Helen Pote

Postnatal posttraumatic stress: A grounded theory model of first-time mothers’ experiences

Objective: To develop a grounded theory model of first-time mothers’ experiences of postnatal posttraumatic stress, with the aim of aiding understanding, formulation and treatment of new mothers. Background: Research into postnatal posttraumatic stress is growing, yet evidence-based treatment models have yet to be fully developed. It is unknown whether existing models of posttraumatic stress are directly applicable to postnatal posttraumatic stress, or whether other factors are particularly relevant for symptoms occurring in this context. Methods: A qualitative design explored first-time mothers’ experiences of pregnancy, labour, birth and the postpartum, following a subjectively identified traumatic labour and/ or childbirth. Eleven mothers were interviewed individually, either reporting full symptoms of posttraumatic stress (n = 6), or partial symptoms (n = 5). Grounded theory methodology was used to code the data and develop a theoretical model of maternal postnatal posttraumatic stress based on these accounts. Results: Factors emerged specific to postnatal experiences, including: antenatal expectations and anxieties, constructions of the experience, perceptions of other people’s views, social support (from specific sources) and adaptive and maladaptive coping strategies. Limitations: The study was based on a small sample of first-time mothers’ accounts, and therefore may not be applicable to mothers with previous children, or a wider maternal population. Conclusions: The new model highlights important areas for development in clinical practice at various stages of maternal healthcare provision: in the antenatal period, during labour and birth, and into the postpartum. The model can inform formulation and treatment of mothers experiencing postnatal trauma symptoms, providing specific areas of focus for intervention.

Developing a model of sustained change following multisystemic therapy: young people's perspectives

Multisystemic therapy (MST) is an empirically validated, family and community-based intervention for young people presenting with antisocial and offending behaviour. This qualitative study aimed to explore young peoples experiences of MST and learn what had helped them to sustain positive outcomes over time. Semi-structured interviews were conducted with eight young people at an average of 14 months after MST (range: 5–21 months). A constructivist version of grounded theory was employed to analyse the data, leading to the development of a model of sustained change in MST. Themes from the model included therapeutic alliance, increases in systemic awareness, recognizing responsibility, positive peer relationships, acknowledging and celebrating success, continued use of specific strategies (for example, worry boxes) and the identification and creation of a preferred future. This research presents an understanding of how change may be sustained after MST, highlighting systemic, developmental and individual factors in relation to this. Clinical implications and a proposed model of sustained change in MST are discussed. Practitioner points The therapeutic alliance was perceived by young people as central to the process of change and sustained change following MST Young peoples contribution to sustaining therapeutic gains at follow up, alongside caregivers, highlighted the importance of actively engaging them in therapy Peer relationships were identified as relevant to sustaining change, particularly in relation to shared values and goals for the future

Sustaining change following multisystemic therapy: caregiver's perspectives

Multisystemic therapy (MST) is an empirically supported intervention for young people presenting with antisocial behaviour. This study explored the process of sustaining positive outcomes following MST from caregiver perspectives. Semi-structured interviews were carried out 5‐21 months post-MSTwith 12 caregivers. A grounded theory methodology was used to analyse the data. Caregivers in this study identified the following themes as contributing to sustaining change; improvements in their relationship with their child, shifting how they viewed difficulties and solutions and feeling personally strengthened and resilient. The therapeutic alliance in MSTwas described as important in initiating these changes. Clinical implications and how the themes from this study fit into the existing model of change in MSTare discussed. Practitioner points • Caregivers validated the therapeutic alliance as key to the MST approach. • Experiencing a positive therapeutic alliance was also identified as important in improving relationships within the family even after therapy was completed. • Positive experiences of MST developed caregivers’ experiences of feeling more resilient in the face of later difficulties helping sustain positive outcomes.

Vulnerability and protection talk: Systemic therapy process with people with intellectual disability

Abstract Background Vulnerability and protection are key concepts within the literature relating to systemic therapy for people with an intellectual disability (ID). This paper explores the processes by which these concepts were discussed in systemic therapy sessions. Method Four videotapes of systemic therapy sessions were evaluated using a qualitative design, incorporating thematic and conversation analysis. The videotapes were drawn from systemic therapy sessions with 3 families with an adult with ID. Results Vulnerability and protection themes were identified within the content of therapeutic conversations, including protection from the disability and its consequences; protection from peers, siblings, and the world at large; and protection from emotionally sensitive topics. Protective strategies were also used by all system members through the process of therapy. Key strategies were topic switch and reversals. Conclusions Protection is a key issue. Clinical practice could be enhanced if therapists reflect on the strategies they employ in addressing protection effectively.

The Experiences of Lesbian and Gay Adults on Acute Mental Health Wards: Intimate Relationship Needs and Recovery

This study explores the psychiatric inpatient experiences of lesbian and gay service users in relation to their intimate relationship needs and how these experiences affected their mental health recovery. Semi-structured interviews were conducted with three gay men and three lesbians who had been resident on public sector psychiatric wards in the United Kingdom. The data were analyzed using Interpretative Phenomenological Analysis (IPA). Five master themes emerged: the conceptualization of intimacy, the relationship between intimate relationships and recovery, experiences of the ward, experiences of prejudice and discrimination in services, and a loss of power and personal identity as a service user.

Exploring the Reliability and Validity of the Social-Moral Awareness Test.

BACKGROUND The aim of the study was to explore the validity of the social-moral awareness test (SMAT) a measure designed for assessing socio-moral rule knowledge and reasoning in people with learning disabilities. Comparisons between Theory of Mind and socio-moral reasoning allowed the exploration of construct validity of the tool. Factor structure, reliability and discriminant validity were also assessed. MATERIALS AND METHODS Seventy-one participants with mild-moderate learning disabilities completed the two scales of the SMAT and two False Belief Tasks for Theory of Mind. RESULTS Reliability of the SMAT was very good, and the scales were shown to be uni-dimensional in factor structure. There was a significant positive relationship between Theory of Mind and both SMAT scales. CONCLUSIONS There is early evidence of the construct validity and reliability of the SMAT. Further assessment of the validity of the SMAT will be required.

Measuring competence in systemic practice: development of the ‘Systemic Family Practice – Systemic Competency Scale’ (SPS)

Ensuring that practitioners are competent in the therapies they deliver is important for training, therapeutic outcomes and ethical practice. The development of the Systemic Practice Scale (SPS) is reported - a measure to assess the competence of novice systemic practitioners trialed by Children and Young Person’s Improving Access to Psychological Therapies (CYP-IAPT) training courses. Initial reliability assessment of the SPS with twenty-eight supervisors of systemic practice evaluating students’ competence using an online recording of a family therapy session is detailed. The SPS was found to be a reliable measure of systemic competence across training settings. Rating variability was noted, with training and benchmarking to improve rating consistency recommended. Further research using the SPS to further establish the reliability and validity of the scale is required.

Anxiety in children attending a specialist inherited cardiac arrhythmia clinic: a questionnaire study

Objectives Inherited cardiac arrhythmia syndromes are life-threatening conditions. There is a paucity of research examining the psychological impact of these conditions in children. This study had three main aims. The first was to explore how the Cardiac Anxiety Questionnaire (CAQ) performs in a child population. The second aim was to compare the level of anxiety of children with an inherited cardiac arrhythmia syndrome and children being screened due to a family history of an inherited cardiac arrhythmia syndrome to control children. The third aim was to examine associations between a sudden cardiac death in the immediate family and levels of anxiety. Method 47 children with an inherited cardiac arrhythmia syndrome, 78 children with a family history and 75 control children completed the Revised Child Anxiety and Depression Scale (RCADS), the Cardiac Anxiety Questionnaire for Children (CAQ-C) and the Childhood Anxiety Sensitivity Index. Children were between the age of 8 and 16 years. Results The study found the CAQ-C had promising psychometric properties. There were no significant differences in total anxiety scores (as measured by the RCADS) between the three groups. There were significant differences in cardiac-focused anxiety scores between the three groups. Conclusions The CAQ has promising psychometric properties in a child population. However, further research is needed. Children attending specialist inherited cardiac arrhythmia clinics should be targeted for routine psychological screening and offered psychological intervention where necessary.