Stephen Briggs

Attachment and the Body in Suicidal Adolescents: A Pilot Study

There is a relative dearth of studies in the field of adolescent attachment despite the potential impact of such developmental changes on the organization of attachment systems. This omission is even more acute among clinical populations, although adolescence is notable for dramatic increases in specific psychopathologies, e.g. eating disorders, delinquency, and suicide and self-harm. This article attempts to address the shortfall using a mixed quantitative/qualitative research design. First, it examines the association between attachment styles and suicidality by comparing two groups of adolescent participants attending a psychotherapy clinic. Second, it explores the phenomenology of different presentations of suicidality in adolescence from a psychodynamically informed attachment theory perspective. The clinical and research implications from these findings are discussed.

Child observation and social work training

Abstract This paper explores the role for child observation on social work training courses. The authors experiences of observing infants over a 2 year period are compared with observations made by students on a social work course. An example of each kind of observation is given and discussed

RISKS AND OPPORTUNITIES IN ADOLESCENCE: UNDERSTANDING ADOLESCENT MENTAL HEALTH DIFFICULTIES

Widespread concerns about adolescent mental health difficulties have generated intense debate and resulted in adolescence being high on the policy agenda. Recent government investments aim to ameliorate widely criticised services for adolescence, and redress the negative images of young people. In order to explore the current state of knowledge regarding adolescent mental health, and relate this knowledge to practice, this paper explores three key questions: are adolescent mental health problems increasing, are adolescents dislocated by new and different contexts, and what are the levels of mental health difficulties in adolescence? The paper suggests that evidence that adolescents are ‘getting worse’ is not convincing, but it is clear that the contexts for adolescence have changed radically and this affects adolescent developmental processes. Adolescent mental health difficulties require a current, developmentally relevant and oriented approach to enhance effective understanding and intervention. Adults in general and professionals in particular need to be able to engage with and not take flight from the impact of adolescent emotionality.

Suicide and trauma: A case discussion

In this paper we explore the relationship between trauma and suicidal thoughts and behaviour. This exploration has a double perspective: a deeper understanding of trauma can illuminate the dynamics of suicidality; and the psychotherapeutic study of suicidal people increases our understanding of the impact of trauma. This discussion addresses three particular configurations: (a) the impact on the individual of the suicide of a close person; (b) the traumatic dimension of suicidal behaviour on the self; and (c) the impact of childhood traumatic experiences on the subsequent development of suicide. We describe the psychotherapy of a suicidal man, who had suffered many losses including that of his mother to suicide, as the basis for commentary by three discussants. The paper concludes that the approach linking trauma with suicide is a fruitful one and further study is recommended.

Service-users’ experiences of interpreters in psychological therapy: a pilot study

Purpose – Working across languages is playing an increasingly important role in the delivery of mental health services, notably through psychotherapy and psychological therapies. Growing awareness of the complex processes that ensue in working across languages, including the presence and role of an interpreter, is generating new conceptualisations of practice, but there is a need now to evidence how these impact on service users. The paper aims to discuss these issues. Design/methodology/approach – This paper discusses the model for working with interpretation developed by Mothertongue multi-ethnic counselling service, which conceptualises the therapeutic process as working within triangular relationships consisting of service user, therapist and interpreter. Second, the paper discusses the qualitative, practice-near methods applied in, and findings from a pilot study to evaluate the interpreters role. Findings – Three patterns of response to interpreters were identified: negative impacts on the therapy,...

Commentary on 'Managing the process of change in residential child care: A consultancy approach'

This paper explores the processes of consultancy to staff in four large children’s units at the point of a reorganisation into smaller units. The scenario is familiar; there is ‘another reorganisation’, and staff are estranged from management who have planned and imposed it. The consultants are invited to enable staff to make the transition, and, applying Lewin’s framework, they attempt to create a ‘positive’ approach to the process of change. Significantly, at one point a representative of management appears to offer a concession of a further 3–4 weeks period of consultancy with staff, so that staff may be reassured about their merits and that they are wanted. Staff, we hear, are concerned about how they are perceived by management, and whether they have the skills required to work in the new units. There is considerable anxiety about how they—the staff—and the young people will experience the impact of change, especially as the staff may be moved to different units and young people may have their care plans changed. It seems on reading the paper there is no doubt that the consultants provided an important and probably effective forum for the staff to enable them to become involved in the process of change and thus to improve morale. As staff retention is such an important issue in social work, interventions which raise morale are crucial. However, as I read the paper I found a number of questions kept being raised in my mind about what was really going on in this process of change. I shall briefly look at some of these. First, the process of change from large institutions, with a heirarchical management structure to smaller institutions with ‘flatter’ management and greater responsibilities for day-today decision making delegated to front line care staff mirrors the change to community care. Large institutions tend to become bureaucratised, developing institutional defences, particularly detachment and impersonalisation (Menzies Lyth, 1988). On the other hand, small units are often under defended, anxiety is not adequately contained and boundaries between the staff and clients/users become blurred. In this case, underqualified residential staff were being given larger and indeed onerous responsibilities, though the supervision and training provided for the staff is not mentioned. Indeed, staff were requiring reassurance that they could undertake the responsibilities of the new role, rather than requiring supervision and training. I think the issue of supervision is very important and I shall return to this later. I wondered if some of the reality of the difficulties of the work were being avoided, or diminished, in the attempt to provide a climate of optimism and positive orientation to the changes. In this sense I am reminded of the study by Dartington et al. (1981) in which the contrast

Assessing and engaging suicidal teenagers in psychoanalytic psychotherapy: a case consultation.

Assessing and engaging suicidal adolescents in psychoanalytic psychotherapy is filled with complexity and stress, but offers a potential for lasting suicide prevention. This study provides a detailed account of the initial psychotherapy sessions with a suicidal teenager, drawing extensively on the comprehensive notes taken by the therapist. Four discussants were invited to provide their perspectives as to how they would assess the main factors in the case and from this to provide a brief commentary for their own perspectives. This study concludes with a discussion of the differences and commonalities between the various contributions.

Time-limited psychodynamic psychotherapy for adolescents and young adults

This article discusses the development of a model of time-limited psychodynamic psychotherapy for adolescents and young adults developed in the context of a multidisciplinary team within the UKs National Health Service working with young people with mental health difficulties. The therapeutic focus in this model is on a significant area of developmental difficulty and/or disturbance, to facilitate the capacity of the young person to meet developmental challenges and/or have this capacity strengthened. The developmental focus is rooted in a psychoanalytic approach to adolescent development, and connects internal, interpersonal and social worlds of young people. Thus this approach understands as psychosocial the mental health difficulties of young people in contemporary contexts. Young people are engaged in therapy through containing anxieties within a clear structure provided by the time frame and the core features of the model. Two case examples are presented and discussed of young people of different ages, both of whom were able to make therapeutic use of this therapeutic modality.

Practitioners' experiences of adolescent suicidal behaviour in peer groups

Accessible summary What is known on the subject?Group suicidal behaviour can be devastating for all concerned.There is an absence of research on adolescent suicidal group behaviour.The perspectives of practitioners’ experiences of these groups are largely lacking from research literature. &NA; What this paper adds to existing knowledge?Practitioners work regularly with suicidal behaviour in adolescent peer groups.Practitioners identify peer relationships in groups as complex, including elements that are both suicide encouraging and preventing.Practitioners identify a range of ways in which young people become involved in suicidal behaviour in groups, including indirectly through risk taking and care‐seeking as well as directly suicidal or self‐harming. &NA; What are the implications for practice?Assessments of young people should routinely include a focus on the qualities of peer relations, including those in the online/digital realm.Assessments and interventions need to consider the complexity of group relationships and roles, and the multiplicity of factors that can contribute to suicidal behaviour in groups.Interventions that sustain therapeutic connectedness are helpful for taking dynamic/fluctuating risks into account. Introduction: Group suicidal behaviour by young people can have harmful effects; it may be increasing, influenced by online media and reported increasing self‐harm rates; new knowledge and understanding to inform interventions is required. Aim: To explore how practitioners experience group suicidal behaviour amongst adolescents, how they assess risks/needs, and how these insights inform understanding about these groups. Method: Ten practitioners, including Mental Health Nurses, were interviewed in one multidisciplinary CAMHS, in England. Data analysis was by Thematic Analysis (Braun & Clarke 2006). Results: Participants described frequently working with suicidal groups. Roles in groups include suicide encouraging and preventing. Practitioners identify risky and protective connections between young people, online and offline. Clinical tensions include living with suicidal risks, emotional and positional challenges, and getting to grips with digital media. Discussion: Peer groups appear to have a larger role in adolescent suicide than recognized to date. Practitioners need to assess young peoples roles in groups, their diverse motivations and to understand constantly changing digital media. Implications for practice: Assessments of suicide risk for young people should routinely include focus on peer relations including the online/digital realm. Maintaining relationships with vulnerable young people facilitates managing fluctuating risks and understanding different group dynamics.

Psychodynamic psychotherapy with suicidal adolescents

Although the treatment of suicidal adolescents is complex and may be daunting to many clinicians, it continues to play an important role in suicide prevention. In this paper, we use case material to address questions that arise in psychotherapy, including the contending priorities of understanding the suicidal act in order to prevent repetition, versus connecting emotionally with the patient in the therapeutic relationship; and the use of an evolving understanding of the complexity of suicide that develops over time as patient and therapist engage in a deepening relationship which fosters life-sustaining development and psychic change. We present a case description of a patient in later adolescence, who began intensive psychoanalytic psychotherapy after a suicide attempt and explore key components of therapeutic action. From this discussion we emphasise the relational aspects of the transference and countertransference that enables interpretation and increased therapeutic receptivity through collaborative interaction. We conclude that collaborative interaction is foundational for therapeutic action with suicidal adolescents.