A conversation with Isca Wittenberg

This paper, based on a conversation with Isca Wittenberg, summarises the dialogue between her and the author and highlights the main points of their discussion, including the observational method, the role of the observer and the influence on clinical practice

Dimensionality, identity and security: Finding a home through psychoanalysis

This paper suggests that Meltzer’s understanding of the development of inner space can be thought about in relation to how a state of ‘being at home’ can be impaired through early trauma and developmental failure. It shows how a very young child developed a greater capacity for recognising inner and outer experience and consequently a greater awareness of inner space through intensive psychotherapy. Clinical material is presented in which this two-year-old boy moves from profound disorientation and disconnection, through physical containment and moments of communication, to some shared expression and symbolisation of his preoccupations. The author uses episodes from the psychotherapy to illustrate links between Meltzer’s thoughts on impaired interior dimensionality and a resulting terror of the ‘breaking of surfaces’ with Winnicott’s understanding of the necessary ‘gravitational pull’ of a good internal object and the negative retreat which may be caused by overwhelming anxiety. The paper suggests that a developmental approach to psychotherapy with young children has some technical ramifications which might include physical containment, emphasised attunement, simple observational commentary and developmental interpretation. The relationship between interior and exterior spatial awareness is discussed and brief reference is made to a study of psychotherapy with homeless adults regarding their capacity to make use of a physical home. Finally, Bion’s encouragement to abandon memory and desire is discussed in relation to the need traumatised children may have for environmental hope and hopefulness in the person of their therapist

Light and movement. Making contact with a traumatised and embattled latency girl

This paper shows a child psychotherapist learning and developing her technique as she attempts to make contact with a child who is extremely hard to reach. It is based on the first two years of three-times-weekly intensive psychotherapy of a latency girl who had little faith in a helpful therapeutic relationship. Her defences against such a relationship were entrenched and hard to shift. In this clinical work, the psychotherapist relies on close observation and her countertransference to develop a relationship with the child, in order to begin to make sense of her non-verbal emotional experience and communication

Finding a place of one's own: A grounded theory approach to reviewing the developmental impact of child psychotherapy with a looked-after 2-year-old child

This chapter focuses on a single-case research study in which grounded theory methodology was applied for a retrospective analysis of the clinical material from an intensive psychotherapy treatment. It presents a brief outline of the case followed by a summary of the methodologies applied in the analysis, prior to a discussion of the material. As child psychotherapy has had a long history in the field of looked-after children, it seemed important to further the understanding of the treatment of this particular population with a focus on early development. Given that a psychotherapist’s work is so often focused on the slow and intimate development of a relationship, it is difficult to imagine what kind of research method could effectively clarify or accurately follow its finer contours. The grounded theory approach gave an opportunity to develop greater understanding about some of the themes and phenomena that lie at the heart of many child psychotherapy cases of very young looked-after children

Continence management in acute stroke :a survey of current practices in Australia

Aim.  The aim of the study was to determine current national urinary incontinence management practices in Australian acute stroke units and their concordance with the National Stroke Foundation guidelines. Background.  Urinary incontinence is a common consequence after stroke and a statistically significant indicator of poor outcome, including disability and admission to institutional care. The National Stroke Foundation has produced guidelines for the acute and post-acute phase of care, offering Australian nurses evidence-based recommendations regarding stroke management including the management of urinary incontinence. Method.  In 2007–2008, dedicated acute stroke units in Australia were identified and a senior nurse from each unit was invited to participate in a 10-minute telephone survey to ascertain their current urinary continence management practices. Results.  Representatives from 41 acute stroke units participated in the survey (response rate 98%). Participants from less than half of the units reported that they had a formal plan for urinary incontinence management (n = 19, 46%), and the majority of those who did not would find a formal plan useful (n = 15, 79%). Two-thirds of respondents stated that they would manage urinary incontinence with indwelling catheterization (n = 25, 61%). Only 30% (n = 12) were ‘satisfied’ or ‘very satisfied’ with urinary continence management in their acute stroke unit. Conclusion.  A large proportion of acute stroke units were yet to establish formal urinary incontinence management plans. The implementation of evidence-based urinary incontinence management plans after stroke is integral to improving patient outcomes. An increase in resources for professional development in the assessment, treatment and management of urinary incontinence is essential to improve and maintain skills in after-stroke care