Trauma, imagery and the therapeutic relationship : Langu's story

This paper, a phenomenological case study, describes the psychotherapy of Langu (pseudonym), a 21-year-old student, who presented with Acute Stress Disorder following a series of motor accidents that affected him and his family. Langu's most distressing experience was having to identify his brother's mutilated and severely burned body. Because of the intensity of the intrusive re-experiencing of traumatic imagery and the degree of dissociative numbing, Langu participated in four intensive guided imagery sessions, which involved reliving the incident, and imaginal dialogues with his dead brother. Session records and supervision notes from the therapy process that unfolded over 22 sessions served as the basis for a thematically selective case narrative. Additional material was obtained from several research interviews with Langu over the following months. The narrative highlights the impact of the imagery work as well as relational aspects of the therapy. The case narrative provides a source for examining many aspects of the psychological impact of trauma and the path to healing, as well as the dilemmas and challenges faced by therapists working with traumatised individuals

Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis

Background: Procedural pain and anxiety in children can be poorly controlled, leading to significant short- and long-term sequelae, such as longer procedure times or future healthcare avoidance. Caregiver anxiety can exacerbate these effects. We aimed to evaluate the effect of interactive video game interventions on children's procedural pain and anxiety, including the effect of different types of video games on those outcomes. Methods: We conducted a systematic review and meta-analysis of the effectiveness of interactive video games compared with standard care in children (0–18 yr) undergoing painful procedures. We searched the databases MEDLINE, Embase, and PsycINFO. We conducted random-effects meta-analysis using ‘R’ of children's procedural pain and anxiety and caregivers' anxiety. Results: Of 2185 studies screened, 36 were eligible (n=3406 patients). Studies commonly involved venous access (33%) or day surgery (31%). Thirty-four studies were eligible for meta-analyses. Interactive video games appear to reduce children's procedural pain (standardised mean difference [SMD]=–0.43; 95% confidence interval [CI]: –0.67 to –0.20), anxiety (SMD=0.61; 95% CI: –0.88 to –0.34), and caregivers' procedural anxiety (SMD=–0.31; 95% CI: –0.58 to –0.04). We observed no difference between preparatory and distracting games, or between virtual reality and non-virtual reality games. We also observed no difference between interactive video games compared with standard care for most medical outcomes (e.g. procedure length), except a reduced need for restraint. Studies reported minimal adverse effects and typically had high intervention acceptability and satisfaction. Conclusions: Our findings support introducing easily available video games, such as distraction-based conventional video games, into routine practice to minimise paediatric procedural pain and child/caregiver anxiety

Victimisation in the lives of lesbian-identified women in South Africa : implications for clinical assessment and treatment

Few clinical studies have examined victimisation in the lives of lesbian women in South Africa and whether there are distinct implications for psychological treatment. This paper presents the assessment and treatment of a lesbian-identified South African survivor of childhood sexual abuse who, as an adult, was raped and later gang raped. Her victimisation in adulthood represented ‘corrective rape’ motivated by the prejudiced assumption that the sexuality of lesbian women is pathological and should be ‘corrected’ through rape. This paper lends insights into the role of heterosexism in shaping vulnerability to victimisation and the process of recovery. It provides recommendations for work with sexual minority clients and highlights the implications when there is an absence of safety and support in the external environment

Outcome of HIV-exposed uninfected children undergoing surgery

<p>Abstract</p> <p>Background</p> <p>HIV-exposed uninfected (HIVe) children are a rapidly growing population that may be at an increased risk of illness compared to HIV-unexposed children (HIVn). The aim of this study was to investigate the morbidity and mortality of HIVe compared to both HIVn and HIV-infected (HIVi) children after a general surgical procedure.</p> <p>Methods</p> <p>A prospective study of children less than 60 months of age undergoing general surgery at a paediatric referral hospital from July 2004 to July 2008 inclusive. Children underwent age-definitive HIV testing and were followed up post operatively for the development of complications, length of stay and mortality.</p> <p>Results</p> <p>Three hundred and eighty children were enrolled; 4 died and 11 were lost to follow up prior to HIV testing, thus 365 children were included. Of these, 38(10.4%) were HIVe, 245(67.1%) were HIVn and 82(22.5%) were HIVi children.</p> <p>The overall mortality was low, with 2(5.2%) deaths in the HIVe group, 0 in the HIVn group and 6(7.3%) in the HIVi group (p = 0.0003). HIVe had a longer stay than HIVn children (3 (2-7) vs. 2 (1-4) days p = 0.02). There was no significant difference in length of stay between the HIVe and HIVi groups. HIVe children had a higher rate of complications compared to HIVn children, (9 (23.7%) vs. 14(5.7%) (RR 3.8(2.1-7) p < 0.0001) but a similar rate of complications compared to HIVi children 34 (41.5%) (RR = 0.6 (0.3-1.1) p = 0.06).</p> <p>Conclusion</p> <p>HIVe children have a higher risk of developing complications and mortality after surgery compared to HIVn children. However, the risk of complications is lower than that of HIVi children.</p