Independence and effectiveness: Messages from the role of Independent Reviewing Officers in England

This paper draws on research into the role of Independent Reviewing Officers (IROs) in England, exploring the dimensions and challenges of their ‘independence’. IROs are specialist social workers whose function is to review the cases of children in public care and ensure that they have appropriate plans and that these plans are being implemented in a timely manner. IROs are ‘independent’ in the sense that they are not the social worker to whom a child’s case is allocated, and do not have line management responsibility for the case, however they are employed by the same local authority. There are detailed regulations and government guidelines on their role, and high expectations, but what does independence mean in this context? The paper draws on a mixed methods study conducted by the authors in 2012-14, which included a survey of 122 files of children in care from four local authorities; interviews with 54 social workers, 54 IROs, 15 parents, and 15 young people; six focus groups; and nationally-distributed questionnaires for IROs (65), social work managers (46) and children’s guardians (39). The study found five dimensions of independence: professional, operational, perceived, institutional and effective. The IROs and social workers generally took more nuanced and pragmatic approaches to their inter-professional working than prescribed in the policy guidance or the pronouncements of politicians and judges, seeing this as more likely to be effective. IROs are not, and cannot be, the solution to all the problems that exist in services for children in care, and the other professionals involved should not be seen as necessarily any less capable or committed to the best interests of the children. Rather, the IRO is part of an interactive system of checks and balances which, together, may increase the likelihood that professional judgement will be exercised effectively on the child’s behalf

TAKING A PRAGMATIC APPROACH TO DIALOGICAL SCIENCE (COMMENTARY)

ABSTRACT. In this commentary in this special issue on psychotherapy as a dialogical enterprise, I consider the current debates in dialogical science represented in these contributions, and the issues arising from these debates for the ongoing project of applying dialogical methods of analysis to clinical interaction. I then propose a perspective from the discipline of pragmatics which, I suggest, offers a grounded empirical method, with a wide range of findings to draw upon, which could resolve some of the theoretical and practical issues in the contemporary practice of dialogical science. A practical application is offered by way of demonstration. Keywords: dialogical science; pragmatics; narrative; interaction Dialogical science is a growing and lively domain of psychotherapy research. Many years of findings have demonstrated that the therapeutic relationship, with its 'alliance' properties, is central to good outcomes no matter what the form of psychotherapy practiced. Dialogic science builds on these findings, offering a strategy for the study of psychotherapy process which is relatively independent of therapeutic schools . In responding to these articles on the theory and practice of the dialogical analysis of psychotherapeutic process, this review article will take a step back, placing dialogism in its philosophical and historical context. Then, pursuing the theme of meaning-as-action, it will propose a further integration of research methods from the discipline of pragmatics in the search for a deepened analysis of psychotherapy process with immediate relevance to clinical practice. Dialogism: Its origins and application to psychotherapy Dialogism is grounded in generic concepts derived from the 'dialogic' model of meaning developed by Bakhtin. Leiman provides a succinct summary of this development (2012). He describes the conceptual origins of dialogism in the work of Vygotsky and Bakhtin, and demonstrates how a semiotic understanding of the construction of meaning making entails the dynamic process of 'positioning' at its centre: 'the subject's positioning to the referential content of speech is, simultaneousl

How to do things with questions : the role of patients’ questions in Short-Term Psychoanalytic Psychotherapy (STPP) with depressed adolescents

The role of patients’ questions in psychoanalytic psychotherapy is a neglected topic in the clinical and research literature. This qualitative study aims to bridge this gap by exploring the role of patients’ questions in Short-Term Psychoanalytic Psychotherapy (STPP) with adolescents suffering from depression. This is a single case study, focusing on the interaction between the patient and his therapist when questions were asked by the patient, using conversation analysis methodology. Data was taken from the IMPACT study, a randomised controlled trial, investigating three types of therapy in the treatment of adolescent depression. The findings identify some typical ways in which the therapist responded to the patient’s questions, and show that ‘surprising behaviours’ that seem associated with heightened affect appeared when the patient asked a question, leading to an enlivening of the therapeutic interaction. The study examines the significance of these findings within the context of the therapeutic relationship and discusses the implication of these findings for technique

How to do things with questions: the role of patients’ questions in Short-Term Psychoanalytic Psychotherapy (STPP) with depressed adolescents

The role of patients’ questions in psychoanalytic psychotherapy is a neglected topic in the clinical and research literature. This qualitative study aims to bridge this gap by exploring the role of patients’ questions in Short-Term Psychoanalytic Psychotherapy (STPP) with adolescents suffering from depression. This is a single case study, focusing on the interaction between the patient and his therapist when questions were asked by the patient, using conversation analysis methodology. Data was taken from the IMPACT study, a randomised controlled trial, investigating three types of therapy in the treatment of adolescent depression. The findings identify some typical ways in which the therapist responded to the patient’s questions, and show that ‘surprising behaviours’ that seem associated with heightened affect appeared when the patient asked a question, leading to an enlivening of the therapeutic interaction. The study examines the significance of these findings within the context of the therapeutic relationship and discusses the implication of these findings for technique

Acanthamoeba keratitis – Clinical signs, differential diagnosis and treatment

Purpose: To summarize actual literature data on clinical signs, differential diagnosis, and treatment of acanthamoeba keratitis. Methods: Review of literature. Results: Clinical signs of acanthamoeba keratitis are in early stages grey-dirty epithelium, pseudodendritiformic epitheliopathy, perineuritis, multifocal stromal infiltrates, ring infiltrate and in later stages scleritis, iris atrophy, anterior synechiae, secondary glaucoma, mature cataract, and chorioretinitis. As conservative treatment, we use up to one year triple-topical therapy (polyhexamethylene-biguanide, propamidine-isethionate, neomycin). In therapy resistant cases, surgical treatment options such as corneal cryotherapy, amniotic membrane transplantation, riboflavin-UVA cross-linking, and penetrating keratoplasty are applied. Conclusion: With early diagnosis and conservative or surgical treatment, acanthamoeba keratitis heals in most cases. Keywords: Acanthamoeba, Keratitis, Cornea, Contact len

Ocular Surface Disease Index and Ocular Thermography in Keratoconus Patients

Purpose. Keratoconus (KC) has been defined as a “noninflammatory” corneal disease, but recent studies have noted a potential inflammatory origin. We analysed the Ocular Surface Disease Index (OSDI) and ocular surface temperature (OST) in KC patients compared to controls. Patients and Methods. A total of 179 eyes in 90 patients with KC (topographic keratoconus classification 0-1 to 4, age 36.1 ± 12.5 years, 65.9% males) and 82 eyes in 41 controls (age 36.4 ± 12.8 years, 47.6% males) were examined. The participants completed the OSDI questionnaire and underwent corneal topography, tomography, and thermography. Additional outcome measures were vision- and discomfort-related OSDI subscores and mean OST  at the corneal centre during 10 seconds of sustained eye opening after blinking. Results. The OSDI score (31.4 ± 22.4 vs. 17.5 ± 17.9) and vision- (17.7 ± 14.6 vs. 10.5 ± 13.2) and discomfort-related (14.3 ± 10.7 vs. 9.4 ± 10.5) OSDI subscores were significantly higher in KC patients than in controls (p 0.174, p<0.005), but did not correlate with the central corneal OST (r < 0.001). OST  also did not correlate with the SAI, SRI, and central corneal thickness (r ≥ −0.086). Conclusion. KC patients had increased OSDI scores and vision- and discomfort-related OSDI subscores without an increase in the OST compared to a normal population. OSDI score/subscores weakly correlate with SAI and SRI but do not correlate with OST in KC patients or controls. Vision- and discomfort-related symptoms of KC have to be managed in parallel in ophthalmological practice, but the necessity of anti-inflammatory treatment cannot be verified through ocular thermography

Exploring group process

This study takes as a starting point the need for further observational research in identifying the phenomenon of cohesion in group psychotherapy. The purpose is to test the possibility that there are relevant observational technologies that, like the microscope, can reveal phenomena that cannot be perceived directly but that underpin events at the perceptual level. Two text analytical approaches will be applied to mutually support possible findings: conversation analysis as a qualitative tool and quantitative computer-assisted text analysis following the therapeutic cycles model (TCM). The text to be analyzed is a transcript of Session 9 of a psychodynamic psychotherapy group for seven women diagnosed with an eating disorder. Within the cycles there is higher category density, higher levels of coherence, and tying across turns. The TCM reliably can identify features of the therapeutic process that are of clinical interest