Bower Place News

Beyond Baxter Seminar

2006-05-31T21:10:00.000+09:30

Beyond Baxter - Thrown Overboard
Mental health dilemmas & clinical practice with community detainees and former detainees

Presenters: Dr Lynette Rose and Malcolm Robinson

When: 5:00 pm - 6:30 pm Friday 16 June 2006
Where: Bower Place, Level 2, 55 Gawler Place Adelaide, South Australia
How Much: Free + drinks and nibbles
Information: For more information or if you wish to attend the Beyond Baxter Seminar please contact Bower Place
Telephone (08) 82216066
Facsimile (08) 82216061
E-mail malcolm@bowerplace.com.au

Practitioners Workshop Friday 9 June 3:00 - 5:00 pm "Adolescent Self Harm" presented by Catherine Sanders & Nicole Best Practitioners Seminar Friday 16 June 5:00 pm "Beyond Baxter-Thrown Overboard: Mental Health Dilemmas & Clinical Practice with Community Detainees and Former Detainees" Presented by Dr Lynette Rose & Malcolm Robinson Consumers & Clients Conference Saturday 17 June "Marriage & Relationships" Salvation Army City Church, Adelaide SA For more information contact info@bowerplace.com.au

Marriage & Relationships Conference

2006-05-30T22:16:00.000+09:30

The Salvation Army, Adelaide City Church presents

Marriage & Relationships Conference

With Malcolm Robinson

A conference for individuals, couples, prospective couples, people in a relationship, out of a relationship, wanting a relationship, entering a relationship, ordinary citizens, consumers, clients, members of corps & congregations. You do not need to be in a couple relationship to attend this conference.

This conference will look at how to communicate & how to avoid communicating. How to manage and live with similarity, difference & conflict. The seasons of a relationship. Disputes, fairness, love, justice, forgiveness, success, disappointment, kindness, failure, romance, reality, coping with the highs & lows of life in a relationship & the role the Church may play

Saturday 17 June 10:30 am - 3:00 pm

Sunday 18 June 5:30 pm - 7:30 pm

277 Pirie Street Adelaide South Australia

$40 per couple

Free Parking & Childcare Available

$25 per individual

Contact

Andrew Short

E: andrew.short@aus.salvationarmy.org

T: (08) 8223 7776

F: (08) 8232 6043

Postal Address

Marriage & Relationships Conference

Adelaide City Church

277 Pirie Street

Adelaide South Australia 5000

Seeing is Believing

2006-05-29T21:58:00.000+09:30

As clinicians we have all had the experience of working with challenging children and their families, whose difficulties have not responded to therapy.

Clinicians at the Southern Child and Adolescent Mental Health Service in Adelaide, South Australia and the Family Development Centre in Wellington, New Zealand have devised a process entitled Parent and Child Therapy. This is an attachment-based intervention using the notion of 'supported looking'. 'Supported looking' between carer and child is designed to ‘reduce distorted perception and provide a basis for clinical intervention with parents and older children’.

Parent and Child Therapy is a four-stage process.

This begins with history taking which aims to ‘work with the narrative aspect of the internal working model of both the parent and the child in parallel’.

This is followed by a preparation of both parties to meet ‘as if for the first time’.

Phase three, an experiential task for mother and child involves the mother viewing the child from 10 to 20 minutes through a one-way screen while supported by the therapist to ‘watch, wait and wonder’.

Once the parent can demonstrate empathy for the child in the relationship it is time for the fourth stage of ‘Looking After’. Now the mother joins the child and therapist in the room and is supported to build the relationship anew through child directed play.
The article concludes with a case study of four-year Josh and his mother Sue who successfully renegotiated their understanding of, and connection to, each other in a manner that has been successfully maintained for eight years ‘ despite difficult life events’.

This is joyful work and may just reconnect therapists to their own heart.

Chambers, H, Amos, J, Allison, S, Roeger, L. “Parent and Child Therapy: Attachment Based Intervention for Children with Challenging Problems” ANZJFT Vol 27 No 2 pp 68-74

Getting Attached in the Right Places

2006-05-28T23:10:00.000+09:30

Intuitively, it has always made sense that family therapists and attachment theorists would make good bedfellows. Attachment is, by its very nature, about relationship, and about relationship between intimates, the baby, the child, and their primary carer.
Anyone who has seen James Robertson’s film “A Two Year Old Goes to Hospital,” which details the process of separation of a child from her family, will appreciate the agony of the child as she moves from active protest to despair akin to depression. Such a dramatic demonstration makes it hard to maintain that attachment is not one of the central processes in the life of a family.
The most recent edition of the Australian and New Zealand Journal of Family Therapy (ANZJFT), Volume 27, 2 has embraced this as its theme. This is the first of two editions with guest editor Dr Steve Allison. The second edition will appear in 2007.
In an interview, Professor Graham Martin details the centrality of attachment theory to his work with children in hospital, youth suicide and therapeutic work with families. This is followed by a set of excellent articles which apply attachment theory to clinical practice.
In 2002 Family Process published a special edition entitled “Attachment and Family Systems”. The authors in this edition addressed theoretical and clinical issues and broadened their perspective to include attachment and the couple relationship, adolescence, culture and community.
Let us not forget that, just as we can draw idea like attachment to us, we can also take it out into the world. Dr Ann Sved-Williams, a pioneer teacher and practitioner of family therapy in Australia, established infant mental health training in Adelaide at Helen Mayo House, a facility within the Mental Health Services. Her 2003 ANZJFT paper, which articulates the intersection of infant mental health and family therapy, not surprisingly includes a section on attachment.

Alcibiades & Pericles

2006-05-26T06:37:00.000+09:30

5th century B.C
Alcibiades debated his uncle, the Greek leader Pericles.
Pericles: "When I was your age, Alcibiades, I talked just the way you are now talking."
Alcibiades: "If only I had known you, Pericles, when you were at your best."

Voices from the Storm: Emergency Docs Share Their Stories

2006-05-24T22:24:00.000+09:30

H Vankawala and R Charles

These are excerpts from an e-mail post Hurricane Katrina which was published in Clinical Psychiatry News, Australian Edition, Nov-Dec 2005. More than the images on television, they indicate the extent of the human toll. It is amazing to think of medicine practiced at this most basic level in a developed nation in 2005.

New Orleans Airport, Sept 6th 2005

I am a member of the Texas-4 Disaster Medical Assistance Team (DMAT)… For the past 8 days, I have been living and working at the New Orleans airport, delivering medical care to the Hurricane Katrina survivors.
Our little civilian team, along with a couple of other DMAT teams, set up and ran the biggest evacuation this country has ever seen.
Our busiest day, we offloaded just under 15,000 patients by air and ground. At that time we had about 30 medical providers and 100 ancillary staff. All we could do was provide the barest amount of comfort care.
We watched many, many people die. We practiced medical triage at its most basic, black tagging the sickest people and culling them from the masses so they could die in a separate area.
We were so short on wheelchairs and litters that we had to stack people in airport chairs and lay them on the floor. They remained there for hours, too tired to be frightened, too weak to care about their urine and stool soaked clothing, too desperate to even ask what was going to happen next.
We did everything from delivering babies to simply providing morphine and a blanket to septic and critical patients and allowing them to die. Many of the sickest simply died while here at the airport; many have been stressed beyond measure and will die shortly.
You will never think of America the same way.
Other articles in the same publication talk of the cascade of disasters magnifying trauma – hurricane, flooding, relief efforts, and forced relocation/displacement. Fragmentation, with people being sent everywhere, meant separation from family and friends, and minimal social support, exacerbating the risk of psychological problems.
Articles stressed the importance of attending to basic practical physical issues of injury, food and water, clothing and shelter, and assistance to locate and communicate with family and friends before more complex psychosocial and psychological needs can be addressed in disaster mental health.

Australian & New Zealand Journal of Family Therapy Google Group

2006-05-21T21:17:00.000+09:30

Friday June 16th is the starting date for the next, Multi JFT Forum, an e-mail based discussion run jointly by Family Process (USA), Journal of Family Therapy/Association of Family Therapy (UK) and the ANZJFT.
Ben Hansen and Paul Rhodes, the Moderating Team, select a paper from the ANZJFT which forms the basis of the discussion. This time they have chosen Carol Boland’s (2006) paper, ‘Functional Families: Functional Teams’, which appeared in Volume 27, 1 and was reviewed on this site.
In order to join the discussion send an empty email to
MultiJFTForum-subscribe@googlegroups.com.

5th Phase for Family Intervention with Schizophrenia?

2006-05-20T18:50:00.000+09:30

Gianfranco Cecchin the mercurial gnome to Luigi Boscollo’s solid bear, died tragically and unexpectedly in a car accident in 2004. As one of the Milan team, he and his psychiatrist collaborators, including team leader Mara Selvini Palazzoli and Guiliana Prata returned to the work of Gregory Bateson as the guiding principles for working with families. Out of their collaboration came Paradox and Counter-Paradox, the text that made them famous for their work with patients with a diagnosis of schizophrenia and established them as the founders of the Systemic School of Family Therapy.
Paolo Bertrando, Director, Episteme Centre in Italy published a paper reviewing the evolution of family interventions for schizophrenia, as a tribute to his deceased colleague. In it he proposes four distinct phases in interventions for schizophrenia. The first from 1955-1965, Conjoint Family Therapy aimed at altering dysfunctional family communication patterns; a second from 1965-1975 termed Anti-Psychiatry was a philosophical position rather than a treatment approach which suggested that schizophrenia was a response to the malaise of western society. The third, Milan Systemic therapy (1975-1985) located symptoms in the relationship patterns within and beyond the family with a particular emphasis upon meaning. Finally the fourth phase, Psycho-education, (1985-2002) aimed to support and educate family members in relation to the illness and to establish co-operation around treatment issues such as medication and rehabilitation. Bertrando proposes a fifth phase where psychoeducational practices are ’merged with other therapeutic modalities’. He suggests there is a wealth of ‘ideas, visions and techniques, belonging to different traditions that may be integrated with the practice of psychoeducation’ including attention to relational patterns and alliances, tri-generational issues, meaning of symptoms and the re-creating of life stories.
It will be interesting to see wether the dramatic swings in orientation and philosophy that have characterised the history of the treatment of schizophrenia will so readily settle into this collaborative and respectful position.

Bertrando,P (2006) ‘The Evolution of Family Interventions for Schizophrenia’ Journal of Family Therapy Volume 28,1 p 4-22

CBT and Psychosis

2006-05-18T17:17:00.000+09:30

Initial teaching was that delusions were fixed beliefs, and therefore would not respond to reasoning. CBT challenged this when it was proven effective in psychosis, applied to the delusions and dysfunctional thinking to reduce psychosis, improve insight and improve compliance with medication.
Two issues arise. One is that CBT is now often used in a generic manner, by people poorly trained and with limited experience in CBT for psychosis, diluting its effectiveness. The second and perhaps larger issue is that there has been a failure to consider the role of emotion in non affective psychotic illness.
A recent article in the British Journal of Psychiatry (Birchwood and Trower 2006) highlights affective symptoms as part of the prodrome of psychotic illness, and that distress and behavioural disturbance may well result from the appraisal of psychotic experiences, and not just as a direct effect of psychosis..
In many areas of psychiatry, therapies have preceded theory – theories have been derived as a secondary process. CBT for psychosis appears no different. Theories need to be generated and tested, and CBT used in a much more specific and targeted manner, in areas other than reduction of delusions and better insight. These may include reduction of distress, depression and behavioural problems associated with the experience of psychosis, the emotional response to and therefore the action when early warning signs are recognised (these are often non specific non psychotic symptoms), dealing with anxiety and depression in psychosis, improving evaluation of and resilience to stress (which is associated with increased risk of relapse), improving self esteem and social confidence, and therefore improving the level of function across a range of areas (even when symptoms are ongoing).

British Journal of Psychiatry The future of CBT for psychosis: not a quasi neuroleptic Max Birchwood and Peter Trower 2006 188: 107-108

Managing Complex Matters & Systemic Co-Morbidity

2006-05-16T23:10:00.000+09:30

When it's all too confusing: Managing complex, co-morbid individual, couple and family 'mental health' difficulties in a complicated systems context
A workshop for practitioners & students
Co-morbidity is ordinarily defined in terms of the concurrent presence of more than one major ‘mental health’ disorder in an individual. Major depression often presents as a co-morbid disorder & the rate with personality disorder may be as high as 60%. Physiological & psychological co-morbidity is also high with substance abuse. The symptoms that many couple & family systems carry, suggests that they too are systemically co-morbid. Such cases are often a gathering point for a bevy of family & professional systems leaving the practitioner feeling helpless & confused. This workshop sets out an integrated systemic approach to the assessment & intervention of complex co-morbid cases & will address the expansive complex systems context of these clients. Attention will be paid to the confusing & contradictory information & solutions in place in such cases & aims to put the practitioner in charge of the process.

Workshop 1: Bower Place Advanced Practice Workshop Series
Presented by Malcolm Robinson

Friday 19 May 3:00 pm to 6:00 pm
Bower Place, Level 2, 55 Gawler Place Adelaide SA 5000
Fee: $55 (includes GST)

Information
E malcolm@bowerplace.com.au
T +61 8 82216066
F +61 8 82216061
PD points can apply

Beaconsfield Goldmine Disaster: It’s Just Like Life

2006-05-14T20:21:00.000+09:30

As a nation we followed with anxiety and distress the disaster in the Beaconsfield Goldmine, one man dead and the saga of two men trapped one-kilometer underground, culminating last week in their triumphant rescue. As the days ground on, we became increasingly familiar with the media reaching for superlatives as they extracted every last drop of ‘news’ from this gruelling crisis. This reached its height on the day of the rescue. More disturbing than the hype was their apparent incredulity that a ‘miracle’, the rescue of the trapped men, and the funeral of their workmate, could possibly occur on the same day. It was as if we had come to believe that life comes in only two forms: success, joy and celebration, or failure, death and mourning. Entertainment, a good ending or a tragic ending, seems to have become the norm, and the apparent contradiction of rescue and burial seemed inconceivable. It lead me to wonder at what point we had lost sight of the words of the Christian funeral service said at the graveside as the body is lowered into the grave “In the midst of life we are in death”. Life and death are not neatly compartmentalised events that never coexist. In the work we do we are often brought face to face with the contradiction of the two intersecting. It is not always as tangible death. We witness one person’s liberation condemn another to the grief of loss of that person and the intimate arrangement of which they were once an integral part. In our work we may support a young person to emotionally leave home and leave parents who are faced with the collapse of the old family unit and, perhaps, even the dissolution of their relationship. No doubt, at some point the joy and relief of the trapped miners and their families will be tinged by the bitter guilt of the survivor and the grief of the bereaved touched by the joy of the spared. As in all things both are inextricably intertwined.

Adolescent Cutting - How to Explain, How to Respond

2006-05-10T06:32:00.000+09:30

Bower Place, Friday 12 May 2006 12:30 pm to 1:30 pm

Nicole Best & Catherine Sanders will repeat the “Adolescent Cutting - How to Explain, How to Respond” lunchtime seminar

Review of the April 6 Seminar

Practitioners at Bower Place have noticed a curious increase in clients with this symptom and supposed that our colleagues may be experiencing the same thing. We were ill prepared for the enormous response we received. The seminar was fully booked within 48 hours and a second seminar booked 24 hours later. Clearly adolescents who self harm by cutting themselves are exercising the thoughts of many practitioners. Nicole & Catherine presented a segment of videotape of a young woman speaking about her experience of cutting & then a review of the literature, which attempts to explain this behaviour, followed by guidelines for clinical ‘what to do’ management of this condition. Whilst seminar participants were clearly interested in the literature & explanations about this symptom, the greatest enthusiasm was in the ‘what do we do?’ discussion which continued over the lunch. Perhaps the strongest focus was on the seemingly ’contagious’ nature of ‘adolescent cutting’. This was particularly expressed by those working in schools, where a ‘group’ may form around a young person who is ‘cutting’ and it may then become a behaviour exhibited by all members of that group. These are interesting perceptions in light of the literature, which refers of a distinction made by young people; between those who self harm for ‘genuine’ reasons and those who ‘attention-seek’. It appears that the ‘genuine’ cutters express contempt for the ‘attention-seekers’, who put on a display of their wounds for others to see. In order to be seen as ‘genuine’ a certain level of damage must be inflicted but it must be kept a secret. Young people may view the ‘attention seeker’ as being rather pathetic & perhaps even competitive with the ‘real’ self-harming person. This then adds another layer of complexity to clinical treatment of adolescent self harm and ‘cutting’ in particular. ‘Cutting’ is a serious symptom that appears to be expressing unmanageable ‘pain’ in a person’s life, yet if it is shown & spoken about that person is then defined as ‘attention seeking’ and not really suffering. That young person is also at risk of rejection by his or her peers at a time when a large part of the adolescent developmental struggle is about acceptance. This distinction between the ‘genuine’ and ‘attention seeking’ cutters appears to be particularly unhelpful and one that those who work with groups of young people are also invited to adopt. The person who ‘self harms’ is communicating with the world around them in the most dramatic way imaginable, that they are suffering some unspeakable form of distress for which they cannot find words. To draw a distinction that suggests that those who overtly draw attention to their actions are less ‘genuine’ and less deserving of help than those whose actions are hidden & secret seems unkind and unhelpful. However, it is interesting to wonder whether the issues with which each group struggles are as different as their style of presentation or in fact more similar.

The next seminar

Friday 16 June 2006 at 5:00 pm

"Beyond Baxter - Thrown Overboard: Mental Health Dilemmas & Clinical Practice with Community Detainees & Former Detainees."

Presented by Dr Lynette Rose & Malcolm Robinson

Contact malcolm@bowerplace.com.au for more information

How Do You Solve This One?

2006-05-10T06:24:00.000+09:30

The authors of the British “Report of the National Enquiry into Self- Harm among Young People” interviewed adolescents who had engaged in self–harming behaviours as a way of exploring treatment options. The majority of the respondents believed that they could manage their situation alone and did not require specialist services. Further, they believed that such resources would not understand or respond appropriately. This finding reflects the paradoxical nature of the young person’s dilemma, which is clearly articulated by Crouch and Wright in their 2004 paper on a qualitative study of deliberate self-harm in an adolescent unit. They report that ‘participants expressed and acknowledged ambivalent feelings about themselves and contradictory expectations about what they needed from others’, they expressed a struggle between needing to be helped and feeling this was unnecessary, between independence and dependence, to disclose and to be private, a fear of rejection and a desire to be understood. While this is not uncommon for any adolescent client it constitutes an additional challenge for the development of appropriate, acceptable services to a group who so desperately need an effective response.

Truth Hurts: Report of the National Enquiry into Self- Harm among Young People; 2005; Mental Health Foundation, UK

Crouch, W & Wright, J "Deliberate Self Harm at an Adolescent Unit: A qualitative Investigation" Clinical Child Psychology & Psychiatry Vol 9 No 2 2004 pp 185 -204

A Comprehensive Service

2006-05-09T22:27:00.000+09:30

The issue of appropriate intervention for young people who self-harm is of concern for all those who work with this population. A service developed in Glasgow provides an assessment & intervention service for 12-17 year olds. The service is staffed by a nursing team. It is a 24-hours/day 7-days/per week, service to a District General Hospital and Accident & Emergency Departments in other hospitals. The service accepts referrals from a Child & Adolescent Mental Health Service where the primary presenting problem is deliberate self-harm. The focus is on the assessment of the young person & their family with an initial goal of crisis management. The young person is given a crisis card with contact numbers for the nurse therapist & other emergency services. Follow up is in the home including a psychosocial risk assessment & interviews with both the presenting person & their parents. Between 4 & 10 therapy sessions may then occur, focussing upon solutions to the difficulties the young person & their family are experiencing. Therapy, using cognitive behavioural techniques may address adolescent issues, problem resolution & communication difficulties. At the conclusion of therapy the young person is offered 3 appointments per year in order to maintain a review of their situation. They can recontact in the event of a crisis. It will be interesting to see outcome studies from this approach.

Truth Hurts: Report of the National Inquiry into Self Harm among Young People; 2005; Mental Health Foundation (UK)

There is a Research Opportunity Here

2006-05-09T22:19:00.000+09:30

For a symptom as prevalent as adolescent self-harm there is a remarkable absence of good research into effective intervention strategies. A range of definitions as to what constitutes self-harm bedevils the literature. There is a reliance upon subjects admitted to a hospital or psychiatric unit and a reliance upon self-report measures. In addition authors emphasise different perspectives, with some responding to the behaviour as indicating a poor capacity to regulate strong emotion, whilst others look more to underlying past and present life and relationship experiences. Tantum and Whittaker view self-harm behaviour as an ‘addictive’ behaviour. Not surprisingly there is a lack of consensus about the most appropriate and effective treatment strategies. One of the few formal research studies is by Linehan et al (1991) who conducted a randomised clinical trial to evaluate the effectiveness of a cognitive-behaviour therapy, dialectic behaviour therapy, over a one-year period, with chronically parasuicidal women who met the criteria for a diagnosis of borderline personality disorder. Their results suggest that those receiving this treatment showed fewer and less medically severe incidents of self-harm at most assessment points. However it appeared to have no effect on depression, hopelessness, suicidal ideation or reason for living. It is hard to know how meaningful this is to young people who self harm. The study fails to distinguish self–harm from suicide and involves an adult psychiatric population. Given the apparent importance of family relationships in the aetiology and maintenance of the symptom it would be interesting to research the effectiveness of family therapy approaches. Now that’s a challenging research proposal!

Workshop: Complex, Co-morbid 'Mental Health' Difficulties

2006-05-07T22:32:00.000+09:30

When it's all too confusing: Managing complex, co-morbid individual, couple and family 'mental health' difficulties in a complicated systems context

A workshop for practitioners & students

Co-morbidity is ordinarily defined in terms of the concurrent presence of more than one major ‘mental health’ disorder in an individual. Major depression often presents as a co-morbid disorder & the rate with personality disorder may be as high as 60%. Physiological & psychological co-morbidity is also high with substance abuse. The symptoms that many couple & family systems carry, suggests that they too are systemically co-morbid. Such cases are often a gathering point for a bevy of family & professional systems leaving the practitioner feeling helpless & confused. This workshop sets out an integrated systemic approach to the assessment & intervention of complex co-morbid cases & will address the expansive complex systems context of these clients. Attention will be paid to the confusing & contradictory information & solutions in place in such cases & aims to put the practitioner in charge of the process.

Workshop 1 in the Bower Place Advanced Practice Workshop Series

Presented by Malcolm Robinson
Friday 19 May 3:00 pm to 6:00 pm

Bower Place, Level 2, 55 Gawler Place Adelaide SA 5000

Fee: $55 (includes GST)

Information

E malcolm@bowerplace.com.au

T +61 8 82216066

F +61 8 82216061

PD points can apply

Risk Factors and Psychopathology

2006-04-30T22:25:00.000+09:30

Abuse and neglect in childhood and insecure attachment are not only associated with deliberate self harm, but also with a range of psychopathology in adulthood, including depression, anxiety, dissociation, borderline and dependent personality disorders. Not everyone who is abused and/or neglected goes on to develop significant psychopathology however - other factors including temperament and resilience, environment and other supports all play a part. Self harm that persists into adulthood is more likely to be associated with significant psychopathology.
A histroy of significant abuse in childhood is almost universal in borderline personality disorder. It is sometimes mistakenly assumed that everyone who self harms must have borderline personality disorder - this is not the case. It is a label that is often used pejoritavely. Mood instability, unstable intense relationships with a very black/white view of people, identity problems, efforts to avoid abandonment, impulsivity, chronic feelings of emptiness and problems with anger also characterise borderline personality problems.

Fatter & Less Fit

2006-04-30T13:33:00.000+09:30

Readers of Adelaide’s local newspaper will have encountered a series of articles addressing Australia’s obesity problem & encouraging us to look seriously at our diet & lifestyle. Clearly we are not only fatter as a nation we are significantly less active.
This focus on our sedentary lifestyle and its implications for obesity was taken by Professor Andrew Hills PhD, Co-Director , ATN Centre for Metabolic Fitness ,who conducted a seminar for psychologists, entitled ”Management of Obesity: Overcoming the Inertia” He demonstrated a population wide decline in physical activity which is comprised of a decline in work related activity, a decline in transportation activity, a decline in home activity & an increase in sedentary activity. Interestingly only leisure time physical activity remained level or slightly increasing. He summarised these trends by stating that the increase in life expectancy which we have come to expect may well come to an end with our current young people who may on average ‘live less healthy & possibly even shorter lives than their parents”. For children obesity related health consequences include psycho-social problems, accelerated growth & maturity, dyslipidemia, elevated blood pressure, insulin resistance, orthopedic difficulties and sleep apnea. There is no doubt that in our appearance sensitive world, self-esteem, self concept, body image & body dissatisfaction are affected by weight & size.
Dr Hills recommended a refocussing from weight to fitness. His view is that to focus on a person’s weight per se is to reinforce the psychosocial problems that accompany obesity. Rather we should be encouraging people to set goals around increasing activity & feeling healthier in a way that is not tied to a number on the scales. Leaner is not necessarily lighter and the goal should be an improvement in body composition, with a reduction and maintenance of fat loss not necessarily weight.
This is an important and immediate challenge for the experts in change.

Adolescent Cutting: Risk Factors

2006-04-30T12:23:00.000+09:30

Gratz (2003) review of the self-harm literature examined six potential childhood risk factors.
Childhood sexual abuse received the most attention from researchers. The evidence suggests a unique relationship between childhood sexual abuse & self-harm in adulthood, particularly for women. Other predictors include physical abuse, neglect, prolonged separation or loss of a caregiver, quality of attachment to caregiver & individual factors of biological vulnerability, all of which suggest a relationship albeit unsubstantiated. The most compelling findings from these limited studies is that emotional neglect may be a stronger predictor of deliberate self-harm than sexual & physical abuse. This warrants further investigation as there is some evidence both emotional & physical neglect may have serious negative consequences for later ego control, affect expression, & emotion regulation, all of which are implicated as potential risk factors for deliberate self-harming behaviour. Most striking in examining these potential risk factors for self-harm is the overriding sense that the interaction of more than one of the above childhood risk factors may increase the risk for later self-harm behaviour. For example, childhood physical abuse, combined with emotional & psychological abuse, or childhood trauma, neglect & insecure attachment, or childhood sexual abuse & an invalidating family environment together predict a greater likelihood of self-harm behaviour.

Gratz, K. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10(2), 192-205.

Pseudo Science & Serotonin

2006-04-26T23:11:00.000+09:30

Just as in clinical trials, it is important not to take on board without question all that one reads. The assertion that there is a chemical basis to self harm, somehow involving endogenous opiods (endorphins) and serotonin, is attractive but simplistic pseudo science, without an adequate evidence base. The issue of questioning the evidence base is clearly illustrated. The comments re serotonin depletion are based on an article in the American Journal of Psychiatry (New, A. et al (2005) Brain Serotonin Transporter Distribution in Subjects with Impulsive Aggressivity. American Journal of Psychiatry,162 (5), 9_5-923) where 10 subjects, average age 35, with significant pathological impulsive aggression (not deliberate self harm) were studied. They had significant co morbidity which included borderline, antisocial, schizotypal, narcissistic, obsessive compulsive, histrionic, dependent and avoidant personality disorders, and suffered from depression, dysthymia, bipolar disorder, generalised anxiety, social phobia, obsessive compulsive disorder, body dysmorphophobia, alcohol dependence and alcohol abuse. Serotinergic depletion could have had many causes, and this is an extremely disturbed and hardly comparable group, not to mention there were only 10 of them!!!

If self cutters had tolerance to endorphins, then you would also expect tolerance to exogenous opiods (eg morphine) – this is not so. If there was a high level of endogenous endorphins circulating, then you would also expect a higher than usual tolerance to pain in general – again this is not the case. SSRI’s increase the level of serotonin at binding sites in the brain, this is a partial explanation of how they work in depression, so if serotonin depletion was a significant contributor to deliberate self harm, you would expect SSRI’s to be an effective treatment - in general they are not (unless there is a significant depressive illness).
Deliberate self harm is a complex behaviour which results from complex developmental and psychosocial factors, and can be associated with clinical depression, anxiety, personality disorders and other psychiatric problems. The mind and the brain are closely entwined, and there may certainly be subtle neurotransmitter changes, but this by no means simple nor proven.

Two Women and a Baby

2006-04-24T12:01:00.000+09:30

My route to work each day takes me through the city centre & the end of the Rundle Mall, the central shopping area for Adelaide. Sometimes I get a clear run with every traffic light green and on other days, especially when I’m running late, it seems that my mere presence makes the lights turn red.
One morning when the lights knew I was rushing, I found myself self stationary adjacent to a bus stop at the end of the Mall. To contain my frustration I entertained myself by watching the people waiting at the bus stop. Seated was an austere looking elderly woman dressed in drab beige & brown set against her pallid white skin. Unsmiling, she sat, staring into the middle distance, waiting for her bus. She looked tired. Standing immediately behind her was a tall, striking, young African woman. Her hair was wound up inside a traditional 'turban' & she wore a full length dress that was wild collection of bright patterns & vivid colors. She too stared into the street, her face blank & expressionless. I wondered for a moment about the reception she had received in Australia & what the elderly woman might have to say.
From behind the seat a tiny child wobbled out, his hair dark & curly, his skin shiny & black, his face open & joyful. In his plump little hand he clutched a brown autumn leaf. He approached the older woman & thrust the leaf toward her. Her attention was captured as she looked down & into the face of the child. For one millisecond I feared she would ignore this innocent child’s offering, but her face then opened & softened as she leant toward him to accept his gift. She glanced up and caught me watching them. We both smiled and the lights changed. It didn’t matter anymore that I was late for work.

It’s Not All Psychological

2006-04-24T09:58:00.000+09:30

In exploring the issue of self-harm in young people it is easy to forget that this confrontingly physical symptom may be supported by a biological element. A group of neurochemicals known as endogenous opioids, similar to to opium & heroin, are released when a person is frightened & believes they are in danger, particularly when there is bodily injury. These opioids produce a positive feeling of calm, well-being and insensitivity to pain, which allows a person to act self protectively in dangerous situations. Clearly these opioids have positive survival value.
These chemical responses are even more important to understand, as it appears that the body comes to require increasing levels of these substances to produce the same positive effect. Consequently more physical damage must be inflicted for the same outcome. This carries with it an increasingly risk of serious & permanent injury and even death, even though the motivation is not to end a life.

The neurotransmitter, Serotonin, is also important. People subjected to high levels of stress experience Serotonin depletion. The consequence is an increased risk of impulsive actions & a lack of constraint, making it harder to resist the desire to self-harm.

The Issue of Bias

2006-04-20T13:59:00.000+09:30

The issue of bias, often subtle, in reports of clinical trials, is well recognised. Unfortunately, there is little funding for research independent of the pharmaceutical industry. I fully support the findings of the paper – but not just in relation to the novel antipsychotics, but in ALL papers related to clinical trials. There are many sources of potential bias in all trials, even those not involving medication.
With specific reference to drug trials, funding should be ‘hands off’, researchers should have editorial control, and researchers should be able to publish all results, even those unfavourable to the company sponsoring the research. They should have control over the nature of statistics used, and how they are used and interpreted. Competing interests of researchers should be declared, including funding for speaking tours and conference attendance. These are just some examples on how to reduce sources of bias and distrust in clinical trials.

The report mentions things such as doses, dose escalation, statistics and selection, but in addition, clinical trials often do not relate to the ‘real world’ – long term often being 6 – 12 weeks, rather than years. Participants are often highly selected - in America they are often paid and are ‘professional’ study participants. All this makes me view clinical trials with considerable caution.
With specific reference to novel antipsychotics, in my experience most are of similar efficacy when used at appropriate doses, different ones suiting different people, and side effects being the main differentiating feature. They have different side effects than the older medications, but none are without significant potential problems.

Why olanzapine beats risperidone, risperidone beats quetiapine, and ...

2006-04-17T10:39:00.000+09:30

Why olanzapine beats risperidone, risperidone beats quetiapine, & quetiapine beats olanzapine: an exploratory analysis of head-to-head comparison studies of second-generation antipsychotics.

Heres S, Davis J, Maino K, Jetzinger E, Kissling W, Leucht S. American Journal of Psychiatry 2006 Feb; 163 (2) :185-94

OBJECTIVE

In many parts of the world, second-generation antipsychotics have largely replaced typical antipsychotics as the treatment of choice for schizophrenia. Consequently, trials comparing two drugs of this class--so-called head-to-head studies--are gaining in relevance. The authors reviewed results of head-to-head studies of second-generation antipsychotics funded by pharmaceutical companies to determine if a relationship existed between the sponsor of the trial and the drug favored in the study's overall outcome.

METHOD

The authors identified head-to-head comparison studies of second-generation antipsychotics through a MEDLINE search for the period from 1966 to September 2003 and identified additional head-to-head studies from selected conference proceedings for the period from 1999 to February 2004. The abstracts of all studies fully or partly funded by pharmaceutical companies were modified to mask the names and doses of the drugs used in the trial, and two physicians blinded to the study sponsor reviewed the abstracts and independently rated which drug was favored by the overall outcome measures. Two authors who were not blinded to the study sponsor reviewed the entire report of each study for sources of bias that could have affected the results in favor of the sponsor's drug.
RESULTS

Of the 42 reports identified by the authors, 33 were sponsored by a pharmaceutical company. In 90.0% of the studies, the reported overall outcome was in favor of the sponsor's drug. This pattern resulted in contradictory conclusions across studies when the findings of studies of the same drugs but with different sponsors were compared. Potential sources of bias occurred in the areas of doses and dose escalation, study entry criteria and study populations, statistics and methods, and reporting of results and wording of findings.

CONCLUSIONS

Some sources of bias may limit the validity of head-to-head comparison studies of second-generation antipsychotics. Because most of the sources of bias identified in this review were subtle rather than compelling, the clinical usefulness of future trials may benefit from minor modifications to help avoid bias. The authors make a number of concrete suggestions for ways in which potential sources of bias can be addressed by study initiators, peer reviewers of studies under consideration for publication, and readers of published studies.

Thanks to Ian Johnston, School of Psychology, The University of Sydney, NSW

Self-Cutting Who Does it More & How Often?

2006-04-15T12:52:00.000+09:30

It’s been an interesting & confusing process exploring the ‘self-harm’ literature. There is poor agreement across studies about the prevalence of the problem and gender distribution. Tantam & Whittaker (1992) confidently state that among adults “more men than women do it, although more women receive psychological treatment.” Gratz et al (2002), in a study that focused on college students, reported that 38% had deliberately self harmed & that this was not significantly associated with gender. They noted this as discrepent from the other literature which suggests that more women self-harm than men.

The British “Truth Hurts-Report of the National Inquiry into Self-harm among Young People” commissioned in 2004 & released in 2006 advise caution in arriving at conclusions given the wide variations in the research methodology of the papers they reviewed. This Report suggests an incidence of between 1 in 12 & 1 in 15 across the UK. One interesting statistic they quote in relation to hospital treated incidents shows that in the 15 to 19 year age group more girls than boys present, whereas this is reversed for the 20 to 24 year age group.

One can only agree with their conclusion & that of a number of other authors, that there is a “clear and important need for much better data on the prevalence of self- harm in young people.”

Children of Depressed Mothers

2006-04-12T22:31:00.000+09:30

Children, whose mothers are successfully treated for depression, show significant improvement in anxiety, mental health problems & disruptive behaviour, without any additional treatment of their own (Journal of the American Medical Association 2006; 295:1389-1398).

The study included 114 pairs of mothers & their children aged 7 to 17.
The children were evaluated for depression at the beginning of the study, and reassessed after their mothers had been on an antidepressant for three months.

Of the 68 children who were not depressed at the start of the study, all of those whose mother’s depression improved remained 'symptom free' while 17 per cent of the children of non-improved mothers acquired their own diagnosis of depression.
WEEKEND Australian March 25-26 2006

Adults Who Self Harm

2006-04-11T21:04:00.000+09:30

The literature I have come across tends to focus on young people. I don’t know how prevalent this symptom is among adults. Tantum & Whittaker, “Personality Disorder & Self Wounding” (British Journal of Psychiatry, 1992, 161, 451-464) state that 1 in 600 adults wound themselves badly enough to require hospital treatment. They quote a study which says that cutting often begins in early teens with half the sample wounding themselves more than 50 times. The symptom peaks in early teens & continues for 5 to 10 years.

I assume that the same issues underlie the presentation in adults as in young people. Self harm is a message to someone in the person’s world (including themselves) that cannot be conveyed in words. It is a maladaptive coping strategy to manage unbearable thoughts & feelings.

The task of the therapist is to help the client articulate the ‘pain’ in a less self destructive manner & to learn strategies to manage the enormity of the associated affect.

The Older We Are The Better It Gets

2006-04-09T19:22:00.000+09:30

Reading research results can be daunting, often confronting one with information you really would rather not know. It’s never cheerful to discover that your favourite food has recently been linked to cancer and that the amount of exercise you don’t take will probably shear two years off your life!
How gratifying then, to recently read in a Family Therapy text, that having survived the crisis of adolescent children and launched them into independent adulthood, most couples report increased marital satisfaction. Companionship, mutual caring, caretaking and ------ intimacy remain highly valued by many couples into their later years.

Please note that an 'offending' word has been removed to prevent the Bower Place News being blocked on many computers. Please email malcolm@bowerplace.com.au for the offending word & it will be sent to you.

What Was Mrs Freud Thinking?

2006-04-02T06:25:00.000+09:30

Jenny Diski writing in the London Review of Books, under the title “Housekeeper of a World Shattering Theory” provides an intriguing review of Katja Behling’s biography of Martha Freud. In it Diski looks behind Behling’s text, which she describes as doing little to disturb the historical view of Martha as a “devoted domestic”, to ponder on the person and place of this woman who was married to the famous man for 53 years. Martha is presented as the provider of a peaceful home who allowed her famous husband to develop the ideas of psychoanalysis yet Diski notes the fascinating exceptions that suggest she was much more. She records that Freud noted in a letter to his friend that, at 34 and following the birth of their 6th child, Martha was suffering from “writers block”. We do not know what she was unable to produce, “a shopping list?” suggests Diski or was it “that book about interesting new ways she had thought of for interpreting her dreams, which she worked on in those odd moments when the children weren’t down with chicken pox or needing their stockings mended.”
Probably the former I fear, as it appears that Freud was attracted to Martha for her sturdy normalcy, her quintessential oppositeness from the patients he worked to explain and cure. Martha was not there to understand, she was there to provide the optimal conditions for her husband to understand others and particularly other women. Martha was his antidote to the misery of his patients and he shaped her “sunny disposition” throughout their 4-year courtship and long marriage.
Perhaps the most fascinating question Diski proposes is how Martha sublimated her self so thoroughly and apparently successfully to her husband’s great works. Martha appears to have done so without rancour or symptoms. However she may have had some extra help. Behling reports that while experimenting with cocaine, Freud sent some vials of the drug to his fiance, urging Martha to try it for its impact on vitality. She responded by telling him that it was helpful in moments of emotional strain and Behling contends that Martha “enhanced her sense of well-being with an invigorating pinch of cocaine.” For how long we don’t know.

How many partners of therapists may be tempted to follow her example?

The Retreating Images of a Child

2006-03-26T08:52:00.000+10:30

As a child I owned a special book. I have no recall of its contents except for one small image, a line-drawing of a child on the inside front cover. The child was reading a book. When I looked closely at the image I could an even smaller image of a child reading a book, & so the images went on & on, smaller & smaller, identical, retreating further & further back toward infinity. I can still recall my fascination with this retreating image of a child reading a book. I knew it was important & that it spoke to things much bigger than the image itself. I now think of that image as a depiction of ‘mirroring,’ a notion that therapists use to describe the proclivity of systems to replicate themselves and their form again & again. It happens across time, a neglected & abandoned child becomes an adult whose stubborn self sufficiency & apparent hardness results in them being abandoned in adult relationships. It also happens across systems & particularly in the organizational systems in which therapists work. It is compelling to observe the features of the families we work with reproduced in our own organizations. Dr Laurie MacKinnon’s excellent book Trust and Betrayal in the Treatment of Child Abuse approached the management of this most difficult area of practice from a truly systemic perspective. She recognizes that the very fabric that produces abuse, powerlessness, anger, mistrust, gender injunctions & class hierarchy are replicated in the helping systems of both welfare & therapist, & at the broadest level of society. MacKinnon writes that “therapy must in some way address the values & premises that support abusive & authoritarian practices.” This is an interesting idea. Where & how can the picture be altered so that it will change every level, the first image, the last or somewhere in between?

The Team Looks in the Mirror

2006-03-26T06:58:00.000+10:30

Boland, C "Functional Families: Functional Teams" Australian & New Zealand Journal of Family Therapy V 27, No 1

Clinicians are very good at looking at, categorising and commenting on their clients. Less common, as clinicians, is the desire to look at and comment on ourselves. This is the stance Boland takes in her excellent article “Functional Families: Functional Teams" where she turns the spotlight on clinician-practitioner teams that deal with very abusive families. In a clearly articulated analysis using a developmental-systemic model Boland identifies the features of the abusive family and the impact of this on the developing child. She then turns her attention to the features of the dysfunctional team and the consequences for the adult clinician-practitioner. These consequences are remarkably similar to those suffered by a child in the abusive family. She looks at the contribution of the practitioner, who has been raised in a dysfunctional-abusive family, to the dynamics of the team. Boland notes that early abusive experience may make it hard for a practitioner to recognize that a situation is toxic and may also make it hard for that practitioner to retain the belief that they are entitled to a safe workplace. Boland is clear that exposure to a dysfunctional-abusive family does not inevitably produce a dysfunctional team. A dysfunctional team is the product of managerial omission! Boland concludes by clearly setting out the features of "Good Enough Management" in terms of policy and the practical steps managers can take to meet the safety and nurturance needs of clinician-practitioners who work in such environments. This short article contains volumes that both managers and clinician-practitioners will find invaluable.

Treating Anorexia: Maudsley Model

2006-03-18T16:54:00.000+10:30

Congratulations to the Australian & New Zealand Journal of Family Therapy (ANZJFT) who are conducting an e-discussion on the use of family therapy with adolescent anorexia nervosa. The discussion, moderated by Ben Hansen, commenced on 13 March, posted its 70th response today, and is due to run until the 27 March. Paul Rhodes, Andrew Wallis, Tahn Le & Andrea Worth from Westmead Hospital (NSW) contributed valuable information about the Maudsley Model backed by their own clinical experience.
The Model is a three-phase process, developed in 1985 at the Maudsley Hospital by Christopher Dare, Ivan Eisler & colleagues & manualised & researched by the Universities of Chicago & Stanford, who claim that 80% of patients are weight restored at the conclusion of treatment. Treatment is, on average, no more than 20 sessions over 6 to 12 months. It is an outpatient process, starting with an intensive re-feeding phase, where parents join to 'defeat' the anorexia & siblings are recruited to provide emotional support. ‘Phase 2’ is the gradual hand-over of the control of eating to the young person. ‘Phase 3’ addresses individuation and marital issues. Paul Rhodes describes it as a marriage between Minuchin’s Structural Family Therapy and White's 'externalising'.
The ANZJFT e-debate has ranged wide, looking at the application of the model in private as opposed to public hospital settings, the risks and benefits of a manualised approach to therapy, and its relationship to the Swedish assertion that anorexia is merely the effect of starvation. The application of this approach to obesity has also been raised. Contributors come from Australia, New Zealand, United Kingdom & South America.
To know more about the model visit www.anzjft.com, go to the interactive section & into the discussion articles where Paul Rhodes ANZJFT V 24 N 4 Dec 2003 can be found.
An excellent article can also be found in the Journal of Family Therapy by Ivan Eisler “The Empirical & Theoretical Base of Family Therapy & Multiple Family Day Therapy for Adolescent Anorexia Nervosa.” V 27 N 2 May 2005

What ARE RSS and XML? What's that funny logo?

2006-03-17T11:23:00.000+10:30

There is a fantastic new way of reading and subscribing to blogs -- RSS feeds.

Here's two links that explain what RSS and XML are:

In a nutshell, you can either subscribe to be automatically sent the new posts on this blog via either RSS feed, or by the 'subscribe' box below (which can also be found in the navigation bar on the right hand side of the blog).

Enjoy being a part of the new Social Conversation web (known affectionately as 'Web 2.0').

Lee Hopkins

Child Abuse, Rundle Mall & Sweden

2006-03-11T18:11:00.000+10:30

Child Abuse, Rundle Mall & Sweden

Some nights I work late, leaving Bower Place around 6.30 p.m. and walk towards the car park watching the stories unfold in the Mall. One night my attention was captured by an angry yell “And don’t you f…ing walk away from me again.” Walking towards me were two young women, no more than 20, each with a child by the hand and one with a babe in arms. The angry reprimand was directed towards a little girl, about 3, who looked into her mother’s face with terror. Clearly this was not the first reprimand and by no means the worst. What to do? To approach the situation would probably escalate the violence to myself, the child or both. Clearly others thought the same. I went on my way saddened, worried and impotent to effect any change. I felt for them, the frightened child, the harried woman and the tiny baby, already exposed to violence from the very person entrusted with their care.
Some days later I heard a radio interview with Assoc Professor Joan Durrant, Child Psychologist (University of Manitoba) speaking about child abuse and in particular the corporal punishment law reforms introduced in NSW which limit the hitting of children. Such laws, she argues, send a message that it is acceptable to hit children in some circumstances. Research clearly shows that physical punishment is consistently associated with negative developmental outcomes including increased aggression, increased antisocial behaviour, weaker moral internalization, poorer mental health and eroded parent-child relationships. She spoke with passion about the Swedish experience where corporal punishment was first abolished in secondary schools in 1928. In 1978 it was proposed that an explicit statement be included in the Civil Code that corporal punishment is not permitted. The following year this was supported by 98% of the Swedish Parliament. The aim was to affirm children’s protection in law, to set a community standard of non-violence, to de-legitimate violence against children, to raise awareness of child maltreatment, and to change the society’s attitudes and behaviours.
This educative, supportive and compassionate approach appears to have paid dividends with a dramatic reduction in the number of Swedes who support corporal punishment and an equally a dramatic reduction in the number of children who are physically punished. Between 1997 and 2000 no child died as a result of child abuse. Even more meaningful to those who believe children will rocket out of control and civilised society will collapse, are the statistics on youth crime, drug and alcohol use, both of which show a decline over these years.
So it is with sadness that I hear the ACT Shadow Attorney-General, Bill Stefaniak, quoted as saying “I don’t see anything particularly wrong with a parent giving a child a smack to discipline them”. Clearly there is plenty wrong and, if we dare, there are better ways to teach our children. However it would take courage, commitment and perhaps most crucially, money, to make this happen. Is it worth it? I remember the face of that small child and I believe it is. Perhaps Mr Stefaniak could walk with me one night!

Joan Durrant’s material can be found at the Australian Institute of Family Studies

http://www.aifs.gov.au/instituteseminars/durrant.pdf

Individual, Couple & Family Therapy Training

2006-03-11T06:45:00.000+10:30

April & September 2006

3 day Workshops

Introduction to 'INDIVIDUAL, COUPLE & FAMILY THERAPY'

Catherine Sanders, Malcolm Robinson, Nicole Best, Marten Johns & Rosemary Freney

10 - 12 April & 25 - 27 September 2006

Bower Place, Adelaide, SA

For: Psychologists, Social Workers, Medical Practitioners, Counsellors, Educators, Psychotherapists, Nurses, Occupational Therapists, & Other Helping Professionals
A 20 hour introduction to the theory & practice of a systemic approach to individual, couple and family therapy as applied to understanding and resolving a wide range of personal, behavioural, emotional, mental health, and relationship symptoms & problems
Applicants require relevant qualifications or experience in the helping professions or similar

This is Unit 1 of the Bower Place Professional Practice:
Certificate in Individual Couple & Family Therapy
Diploma in Individual Couple & Family Therapy

For more information and enqiries go to

Bower Place: http://www.bowerplace.com.au/
Rosemary Freney: rosemary@bowerplace.com.au

Psychiatry & Detention

2006-03-08T18:00:00.000+10:30

Psychiatric Aspects of Detention: Illustrative Case Studies

Leslie Kooperwitz, Sotoodch Abhary

Australian and New Zealand Journal of Psychiatry, July 2004, Vol 38, No 7

This article compares the psychiatric and psychosocial issues raised by people detained under the migration regulations in Australia, and those detained under security legislation of the last apartheid government in South Africa. One difference is that in South Africa, political detainees entered into the struggle expecting to face hardship and torture, and their incarceration had meaning. Asylum seekers flee to Australia expecting support, and are not prepared for further incarceration. Two case scenarios are presented, of the cumulative experience in acute psychiatric units in each country. Division occurs within treating teams - detention is associated with symptom manifestation, but is it genuine psychopathology, is it a normal response appropriate to the situation, or is it malingering? Is it the role of the mental health system to protect these people, or are mental health workers colluding with the government? Should they be kept in hospital, or discharged back to the detention centre? Other issues such as confidentiality of information and direct interference in treatment arise.

Debilitating depression, helplessness and hopelessness occur, and depression is not amenable to antidepressants and psychotherapy alone. PTSD is very common – experiences leading to flight, the circumstances of this, separation from the support systems, relocations within detention, and experiences within detention all interact. Even on a Temporary Protection Visa, with ‘genuine refugee’ status recognised, asylum seekers have no rights of citizenship, permanent resettlement or reunion with immediate family. They are still imprisoned. The resilience shown is remarkable.

The issues raised in this article will resonate with anyone involved in the psychiatric and psychological management of asylum seekers.

Bean There Drank That

2006-03-07T21:16:00.000+10:30

Bean There Drank That

By Rosemary Stanton Australian Doctor 9th March 2001

This article is outlines the major sources of caffeine and its effects. Guarana, in high energy drinks, has about three times as much caffeine as coffee beans or tea leaves. These drinks also have a high sugar content. High energy drinks are popular with children and teenagers, and are used by some to enhance sports performance. In children in particular, where the relative dose for their body weight is high, it may be a cause of sleep problems, jitteriness, strange/rapid heartbeats and hyperactivity. – children presenting with these problems should be asked about caffeine intake.
Cola drinks also contain significant caffeine. All cola drinks, whether ’diet’ or not, are highly acidic, potentially damaging to tooth enamel, and may increase the risk of fractures significantly.
Withdrawal symptoms include headache and mood changes. Even missing a regular morning cup of coffee can produce withdrawal symptoms by the middle of the day, fixed by another ‘hit’. Positively, caffeine can increase alertness, and increase the metabolic rate in lean people.
For most people 2 cups of coffee or 4-5 cups of tea a day is fine, but enough. All tea contains about 3% caffeine. Decaffeinated teas or coffees have 0.3% caffeine. The conclusion is that caffeine is fine in moderation, but should be avoided in children, and less than moderate in those with sleep problems or hypertension, and in pregnant women (increased rate of miscarriage, and slower caffeine metabolism).

Caffeine Content of Beverages
Coffee, instant, average mug 60 – 90mg
Coffee, expresso or brewed, average serve 80 – 90mg
Tea, weak, average cup 20 – 30mg
Tea, strong, average cup 50 – 60mg
Energy drinks, 250ml 80mg
Cola drinks, 375ml 30 – 35mg
Desirable daily intake <> table.

Psychologist Takes 'Flight'

2006-03-05T11:30:00.000+10:30

The Psychologist Goes to the Opera - A Flight into ?

The opera 'Flight' has been billed as one of the draw cards for this year’s Adelaide Festival and last night it opened at the Festival Theatre. According to the program notes it is composed by Jonathon Dove, the librettist is April de Angelis and it premiered in 1998. It is set in an airport where a group of couples or would be couples are stranded as they wait for their flights or each other.
While comic at one level, with one liners that made the audience laugh, at another it was sad and disturbing. Here is a group of cynical, foolishly naïve, or shallow, frightened people who play out their personal drama’s in front of the refugee and the controller, an austere and isolated character who watches all from the control tower. The refugee both waits for his brother and hides from the immigration official. Night falls and a storm condemns them to spend the night together. Now restraint is removed, couples change partners, magical hope is created, and violence unleashed. In the dark of the night people do things they regret or ‘forget’ in the light of day.
With the day comes the birth of a baby, return of a husband and commitment of a wife, reconciliation between an estranged couple and hope of future happiness in a jilted fiancé. The crimes of the night are forgiven and forgotten, and the couples leave the airport jaunty and foolishly hopeful.
But the day also brings the immigration officer with news of the refugee’s brother who was seen falling ‘like a star’ from the wheels of the aeroplane in which the two had stowed away. As an act of compassion he agrees to turn a blind eye to the refugee who can now wander the airport at will but never leave. As the scene concludes, the controller, who is also unable to leave, joins the refugee and a new couple is formed.
No sillier than most opera stories you will say, but this left me uneasy, and all day I have wondered. Perhaps it is the echo of other older operas, Mozart's Cosi fan tutte for example, where the couples change and reform, and all are happy at the end. Somehow it doesn’t seem so hopeless in fancy dress; you can suspend your knowledge of what really happens to those who stray. For the jaunty couples in ‘Flight’ you know that next week or next month, the recriminations will reappear, and they will be as trapped as they were last night, no matter where they are.
For the baby whose foolish parents decide to emigrate to Minsk, and whose eyes are ‘like stars’, just like the falling body of the refugee’s brother, how will this innocent’s life unfold?
And finally the refugee and the controller trapped in the gilded cage of the airport with the knowledge of the falling frozen brother ever present. He will fall and fall forever, and they have nowhere to go.

Complementary Medicine

2006-03-04T23:49:00.000+10:30

The other side of the coin: safety of complementary and alternative medicine

Stephen P Myers and Phillip A Cheras

MJA Vol 181 Number 4 16th August 2004

This article makes the point that although most consumers consider complementary and alternative medicine (CAM) products inherently safe, they are not. The growing simultaneous use of CAM products and pharmaceutical drugs by Australian consumers increases the risk of CAM-drug interactions.
Adverse reactions to CAM products may be intrinsic (innate to the product) or extrinsic (where the risk is due to failure in good manufacturing practice). Side effects, allergic reactions and interactions are under reported. Use of CAM products can also cause problems where consumers use them to replace medical therapy, or fail to seek necessary medical treatment. CAM practices (including acupuncture) are generally unregulated and there is little capacity to set and enforce education and practice standards. The adverse event rate in Chinese medicine for example, primarily acupuncture, is significantly higher for those with 0 – 12 months CAM education than for those with 37-60 months education.

There is no doubt that CAM products and practices have real risks associated with their use, but overall they are relatively minimal (except for those experiencing them!). If you are using CAM, check that the practitioner is experienced, seek other medical attention when necessary, and check with the pharmacist about potential side effects and CAM-drug interactions (eg with St Johns Wort (Hypericum), Ginkgo, Liquorice (Glycyrrhiza), Ginseng and Garlic).

Cruises & marriages on the rocks

2006-02-26T08:38:00.000+10:30

The Times

February 22, 2006

Retirement cruises put marriages on the rocks

From Leo Lewis in Tokyo
http://www.timesonline.co.uk/article/0,,25689-2051612,00.html

As a generation of postwar baby boomers approaches retirement in Japan, marriage guidance counsellors are issuing a stark warning: if you hope to spend your twilight years together, for goodness sake don’t go on a cruise.
Foreign beach holidays, sightseeing tours, cruises and other extravagant trips to celebrate a husband’s retirement are off the menu. They are, say the experts, sure recipes for a “New Narita Divorce”, an acrimonious parting of the ways that takes place almost as soon as an elderly couple return from their holiday to Narita, the international airport. The term was originally used to describe newlyweds filing for divorce after discovering on returning from their honeymoon that they did not like one another.
The post-retirement cruise is now having the same effect. Couples who have been married for 30 or 40 years are discovering that they barely know each other, and what they do find out is not that attractive.
A better option, say the counsellors, is to ease into retirement gently by starting with a one-day coach excursion.
The classic social pattern behind the delayed marital misery is that while the husband is working, he scarcely sees or speaks to his wife. On weekdays he comes home late, eats in silence and collapses exhausted into bed. On weekends he disappears early in the morning to pursue a hobby such as fishing. A two-week cruise is the first proper time many 60-year-old couples have spent together for decades and the effect is proving devastating.
The Health Ministry calculates that divorces have risen 26.5 per cent in ten years. Figures from 2004 suggest that there were more than 42,000 divorces between couples who had been married for 20 years or more, a doubling of the figure in 1985. Among those married for more than 30 years, the number quadrupled during the same period.
“It is dangerous for couples to suddenly go on overseas trips after the husbands retire,” said the author and “retirement school” teacher Sayoko Nishida. “Disagreements between the spouses often deepen when they spend a lot of time together in a foreign setting. Husbands pay the price for placing more importance on their jobs than their wives.”
Many wives increasingly resent how little their husbands contribute to home life and are seeking divorce when the men retire and show no sign of changing their habits. Influential magazines have been egging on the phenomenon. In a survey of married men, Spa! found that 58 per cent regretted marrying, while Shukan Post said that husbands begged for their wives not to leave them. The same magazine also published a report by the National Institute of Population and Social Security Research suggesting that divorce at the age of 60 shortened men’s lives by up to ten years.

SUN SETS ON LOVE

Number of divorces where the husband is aged 60 or over
1950: 888
1970: 1,352
1980: 1,682
1990: 2,743
2000: 8,035
2001: 8,979
Source: Japan Ministry of Health, Labour and Welfare

Couples Therapy

2006-02-26T07:24:00.000+10:30

'I Thought We Came for Therapy!': Autobiography Sessions in Couple Work

Le Hoang, Australian & New Zealand Journal of Family Therapy Vol 26, No.2 pp.65-72

It is fascinating to read this paper alongside the Robert’s article on self-disclosure, as this too touches some of the same questions but from quite another angle. Le Hoang proposes a process for working with couples which encourages them to reflect on their differences and frames these as different cultures from which they have come. Each person is supported by the therapist to write their own autobiography while their partner observes as if ‘they are the reader’. This process aids the journey of self-differentiation in each person but it also provides a metaphor which introduces the therapist into the system. Le Hoang notes that focussing on cross-cultural matters between the couple provides a different centre of attention than that of her accent, ‘Asian look’ or ‘tiny build’. The paper describes the use of the approach with four couples and reflects on each one.as a tool to aid ‘the process of becoming’ or ‘healthy differentiation of the self’.

Transparency & Self-Disclosure

2006-02-26T07:21:00.000+10:30

Transparency & Self-Disclosure in Family Therapy: Dangers & Possibilities

Janine Roberts, Family Process Vol 44, No. 1 45-63

This dense, well written and engaging paper is thought provoking & informative. The author begins with a review of the approach taken by various schools of family therapy to the issue of therapist transparency & self-disclosure, and while acknowledging that there are a wide variety of positions, observes that these are based on anecdotal clinical experience rather than research studies. She then explores the dangers & possibilities of such transparency noting that whilst one family member may find such exchanges helpful others may have the opposite experience. Using rich clinical examples she then proposes descriptive guidelines for therapists to aid the process of deciding whether, when, where & how self-disclosure may be appropriate.
A review of research reveals few studies of the issue in family therapy, although those that have been done suggest disclosure is generally experienced as helpful in strengthening the therapeutic alliance. The author makes suggestions for further research in the area and concludes with the idea the ‘the core of the therapeutic work is the human connection that comes from the reflective possibilities between lives’

Psychologist:& the Fringe

2006-02-25T19:30:00.000+10:30

Last night we attended the opening of the Adelaide Fringe Festival, the bad boy/girl hanger on of the more respectable Adelaide Festival of Arts. The Festival occurs on a 4 yearly basis and for a month this relatively quiet city is transformed with every imaginable art form acting itself out right under your nose. You could stay up all night for the entire time and still miss some wonderful opportunities.
The Fringe opens with a parade around the city streets, and for an hour or more before it arrives, people pour into the vicinity to eat at one of the many restaurants that line the road, meet friends, and party. As night falls, they drift to the sight of the parade, and wait.
As you can imagine, the term Fringe suggests a radical, alternative, and less than law abiding edge, and it was as if, for a brief moment, the crowd, largely middle class, well off, and somewhat staid (yes…us too), allowed ourselves to imagine we too were ‘fringe’. The police were there, and good humouredly encouraged the revelers behind the designated line, where we all obediently stayed to watch.
I could not help reflecting on the wonderful contradiction between how we imagined ourselves participating, and what I could see. Perhaps it is similar to Gregory Bateson’s anthropological observations about groups, societies, and cultures that include rituals of aggression that appear to channel their member’s behaviour in ways that protect the society from more dangerous outbursts.
Perhaps we too were having our ‘wild’ ritual to protect all of us from more radical conduct.

Bower Place Training & Research

2006-02-25T10:07:00.001+10:30

Training at Bower Place

Professional training in systemic psychotherapy has been offered at Bower Place since 1986.The directors of the practice, Catherine Sanders & Malcolm Robinson have taught courses that cover both theoretical & practical skills. A key feature of training at Bower Place has been the Clinical Practice subjects where students, after completing Unit 1, have the opportunity to work in a peer team & individually, consulting to clients who are referred to the Training & Research Clinic. These courses have been run both privately (The Professional Practice Diploma in Family Therapy) & in partnership with the University of South Australia (1998 - 2003 Graduate Certificate in Family Therapy). In 2005 changes were made to the Bower Place training whilst retaining the best elements of the previous years.

Training 2006

Since 1986 training in Systemic Therapy has been offered by Malcolm Robinson and Catherine Sanders with an emphasis on both the development of a coherent theoretical framework and its application to clients presenting to the Bower Place Training and Research Clinic. The recognition that students require a course that is fully accredited by an independent relevant body has led to an expansion of the training available. Guidelines provided by PACFA, CASA and the Victorian Association of Family Therapy have been used to expand the program to meet their requirements with a view to students being able to seek formal membership with them. We are currently engaged in this accreditation process for the Bower Place Course.

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Unit 1: 2006

3 day Intensive course 10th - 12 April, 2006 & 25th - 27th September 2006

INDIVIDUAL, COUPLE & FAMILY THERAPY

CATHERINE SANDERS & MALCOLM ROBINSON

Suitable for: Psychologists, Social Workers, Medical Practitioners, Counsellors, Educators, Psychotherapists, Nurses, Occupational Therapists, & Other Helping Professionals

A 20 hour introduction to the theory & practice of a systemic approach to individual, couple and family therapy as applied to understanding and resolving a wide range of personal, behavioural, emotional, mental health, and relationship symptoms & problems

Applicants require relevant qualifications or experience.

Unit 1: Bower Place Professional Practice Certificate & Professional Practice Diploma in Individual Couple & Family Therapy

http://www.bowerplace.com.au

info@bowerplace.com.au

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Professional Practice Diploma in Individual, Couple &Family Therapy

Course Description

The Professional Practice Diploma in Individual, Couple and Family Therapy is a specialised professional, clinical, training programme designed for psychologists, social workers, medical practitioners, counsellors, educators, psychotherapists, nurses, occupational therapists, and other helping professionals. The course emphasises clinical practice and supervision and is ideally suited to practitioners interested in developing practice knowledge and clinical skill.

Each student undertakes 252 hours of lectures, workshops, observation, clinical practice, and supervision, over a two-year period. The unique programme allows students to directly practice Individual, Couple, and Family Therapy with clients in the Training and Research Clinic, under close and personalised supervision. Most consultations in the Training and Research Clinic are electronically recorded. Practice knowledge and clinical skill is developed out of the student’s experience working with clients and families. Students receive immediate feedback about the consultations with which they are involved, and engage in comprehensive reviews and analyses of their clinical work.

While the course can be taken in negotiated blocks of time over a shorter period, those wishing to complete the full workshop series and be eligible for accreditation must take two-years.

The ‘Workshop’ Units of this course can be taken as separate workshops.

The ‘Supervised Clinical Practice’ Units are limited to Professional Practice Diploma and Certificate candidates and some applicants from other graduate programmes.

The course is located in the Bower Place Training and Research Clinic

Accreditation

This Diploma course has been designed to meet the requirements of the Psychotherapy and Counselling Federation of Australia (PACFA), so that graduates can meet the membership requirements of member organisations of PACFA. This Diploma is currently being put to the Counselling Association of South Australia (CASA) and the Victorian Association of Family Therapist’s (VAFT) for accreditation. Whilst some parts of the programme can be taken as stand-alone Units and workshops it must be understood that accreditation and membership eligibility for some professional bodies requires the successful completion of the entire Professional Practice Diploma.

Professional Practice Certificate in Individual, Couple & Family Therapy

Bower Place also offers a one-year, part-time, Professional Practice Certificate in Individual, Couple, and Family Therapy. This constitutes the first year of the Professional Practice Diploma course, and can be taken in negotiated blocks of time over a shorter period. It is important to note that the Professional Practice Certificate does not satisfy the PACFA, CASA, or VAFT requirements.

Course Outline

The Professional Practice Diploma in Individual, Couple, and Family Therapy is a 2-year, 252-hour course with 80 hours of Workshops and 172 hours Clinical Practice.

Unit 1 Introduction to Individual, Couple and Family Therapy

Year 1
Certificate & Diploma
10 x 2 hour Lectures
Entry into Unit 1, Introduction to Individual, Couple and Family Therapy, requires a relevant academic qualification, or experience, in the helping professions.
20 Tuition Hours
Wednesday 5.30 p.m. to 7.30 p.m. or as a 3-day intensive
Introduction to the central ideas and practices of Individual, Couple, and Family Therapy
$330.00 including GST

Units 2 & 3 Individual, Couple, and Family Therapy Workshops

Years 1 & 2
Certificate & Diploma
20 x 3 hour Workshops over 2 years
Entry into Units 2 & 3, Individual, Couple and Family Therapy Workshop, requires the successful completion of Unit 1, Introduction to Individual, Couple, and Family Therapy.
30 hours/Unit (60 hours) over 2 years
Friday 3.00p.m - 6.00p.m.
Theory & practice of a systemic approach to Individual, Couple & Family Therapy.
Addressing specific symptom & problem categories & complex needs
$462.00/Unit including GST

Unit 4 Observation of Clinical Practice

Year 1
Certificate & Diploma
5 x 4.0 hrs clinical sessions
Successful completion of Unit 1: Introduction to Individual, Couple and Family Therapy.
20 hours tuition
Wednesday/Thursday: time to be negotiated with student
Observation of Clinical Practice in the Training & Research Clinic
$330.00including GST

Unit 5 Supervised Clinical Practice

Year 1
Certificate & Diploma
The student works in a Therapeutic Team with a supervisor and other students doing Individual, Couple, or Family Therapy.
Entry into the Supervised Clinical Practice, Unit 5, requires a formal interview, and the successful completion of Unit 1: Introduction to Individual, Couple and Family Therapy; and Unit 4, Observation of Clinical Practice.
Tuition Hours 38 hours
Supervised Clinical Practice, is about real work with real clients. Students negotiate to work in the Bower Place Training and Research Clinic, on Wednesday’s, between 9:30 a.m. and 7.30 p.m. Students are free to choose their working hours in the clinic in order to complete the clinical requirements of this Unit. Students are required to attend at the times they have negotiated.
Supervised practice with clients in the Training & Research Clinic
$704.00 including GST

Units 6,7 & 8 Supervised Clinical Practice

Year 2
Diploma
The student works with clients referred to the Training & Research Clinic, under the guidance of a supervisor and with other students studying Individual, Couple and Family Therapy.
Entry into the Supervised Clinical Practice Units 6,7 & 8, requires a formal interview and the successful completion of Unit 1: Introduction to Individual, Couple and Family Therapy, Unit 2: Individual, Couple and Family Therapy Workshops, Unit 4: Observation of Clinical Practice, and Unit 5: Supervised Clinical Practice.
3 x 38hrs (114 hours) tuition Hours
Supervised Clinical Practice, is about real work with real clients. Students work in the Bower Place Training and Research Clinic, weekly, on Wednesday’s, between 9:30 a.m. and 7.30 p.m. Students are free to negotiate their working hours in the Training and Research Clinic in order to complete the clinical requirements of this Unit. Students are required to attend at the negotiated times.
Supervised practice with clients in the Bower Place Training & Research Clinic
$704.00 including GST per Unit ($2,112.00 including GST for 3 Units)

Total Course Fees

Professional Practice Diploma: $4,400.00 inclusive of GST

Professional Practice Certificate: $1,862 inclusive of GST