An enquiry into psychotherapy training: challenges to developing a generic foundation year and links to clinical practice training

This document presents an action research enquiry into psychotherapy and counselling training within the context of a training institute. The starting point for the enquiry were the apparent gaps that exist in clinical practice training. Recognising that the commonly used training structure in psychotherapy and counselling training, which separates clinical practice, formal teaching and supervision, often leads to practice and training disparity raising ethical concerns, I aimed to use the enquiry to enhance the effectiveness of clinical training. I formulated two research questions: • Could a more generic psychotherapy training in the foundation year serve as a better preparation for clinical practice? • Would it be possible to develop an integrated structure between clinical practice, training and supervision? These questions led to developing the project in two parts: • An exploration of the feasibility ofa generic foundation year, and • The development of an internship component. The methodology I used was action research, particularly relevant to this enquiry because of the focus on developing practical knowledge through involvement with an organisational system. Another aspect of the enquiry was internal consultancy. As well as being a researcher, I acted as a consultant for the organisation I worked for. The organisational setting was the Metanoia Institute, a counselling and psychotherapy training institute based in London. The Metanoia Institute runs several courses in counselling and psychotherapy - Person Centred, Transactional Analysis, Gestalt and Integrative - as well as a Doctoral programme in psychotherapy in collaboration with Middlesex University. Middlesex University validates the academic programme at the Metanoia Institute, which leads to BA and MSc awards in counselling and psychotherapy. The Institute also contains an internal clinical placement for students - Metanoia Counselling and Psychotherapy Service (MCPS), which I manage. The Metanoia Institute sponsored the enquiry and acted as a principal collaborator throughout. The project shows how the process of enquiry initiated a dynamic of organisational change, highlighting systemic issues and challenges to the development of psychotherapy training, particularly in relation to generic training. The implementation of the findings became possible through focusing on internship, which became the central area for development within the project. The final outcome of the research has been used to develop an extensive pilot project, entailing restructuring of the training programme in one of the academic departments. As well as presenting the enquiry, this document discusses the theme of organisational change and suggests that it offers a lens through which issues of professional integration could be viewed from a systemic (organisational) perspective. Particular themes highlighted by the enquiry relate to: • Issues of culture and identity related to allegiance to a particular theoretical orientation • Factors related to the structure and funding of training organisations, and • The role of clinical practice in the process of professional integratio

Effect of exercise after a deep venous thrombosis:A systematic review

Post-thrombotic syndrome (PTS) is a common complication after deep vein thrombosis (DVT) and has a major impact on physical symptoms, quality of life (QoL) and economic costs. Relatively simple lifestyle interventions as physical exercise might reduce PTS severity and increase QoL. To evaluate the direct and long-term effects of physical activity in patients with an acute or previous DVT. We conducted a systematic review through an additional search from 2007 up to March 2022, to complement the comprehensive systematic review of Kahn et al. Articles evaluating the effect of exercise after a DVT including symptoms, QoL and the incidence and severity of PTS, were included. Quality of the studies was assessed using a GRADE-like checklist and results were reported according to the PRISMA Statement. Ten studies were included, seven randomized controlled trials and three cohort studies. We identified three types of physical activity based on timing and duration; (1) early mobilisation in the acute phase of the DVT; (2) short duration exercise 1 year after DVT and (3) prolonged exercise during follow-up after a previous DVT. Early mobilisation showed improvement in QoL and pain reduction and after 2 years it resulted in a significant reduction of PTS severity. Prolonged supervised exercise resulted in improvement of QoL. In addition, positive effects on symptoms of venous insufficiency and muscle functions were observed. None of the included studies reported an increased risk of PTS or worsening of symptoms due to physical activity. Physical exercise after a DVT is safe, improves QoL, reduces pain and decreases PTS severity. Lifestyle intervention such as guided individualized training programs can be a useful supplementary therapy for patients after a DVT or for PTS patients. Optimal training programs may be identified by further studies that improve patient-oriented outcomes for both adults and children after a DVT.</p

Strain driven antiferromagnetic exchange interaction in SrMnO3_3 probed by phase shifted Spin Hall magnetoresistance

Multiferroics have found renewed interest in topological magnetism and for logic-in-memory applications. Among them, SrMnO$_{3}$, possessing strong magnetoelectric coupling is gaining attention for the design of coexisting magnetic and polar orders upon straining. Here we demonstrate antiferromagnetic exchange interactions in strained SMO thin films extracted from a new feature in the phase response of Spin Hall magnetoresistance, which has not been explored in earlier works, such as in magnetic insulators. We explain our findings with a model that incorporates magnetic anisotropy along [110] direction, corroborates with DFT studies and is consistent with the direction of ferroelectric polarization in SrMnO$_{3}$. The fundamental insights obtained from our studies establishes the potential of this material in magnetoelectrically coupled devices for different logic and memory applications.Comment: 9 pages, 5 figures, accepted for publication in Physical Review

High incidence of acute lung injury in children with Down syndrome

OBJECTIVE: Acute respiratory tract infection is a common reason for hospitalization in children with Down syndrome (CDS) and is characterized by a high morbidity. The severe course of disease in CDS may be related to a higher incidence of acute lung injury (ALI). This study evaluated the incidence of ALI and acute respiratory distress syndrome (ARDS) in mechanically ventilated CDS. DESIGN AND SETTING: Retrospective cohort study in a pediatric ICU. PATIENTS AND PARTICIPANTS: Cases were all mechanically ventilated CDS admitted to our unit between January 1998 and July 2005. All mechanically ventilated patients without Down syndrome from January 1998 to January 2001 served as controls. Postoperative patients (cases and controls) and those with a cardiac left to right shunt were excluded. MEASUREMENTS AND RESULTS: The main outcome measure was the incidence of ALI and ARDS. The criteria for ALI were met in 14 of 24 CDS (58.3%) in 41 of 317 of controls (12.9%; OR 9.4, 95% CI 3.9-22.6). The criteria for ARDS were met in 11 of 24 CDS (46%) and in 21 of 317 of controls (7%; OR 11.9, 95% CI 4.8-29.8). None of the CDS with ALI died; in the control group ten patients with ALI died. CONCLUSIONS: CDS had a significantly higher incidence of ALI and ARDS than children without Down syndrome. The explanation for this remains to be elucidated; further study is necessary before clinical implications become clea

Validation of Observed Bedload Transport Pathways Using Morphodynamic Modeling

Phenomena related to braiding, including local scour and fill, channel bar development, migration and avulsion, make numerical morphodynamic modeling of braided rivers challenging. This paper investigates the performance of a Delft3D model, in a 2D depth-averaged formulation, to simulate the morphodynamics of an anabranch of the Rees River (New Zealand). Model performance is evaluated using data from field surveys collected on the falling limb of a major high flow, and using several sediment transport formulas. Initial model results suggest that there is generally good agreement between observed and modeled bed levels. However, some discrepancies in the bed level estimations were noticed, leading to bed level, water depth and water velocity estimation errors