Judith Trowell

THE CONTRIBUTION OF OBSERVATION TRAINING TO PROFESSIONAL DEVELOPMENT IN SOCIAL WORK

This paper first describes a range of uses of observational training and the learning to which it can give rise. It goes on to describe in detail a specific project that was undertaken by the authors with a selected group of social work trainers. The range of observations undertaken by the participants is described and their own comments provide first‐hand evaluations of the experience. Observation is seen by the authors as one of the most important foundation skills in social work practice. They conclude by sketching out the possible place of such training in the social work career continuum in the UK.

Sexually abused girls: patterns of psychopathology and exploration of risk factors

Abstract.This paper studies the patterns of psychopathology in sexually abused girls. It also explores some environmental risk factors for psychopathology including abuse characteristics and environmental experiences. The data are derived from the baseline assessment of 81 sexually abused girls referred to the London Child Sexual Abuse Psychotherapy Outcome Study (collaborative Tavistock and Maudsley project). Data about abuse were collected from the parent or foster parent using a standardised, semi-structured interview format. The girls’ psychopathology was assessed using the Kiddie-SADS schedule. Widespread and serious psychopathology in sexually abused girls attending a psychotherapy clinic previously reported in a smallscale study was confirmed; so, too, was the extent of comorbidity and impairment of psychosocial functioning. Further, a significant association was found between children looked after away from home and high rates of Separation Anxiety Disorder. No such significant associations were found for Major Depressive Disorder nor impairment of functioning. Multivariate prediction analysis revealed that significant predictors of Major Depressive Disorder consisted of seriousness of abuse, the abuser not being a parent figure, and the abuse not being recent; the only significant predictor of Separation Anxiety Disorder was that the abuser was not a parent figure; finally, impairment of general functioning was strongly predicted by the greater seriousness of abuse and also by the abuser/s not being a parent figure. Theoretical explanations advanced for the reported associations have a sense of face validity: that girls abused by strangers will be at risk of developing Separation Anxiety Disorders; that serious sexual abuse is followed by the development of a Major Depressive Disorder and a high level of impairment of social functioning.

Lessons from a Psychotherapy Outcome Study with Sexually Abused Girls

In this article, we address diverse issues arising during the course of a psychotherapy outcome study for sexually abused girls. These issues relate to the organization and management of a comparison study, implications for professionals involved, the training needs and supervision requirements of staff, case management and implications for clinical services.

Physical abuse of children: Some considerations when seen from the dynamic perspective

SUMMARY Consideration of the psychodynamic perspective in physical abuse of children can help to enhance our understanding of individual cases and also enable agencies working in this area to plan their services with due regard to the needs of their staff. If efficiency and effectiveness are to be sustained sufficient emphasis needs to be given to the very powerful experiences that are occurring, at all levels. Space needs to be provided for these to be considered, processed and dealt with by the children, adults and professionals since child-abuse occurs as a result of impulsive behaviour where conflicts cannot be resolved, at the time, in another way. In order to establish more appropriate patterns of conflict resolution, families need to be helped to think rather than act, and if professionals are to be able to function in this way themselves, as conscious and unconscious models to their families, the professionals need to have experienced this themselves, to know from experience. Knowing intellectuall...

Developing healthy mental health professionals: what can we learn from trainees?

Abstract There is considerable interest in the recruitment, training and retention of workers in the field of mental health, as evidence shows significant problems in the retention of highly qualified professionals in this field. Large numbers leave, some leaving the professions for other careers as a result of burnout, caused in part by the emotional burden of work in stressful and emotionally charged environments. We propose a training approach in which students are encouraged to reflect on their own emotional responses to such stressful and upsetting situations. We argue that this approach, in allowing them to be more at ease with themselves, would make them both more available to the emotional experiences of their patients, and in turn enhance their own resilience and capacity to survive stressful situations. We took for our study a cohort of trainees from The Tavistock Clinic in London, a major training institution providing post-graduate mental health courses based in psychoanalytic and systemic theory. We aimed to investigate what the students reported to be the key components in these trainings to enhance their capacity to manage in their demanding and highly stressful work environments, alongside ordinary human experience. The trainees were from a range of backgrounds and included doctors, psychologists, social workers and teachers. The courses had in common the following elements: small work discussion groups providing an opportunity to reflect on their work in practice, lectures on background theory, tutorials, and small seminar groups to which they brought ongoing observations of young children in ordinary settings. Some also had the opportunity to undertake supervised clinical work in the Clinic. We used a detailed qualitative questionnaire to elicit the trainees’ expectations and experience of the trainings. In addition, all participants completed the 30-item General Health Questionnaire (GHQ), and some took part in the Adult Attachment Interview, later rated for Reflective Function.

Assessing change in psychoanalytic psychotherapy of children and adolescents. Today's challenge

This book draws together work from across Europe by leading clinical researchers who have been looking into the effectiveness of psychoanalytic interventions. They are mostly time limited, brief, non-intensive ways of working so are applicable in many settings and can therefore be generalised to other clinical teams. The populations worked with are diverse and often present mainstream services with refractory clinical problems, so an applied psychoanalytic approach is well worth trying given the evidence presented in this volume. There is in addition an excellent theoretical chapter on the issues for such clinical research from Stephen Shirk which merits consideration by those wanting to evaluate their own work. This book has had a long gestation but it is an important contribution to services for child and adolescent mental health services to ensure the full menu of interventions is retained in these times of financial restraint with increasing family distress and concerns about inadequate parenting, family breakdown and troublesome adolescents.

Diagnosis and classification in child and adolescent psychiatry: the case of unipolar affective disorder.

Child and adolescent psychiatric classification is a broad domain in which the consideration of a developmental and longitudinal approach is essential. Some of the key issues involved are reviewed in this paper by focusing attention on childhood affective disorders, which are important both clinically and epidemiologically. It has been argued and demonstrated by Kovacs that in contrast to adults, children may not be capable of experiencing or reporting the symptoms thought to be representative of major depressive disorder. Nor may they be able to give an account of their duration. Hence, the pattern of manifested depressive symptoms is likely to vary according to age and stage of development of the child and young adolescent, and this is probably related to concept and language development. Further, distress and negative affect may be expressed by externalising symptomatology, especially in the pre-school years. The complexity of multiple depressive disorders, their coexistence and comorbidity with anxiety disorders needs to be studied further, employing whenever possible a developmental perspective and a longitudinal design.

Individual brief psychotherapy with sexually abused girls

SUMMARY This paper describes the clinical analysis of process notes from individual therapy sessions of twenty girls between 6 and 14 who had been sexually abused. Factors were identified from the material which could facilitate the future therapy for girls, particularly how their experience was that of losing a containing maternal object and then the subsequent trauma of sexual abuse.

The use of observation in court & assessment work

Abstract Over the last decade, across the UK, there has been a change in Legislation in relation to children. The Children Act 1989 came into effect in 1991 in England & Wales. The Children (Scotland) Act followed and the Children Order in Northern Ireland. These are consolidating pieces of legislation bringing together previous Acts in relation to children, but they also introduced a profound shift in societys view of children. The best interests of the child was to be taken as paramount, parents were seen as responsible, rather than having rights, and the whole child was to be considered. Hence, a change in the way children were to be seen and their needs assessed. Children were seen as having physical, emotional and educational needs (Part 1 (1) Children Act 1989) and harm was defined as ill-treatment or impairment of health or development. Development meant physical, intellectual, emotional, social or behavioural development and health meant physical or mental health (Children Act 1989 Part IV(9)). T...

Does interprofessional care matter in child protection

This article explores the reason why interprofessional care is so vital in child protection work. The complexity of the work and the pain and stress all too easily block communication, particularly if there are rivalries and power struggles.