families of children with intellectual disability. Remotely delivered support may enhance access to therapy for those who might otherwise struggle to access support. To date, no definitive effectiveness trial of VIG, or remotely delivered VIG, has been conducted, including in intellectual disability. Methods: A feasibility randomised controlled trial (RCT) aimed to recruit 50 parents of a child with intellectual disability (aged 6-12) referred to specialist mental health services. Participants were randomised on a 1:1 basis to VIG plus treatment as usual (TAU) or just TAU. Measures were collected remotely at baseline, 3-month, and 6-month follow-up. A parallel economic study explored the feasibility of a future economic evaluation, while an embedded process evaluation explored feasibility and acceptability through qualitative interviews. A survey investigated TAU in specialist mental health services. A Parent Carer Advisory Group of 10 parents of children with intellectual disability worked with the research team on design, recruitment, data analysis and interpretation. Results: Forty-four parents consented to participate in the study and 40 were randomised to the RCT. Of those, 75% remained in the study at 6-month follow-up, and 70% of the VIG-arm participants completed at least 3 cycles of VIG. At 6-month follow-up, between 83.3% and 100% of parent-completed questionnaires were completed, including the Developmental Behaviour Checklist (DBC2 at 86.7% completion rate). The acceptability of VIG was high among parents and practitioners. Parents identified few barriers to participation when VIG was delivered remotely. The cost of VIG was calculated at £153.35 per session and £306.70 per cycle. Video-feedback interventions are not typically part of TAU: just 15% of 66 specialist mental health services reported offering any video-feedback intervention to parents of children with intellectual disability. Conclusions: Findings supported the feasibility and acceptability of a definitive trial of remotely delivered VIG to parents of children with intellectual disability referred for support to specialist mental health services. Adaptations will be needed to enhance recruitment and align some of the study outcomes and processes more closely to parent preferences

Talking about non-recent child sexual abuse: Survivor, Clinician and Researcher perspectives

This book addresses the issue of non-recent child sex abuse and its long-term impact on adult survivors from a broadly psychodynamic perspective. Non-recent CSA is not a subject that can or should be confined to the clinical arena. It has legal, welfare and profound social implications, with its impact broadening out from the survivor to the family to the community and into wider society. The politics of power and oppression are intertwined with the experience and may be unconsciously repeated into adult experiences, often worsened by the interplay of intersectionality and the withdrawal of public services and support for people with complex mental health problems. This book has been developed to support survivors, families, practitioners and the wider public break the social taboo around the topic of child sexual abuse. It unites a broad range of voices to encourage better community support and improve social services to support those impacted. With an ethical commitment to the field, this book will appeal to clinicians working in mental health but will also hold interest to those in other fields such as the social sciences, as well as the interested public, and CSA survivors in particular

Cultural narratives and the self of the therapist: A journey in systemic therapy

This paper is based on my experiences of becoming a systemic family therapist, reflecting on how my identity and Greek cultural narratives have shaped my practice. A historical overview of first-, second-, and third-order approaches illustrates the evolution of the self of the therapist in systemic therapy through self-reflexivity. Reflecting on my experiences in a multicultural context, I explore the significance of curiosity in understanding how my cultural narratives influence my practice. I examine how my identity is formed and re-formed based on context. To achieve this, I provide practice examples where I attended to my internal dialogues, used supervision, and applied reflective tools such as the cultural genogram. Expanding on these reflections, I propose the Culturally Permissioned Reflexivity Map (CPRM) framework, which integrates insights from the Location, Dislocation, and Relocation (LDR) framework (Draper, Marcellino & Thomson 2023), reflexive mapping approaches, including the Social Identity Map (Jacobson & Mustafa, 2019), the cultural genogram (Laszloffy & Hardy, 1995), and conceptual work on mapping emotional reflexivity (MacKian, 2004). The CPRM framework aims to deepen further our understanding as to how cultural contexts shape which emotions and professional positions feel permitted, silenced or tolerated within the therapeutic and supervisory relationships. The core argument of this paper is that, in therapeutic relationships, therapists should integrate all aspects of their selves to establish meaningful connections with clients. This integration is central to the therapeutic process and facilitates change