When adolescents stop psychological therapy: rupture-repair in the therapeutic alliance and association with therapy ending

therapeutic alliance consistently predicts dropout from psychological therapy, and ruptures in the therapeutic alliance may also predict dropout, yet there is a dearth of research with adolescents. This study investigated whether markers of rupturerepair in the therapeutic alliance were indicative of different types of treatment ending in adolescents who received psychological treatment for depression. Data were from the IMPACT study, a trial investigating the effectiveness of therapies for adolescent depression. Participants were randomly allocated to receive a psychological therapy: Brief Psychosocial Intervention, Cognitive-Behavioural Therapy or Short-Term Psychoanalytic Psychotherapy. The sample (N=35) comprised adolescents who had either completed their treatment (n=14) or dropped out (n=21) according to their therapist. Dropout cases were further classified as dissatisfied (n=14) or got-whatthey- needed (n=7) based on post-therapy interviews with the adolescent and therapist. Selected audio-recordings of therapy sessions were rated using the Rupture Resolution Rating System and Working Alliance Inventory (observer-version). Therapeutic alliance and rupture-repair during therapy were similar for completers and got-what-they-needed dropouts, while dissatisfied dropouts had poorer therapeutic alliance, more ruptures, ruptures were frequently unresolved, and therapists contributed to ruptures to a greater extent. Qualitative analysis of the sessions led to the construction of three categories of therapist contribution to ruptures: therapist minimal response; persisting with a therapeutic activity; and focus on risk. Results suggest that ruptures, especially when unresolved, could be regarded as warning signs of disengagement and dropout from psychological treatment. Future research should investigate how ruptures may be effectively identified and resolved in treatment with adolescents

What is Community Operational Research?

Community Operational Research (Community OR) has been an explicit sub-domain of OR for more than 30 years. In this paper, we tackle the controversial issue of how it can be differentiated from other forms of OR. While it has been persuasively argued that Community OR cannot be defined by its clients, practitioners or methods, we argue that the common concern of all Community OR practice is the meaningful engagement of communities, whatever form that may take – and the legitimacy of different forms of engagement may be open to debate. We then move on to discuss four other controversies that have implications for the future development of Community OR and its relationship with its parent discipline: the desire for Community OR to be more explicitly political; claims that it should be grounded in the theory, methodology and practice of systems thinking; the similarities and differences between the UK and US traditions; and the extent to which Community OR offers an enhanced understanding of practice that could be useful to OR more generally. Our positions on these controversies all follow from our identification of ‘meaningful engagement’ as a central feature of Community OR

Spectral Analysis of a Four Mode Cluster State

We theoretically evaluate the squeezed joint operators produced in a single optical parametric oscillator which generates quadripartite entangled outputs, as demonstrated experimentally by Pysher et al. \cite{pysher}[Phys. Rev. Lett. 107, 030505 (2011)]. Using a linearized fluctuation analysis we calculate the squeezing of the joint quadrature operators below threshold for a range of local oscillator phases and frequencies. These results add to the existing theoretical understanding of this potentially important system.Comment: 4 pages, 6 figure

The Herts and Minds study: feasibility of a randomised controlled trial of Mentalizationbased Treatment versus usual care to support the wellbeing of children in foster care

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Background: There is a lack of well-designed randomized controlled trials (RCTs) to investigate the efficacy of psychological therapies for children in foster care with emotional and behavioural difficulties. Mentalization-based therapy (MBT) focuses on supporting the carer-child relationship by promoting reflective capacity. This study examined the feasibility and acceptability of an RCT of MBT, delivered in a family-format, for children who are in foster care in the UK. Method: Herts and Minds was a phase II, blinded feasibility RCT with follow-up of at 12 and 24 weeks post-randomisation. Participants were children (age 5-16) in foster care referred to a targeted mental health service, who had some level of difficulty as identified by the Strengths and Difficulties Questionnaire (SDQ). Aims were to assess: the feasibility of recruitment processes and study uptake; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; establish acceptability and credibility of MBT as an intervention for children in foster care; establish feasibility and acceptability to participants of conducting an RCT; and estimate the likely treatment efficacy effect size. Participants were randomly allocated to either MBT (n = 15) or Usual Clinical Care (UCC) (n = 21) individually or in sibling groups. A range of qualitative and quantitative data was gathered to assess feasibility. Results: Feasibility was established with regard to: capacity to recruit participants to a study; capacity to train mental health practitioners to deliver MBT to an acceptable level of treatment integrity; acceptability and credibility of MBT; and feasibility and acceptability to participants of conducting an RCT. A number of issues made it difficult to estimate a likely treatment efficacy effect size. Conclusion: With modifications, it is feasible to run an RCT of MBT for children in foster care. Both the therapy and research design were acceptable to participants, but modifications may be needed regarding both the timing of assessments and the identification of appropriate primary outcome measures. Given the lack of evidenced based therapies for this population, such a trial would be a significant contribution to the field. Findings may be useful for other groups planning clinical trials of psychological therapies for children in foster care. Trial registration: ISRCTN 90349442. The trial was retrospectively registered on 6 May 2016.Peer reviewedFinal Published versio

Open Space – a collaborative process for facilitating Tourism IT partnerships

The success of IT projects depends on the success of the partnerships on which they are based. However past research by the author has identified a significant rate of failure in these partnerships, predominantly due to an overly technical mindset, leading to the question: “how do we ensure that, as technological solutions are implemented within tourism, due consideration is given to human-centred issues?” The tourism partnership literature is explored for additional insights revealing that issues connected with power, participation and normative positions play a major role. The method, Open Space, is investigated for its ability to engage stakeholders in free and open debate. This paper reports on a one-day Open Space event sponsored by two major intermediaries in the UK travel industry who wanted to consult their business partners. Both the running of the event and its results reveal how Open Space has the potential to address some of the weaknesses associated with tourism partnerships

Psychological Mediators of the Association Between Childhood Emotional Abuse and Depression: A Systematic Review

Background: A number of existing meta-analyses and narrative reviews have already addressed the relation between childhood adversity and depression, yet none of them has examined the specific link between emotional abuse and depression highlighted by previous research. It is no longer appropriate to regard childhood maltreatment as a unitary concept when considering its effects on subsequent depression; instead, subtypes of childhood maltreatment need to be scrutinized separately. This review addresses this significant gap by critically evaluating empirical studies examining psychological mediators of the relationship between childhood emotional abuse and subsequent depression. / Methods: A systematic search of nine electronic databases was conducted to identify eligible studies published in English between January 1980 and January 2020. Given the heterogeneous outcomes of eligible studies and the inconsistent reporting of indirect effects, a narrative synthesis, rather than a quantitative meta-analysis, was conducted. An appraisal of methodological quality was also included. / Results: We identified 34 papers, comprising 18,529 adults and 3,434 adolescents, including 888 clinical participants. Our synthesis suggests that studies on mediators in the emotional abuse–depression link have focused on five clusters of intervening variables: early maladaptive schemas, cognitive-personality variables, emotion dysregulation, interpersonal styles, and stressful negative events. Only 11 studies identified the unique contribution of emotional abuse to depression by controlling for other forms of childhood maltreatment. / Conclusions: Our findings support several routes with relative consistency (e.g., early maladaptive schemas, hopelessness, negative cognitive styles, brooding rumination, overall emotion dysregulation). Because psychological mediators function as a complex interrelated system, controlling for the interrelation between them is important. The evidence for the purported mediating role of the factors identified in this review should be considered with caution given the relative dearth of large-scale, adequately powered longitudinal studies. This review proposes a comprehensive multilevel theoretical framework as a basis for future research

The child psychotherapists' role in consultation work with the professional network around looked after children

Consultation with the network around a child is a core aspect of a child psychotherapist’s role; however, little has been written about this aspect of their work with looked after children. Aims: To gain an understanding of child psychotherapists’ work with the network around looked after children, and what they see as specific to the psychoanalytic approach. Methods: Nine participants with expertise in working with foster carers and looked after children’s professionals, participated in in-depth interviews. Results: Thematic analysis identified three themes concerned with the tensions child psychotherapists hold within themselves whilst consulting to the network around looked after children. The first theme encapsulates participants’ sense of dilemma between what they felt was demanded of them versus what they could offer. The second theme describes participants’ sense of tensions around the way the system is organised versus what they felt is in the best interests of the child and network. The third theme captures participants’ views about whether their consultant role fits a generic model of reflective practice similar to that offered by professionals from other disciplines, or whether the psychoanalytic approach brings something distinctive to this model of consultation. Links to existing theory and practice implications are discussed

Facing Shadows: working with young people to coproduce a short film about depression

Background: IMPACT (Improving Mood with Psychoanalytic and Cognitive Therapies) is a multi-centre randomised controlled trial of three therapeutic interventions for the treatment of depression in young people. IMPACT- My Experience (IMPACT-ME), a qualitative research study, followed up a sub-sample of families involved in IMPACT to explore young people's experiences of therapy and depression. Members of the IMPACT-ME steering group, who brought their own experiences of depression and engaging with mental health services, were keen to find ways to provide information about depression and help-seeking beyond traditional academic audiences, specifically to other young people experiencing depression and wondering where to turn: their chosen medium was film. Here we describe and reflect on the four-day coproduction workshops in which researchers, young people and film-makers coproduced 'Facing Shadows', a short animation about depression and therapy (https://www.youtube.com/watch?v=LdmRPKUhNEY). Main body: We outline the process, focusing on the four-day creative, collaborative workshop in which young people shared their experiences, decided on the tone, tenor and message of the film, identified their primary audience and produced the bulk of the audio and visual material. The adults acted as facilitators: developing a creative, collaborative learning environment in which trusting relationships could flourish, as well as offering guidance, instruction, advice and support. To date the film has been viewed around 12,000 times on YouTube. The young people learned new skills, felt listened to and enjoyed the process. They produced a film which sends a hopeful message to other young people, '… that they are not alone'. Conclusion: We reflect on the creative participatory workshop approach which transformed the project from dissemination to an insightful learning experience for young people and researchers alike