bluuebunny/crossref_metadata_2025 huggingface dataset:
Attachment research in eating disorders
Authors: Ward Anne , Ramsay Rosalind , Treasure Janet
Published: February 2003

Aim. In a recent review, disturbances in attachment have been linked with eating disorder symptomatology. However, because of the limitations of study design, few inferences could be drawn about these processes in the aetiology and maintenance of eating disorder. Since that review, there has been further development in the instruments used and the publication of several further studies of attachment processes in eating disorders. We reviewed the field, expecting that greater clarity may have emerged in the 3 years since the previous review.

Method. A review of the literature was carried out, using the computer search PsychLIT, Medline, Embase and The Cochrane Library.

Results. There have been more studies published in this area in the last 3 years than in the entire period up until then. These can broadly be divided into those carried out in clinical and non‐clinical populations, with greater weight ascribed to the former. The vast majority of studies found that attachment processes, by whatever method measured, are abnormal in eating disordered populations. Attachment style (dismissing versus preoccupied) may be linked with eating disorder diagnostic subgroup.

Conclusions. Insecure attachment is common in eating disordered populations, with implications for therapy. Further work with refined instruments may clarify whether or not there is a specific association between attachment style and eating disorder subgroup. However, such an association is likely to be complicated and it may be more fruitful to study specific aspects of attachment, rather than global attachment style, in relation to eating disorder behaviour. The transgenerational transmission of attachment is a fruitful area for further investigation in eating disordered populations.
The personal construction of death in anorexia nervosa
Authors: Warren Bill , Beumont P. V. J.
Published: February 2003

This paper reports a study concerned with an attempt to understand the manner in which individuals at high objective risk of death through their own behaviour, understand the phenomenon of death, and their own death. It is an extension of an earlier empirical study (Warren et al ., 1994) which in turn, set out to test a hypothesis advanced by Jackson and Davidson (1986) that disturbed death ideation was aetiologically significant in anorexia nervosa; and an extension of earlier work on death constructions, and death education (Warren, 1984, 1989). Constructs were elicited from a sample of hospitalized sufferers of anorexia nervosa. These participants also completed the provided construct, Death Threat Index. Repertory grids were analysed for the information they yield concerning death constructions in sufferers of anorexia nervosa. Various quantitative measures were also derived and compared with similar measures from a control group.
Anorexia nervosa: Some connections with the religious attitude
Authors: Huline‐Dickens Sarah
Published: February 2003

This paper examines the religious and ascetic features of anorexia nervosa. The concept of asceticism in the Judeo‐Christian culture and the many connections between the ascetic religious attitude and the anorexic are described. Whilst empirical evidence for religious themes in anorexia is not strong, in the family therapy literature there are indications of ethical codes of sacrifice, loyalty and sexual denial in the families of anorexics. The themes of sin, denial and self‐punishment in the Judeo‐Christian tradition are then discussed and the significance of the original sin with respect to both eating and sex emphasized. The psychological features of the ascetic mode are then described. It is argued that there exist many connections between the religious ascetic and the anorexic and that there are many psychopathological features common to both. Both anorexia and asceticism are considered to be connected conceptually in the process of idealization. It is suggested that this line of enquiry can enrich clinical approaches to the understanding and treatment of this neurotic disorder and stimulate further research.
Preventing psychological trauma in soldiers: The role of operational stress training and psychological debriefing
Authors: Deahl Martin , Srinivasan Michael , Jones Norman , Thomas Janice , Neblett Carl , Jolly Allan
Published: February 2003

Armed conflict is associated with significant long‐term psychiatric morbidity. Interventions to reduce the incidence of psychiatric disorder following psychological trauma may be classified into three categories. Primary prevention includes the selection, preparation and training of individuals likely to be exposed to potentially traumatizing events. Secondary prevention comprises a variety of brief psychological techniques immediately or shortly after traumatizing life events, the best known of which is Psychological Debriefing. Tertiary interventions comprise the treatment of established PTSD and others. Psychiatric morbidity was studied in 106 British soldiers returning from UN peacekeeping duties in the former Republic of Yugoslavia. All 106 soldiers received an Operational Stress Training Package prior to their deployment and a randomly selected group also received a post‐operational PD. Very low rates of PTSD and other psychopathology were found overall and the Operational Stress Training Package may have contributed to this. Elevated CAGE scores suggestive of significant alcohol misuse were observed in both groups and chemical avoidance behaviours arising from this may have masked psychopathology. CAGE scores diminished significantly in the debriefed group by the end of the follow‐up period suggesting that PD may have been of benefit despite the apparent absence of PTSD. This study also demonstrates that a high incidence of psychiatric morbidity is not an inevitable consequence of military conflict.
The influence of occupational debriefing on post‐traumatic stress symptomatology in traumatized police officers
Authors: Carlier I. V. E. , Voerman A. E. , Gersons B. P. R.
Published: February 2003

Certain individuals, such as police officers, are exposed to traumatic events as part of their occupational roles. In an effort to prevent psychological illnesses, notably the post‐traumatic stress disorder, from arising out of work‐related traumatic incidents, psychological interventions have been developed such as Critical Incident Stress Debriefing (Mitchell, 1983; Mitchell & Everly, 1996). The present study tests the hypothesis that debriefing reduces the psychological morbidity caused by work‐related incidents. Because debriefing techniques were not designed for application on a ‘one‐off’ basis (Robinson & Mitchell, 1993), the procedure studied here consisted of three successive debriefing sessions (at 24 hours, 1 month and 3 months post‐trauma), which included traumatic stress education. In a sample of 243 traumatized police officers, a subgroup of debriefed officers (N = 86) was compared with non‐debriefed internal (N = 82) and external (N = 75) control groups. No differences in psychological morbidity were found between the groups at pre‐test, at 24 hours or at 6 months post‐trauma. One week post‐trauma, debriefed subjects exhibited significantly more post‐traumatic stress disorder symptomatology than non‐debriefed subjects. High levels of satisfaction with debriefing were not reflected in positive outcomes. The findings are translated into recommendations for the future use of debriefing in police practice.
Measuring communication skills of medical students to patients with cancer
Authors: Claire Lindsay
Published: February 2003

Progress in improving doctors' communication skills has been hampered by a lack of consistent theoretical underpinning. Resource constraints have contributed other problems, including difficulties in evaluating medical students' communication skills. Although use of unpaid evaluators has helped to alleviate these, differences between evaluator groups have led to a second generation of problems concerning accuracy and reliability. To address these issues, a conceptual clarification of doctor‐patient communication is suggested. On its basis, seven communication skills needed by doctors are identified and then operationalized as a questionnaire measure of medical students' communication skills when talking to patients about cancer. An unusual feature is that the questionnaire can be used by lay and professional raters with only 1 hour of training. An empirical study was undertaken of the properties of the questionnaire. Generalizability theory, as well as more conventional approaches to reliability, was used to examine systematically the differences between simulator patient, psychologist and general practitioner raters. Results suggested that the questionnaire was of satisfactory overall reliability and validity. An unexpected finding was that more efficient future use of it might accrue if general practitioner raters are not used. Further uses of the questionnaire in theoretical and applied fields are suggested.
Availability bias in clinical formulation: The first idea that comes to mind
Authors: Waddington Louise , Morley Stephen
Published: February 2003

This study tested whether initial client formulations are based simply on the ideas that come most readily to mind, irrespective of the validity of these ideas. This phenomenon is known in decision theory literature as availability bias. The study tested the influence of two possible sources of availability bias in formulation: (a) theoretical orientation; and (b) a suggestion in a referral letter. Forty‐four qualified and 20 trainee clinical psychologists participated in a procedure designed to reflect clinical practice. Clinical materials consisted of a fictional referral letter describing a client with adult attachment difficulties and post‐traumatic stress disorder. Participants recalled information from the referral letter, described their areas of further interest and initial hypotheses. Results showed no evidence of an availability bias in clinical formulation as a result of theoretical orientation. Theoretical orientation towards attachment did appear to influence the availability of attachment ideas and predicted clinicians taking a stronger attachment focus when discussing the client. In particular, a self‐report measure of theoretical orientation demonstrated high predictive validity. However, orientation towards attachment did not predict bias in the sense of selective recall of attachment information or neglect of alternative psychological frameworks. The study provided an inadequate test of availability bias as a result of a suggestion in the referral letter, possibly due to a ceiling effect, and no conclusions can be drawn as to clinical materials as a potential source of availability bias. The discussion addresses implications for further research and for a scientist‐practitioner approach to individual case formulation.
Editorial: Cognitive analytic therapy: A case study in treatment development
Authors: Margison Frank
Published: February 2003

A summary of the main literature on cognitive analytic therapy (CAT) is given. Ryle first developed CAT over 20 years ago, and use of the model is increasingly widespread in diverse settings and with various conditions. CAT stands as an example of modern dialogical approaches to therapy, and the underlying theory is consistent with that stance. The developments within training stress self‐reflexive practice and the maintenance of a collaborative approach. In contrast, however, to the rapid development in training and practice the research summarised here is primarily descriptive with a small number of open trials and one randomized controlled study in a physical disorder (Type I diabetes). The urgent need for randomized controlled research in this treatment is highlighted.
Childhood trauma, dissociation and self‐harming behaviour: A pilot study
Authors: Low Gail , Jones David , MaCleod Andrew , Power Mick , Duggan Conor
Published: February 2003

Objective: Childhood trauma is known to be an important antecedent in those who engage in deliberate self‐harm (DSH). We aimed to explore the mediating mechanisms between childhood trauma and subsequent DSH in a sample of women detained in a high secure setting. Method: From a previous incidence study into DSH, we subdivided a group of 50 women as follows: non‐harmers (N = 13), infrequent harmers (N = 22) and frequent harmers (N = 15). These three groups were then compared on several measures believed to be associated with DSH. Results: The frequency of DSH was related to low self‐esteem, increased dissociation, anger (both inwardly and outwardly directed), impulsivity, and a history of sexual and physical abuse. When these variables were entered into a path analytic model exploring the relationship between childhood trauma and subsequent DSH, two paths emerged: one major path which linked childhood sexual abuse to DSH via increased dissociation and another, more minor association, linking childhood sexual abuse via reduced self‐esteem. Conclusion: This study shows a strong association between high levels of dissociation and an increased frequency of self‐harming behaviour. This association is theoretically plausible and has therapeutic implications.
Assessing adult attachment status with clinically‐orientated interviews: A brief report
Authors: Hughes Jan , Hardy Gillian , Kendrick Don
Published: February 2003

The object of this study was to examine the possibility of using clinically‐orientated interviews to gain a similar attachment classification to the Adult Attachment Interview. Little agreement on classifications was shown between the two interviews, showing insufficient evidence to suggest that it is possible to assess adult attachment status using clinically‐orientated interviews.
Rescuer and rescued: Applying a cognitive analytic perspective to explore the ‘mis‐management’ of asthma
Authors: Walsh Sue , Hagan Teresa , Gamsu Deborah
Published: February 2003

Asthma is a life‐threatening and disabling condition in which medication is the major form of management. However, there is widespread evidence that asthmatic patients do not comply with their medical regimens which increases the likelihood of relapse, crisis, hospital admission and can represent a threat to the patient's life. A phenomenological qualitative study was designed which integrated the framework of cognitive analytic therapy. The aim was to explore those factors that influenced the self‐care regimens of asthma sufferers. Thirty‐five patients were interviewed and three patterns of ‘non‐compliance’ were identified. The clinical implications are discussed. The paper concludes with comments on the contribution of psychotherapeutic tools as a means of understanding ‘risky’ patient behaviours.
Personal constructs of male survivors of childhood sexual abuse receiving cognitive analytic therapy
Authors: Clarke Sue , Pearson Christine
Published: February 2003

Objective. This study assessed whether male survivors of sexual abuse identified with their abusers rather than their child‐ or victim‐selves and failed to identify with men in general or with their victims, following abusive ‘acting out’. Changes in both identification and symptomatology were assessed following cognitive analytic therapy. Design. A patient series within‐participants design was used. Method. A repertory grid methodology examined four male survivors' self‐construals before and after therapy. Measures of symptomatic distress, depression, self‐esteem and distorted beliefs related to childhood sexual abuse were also obtained. Results. Before therapy, patients showed little identification with the child‐selves, men in general and ideal‐selves. Two heterosexual patients identified with their abuser(s) whereas another, homosexual, patient negatively identified with his abuser. Patients did not identify with their victims following aggressive ‘acting out’. After therapy, identification with the abuser reduced markedly; identification with victim‐ and ideal self increased. Depression and distorted beliefs declined. Conclusion. Male survivors tend to identify with abusers and disavow their victimhood. Sexual orientation may predict identification patterns. Cognitive analytic therapy may be a promising method of enabling survivors to integrate their abuse experience and reduce their commitment to the abuser role.
A CAT‐derived one to three session intervention for repeated deliberate self‐harm: A description of the model and initial experience of trainee psychiatrists in using it
Authors: Sheard Tim , Evans Jonathan , Cash Debbie , Hicks Jane , King Amanda , Morgan Neil , Nereli Ben , Porter Ian , Rees Harvey , Sandford John , Slinn Rebecca , Sunder Keerthi , Ryle Anthony
Published: February 2003

We describe a new Cognitive Analytic Therapy (CAT)‐based intervention for those who repeatedly self‐harm. It is specifically designed to be deliverable by staff with no training in psychotherapy. The intervention is simply manualized into sequential tasks that are mediated by new CAT‐style standardized tools. A particular feature of this intervention is the deliberate use of feelings elicited in the therapist (‘counter‐transference’) as (a) a guide to how professional poise is being threatened or lost and (b) an indicator of the appropriate focus for this very brief therapy. The psychiatrists' reflection on their elicited feelings is mediated by a new CAT tool, the ‘Assessor's Response File’ developed in this project. Audiotape analysis suggested that following a very brief learning period, trainee psychiatrists were able to adhere to the structure of the model and arrive at an appropriate reformulation in the first session but tended to be collusive in reciprocating the patients' dysfunctional coping styles.
Effectiveness of time‐limited cognitive analytic therapy of borderline personality disorder: Factors associated with outcome
Authors: Ryle Anthony , Golynkina Katya
Published: February 2003

Most patients with borderline personality disorder receive no formal treatment for their personality disorder and psychotherapy is widely believed to be necessarily intensive, of long duration and of uncertain effect. This study seeks to demonstrate the scope and limits of time‐limited outpatient cognitive analytic psychotherapy. Cases were identified by standard diagnostic procedures. Most were referred from psychiatrists and were typical of inner city patient populations. At an assessment 6 months after therapy the 27 patients completing therapy were divided into ‘improved’ and ‘unimproved’ groups. The patients classified as improved no longer met diagnostic criteria for borderline personality disorder. The two‐thirds still traceable were re‐tested at 18 months. These groups were compared in terms of a number of pre‐therapy measures and features. Poorer outcome was associated with greater severity of borderline features, a history of self‐cutting, alcohol abuse and unemployment.
Correspondence between delusions and personal goals: A qualitative analysis
Authors: Rhodes John E. , Jakes Simon
Published: February 2003

Objectives. This pilot study describes a qualitative method for exploring delusions in terms of motivational themes. Design. A semi‐structured interview schedule was developed on the basis of an elementary conceptual frame specifying research questions. The analysis of each case uses a structured format. Triangulation was used to check: (i) reliability of motive categories; (ii) their consistent application to delusions. Methods of analysis. All patients had delusions and were diagnosed as having a psychotic disorder. Two types of analysis were used: (i) Interpretative phenomenological analysis with features of grounded analysis was used to classify motives. Data from 14 participants was used for this. (ii) The second phase was an examination of a possible correspondence of themes and involved: (a) a category‐led thematic analysis of the delusion in terms of motivations; (b) a category‐led thematic analysis of life goals and problems again in terms of motivations; and (c) an examination of correspondence between (a) and (b). Results. The classification of goals and difficulties suggested six main categories: social connection; competence; experiential base (i.e. states of mind and body); material base (e.g. housing); direction; and evaluation (i.e. how a person evaluates himself or believes others evaluate him). Four cases are presented, each exploring the correspondence of themes. Conclusion. The methods of analysis seemed coherent and useful. In the cases presented, the delusions appeared to relate to fundamental concerns in a person's life.
Reality and discourse: A critical analysis of the category of ‘delusions’
Authors: Georgaca Eugenie
Published: February 2003

Delusions are seen in psychiatric research and practice as central indicators of the psychotic loss of contact with reality. In this paper the psychiatric concept of ‘delusions’ is critically examined both theoretically and through the analysis of extracts from interviews with individuals diagnosed as ‘delusional’. The diagnostic criteria for delusions, implausibility, idiosyncrasy, conviction and incorrigibility, are scrutinized, and the notion of reality that underlies the concept of delusions is deconstructed through the use of social constructionist approaches. The main arguments pursued in the paper are: first, that delusions are meaningful, not because they express something about the world or the speaker, but rather because they employ culturally available discourses and discursive strategies for their construction; second, that delusions are claims which are argued and negotiated in speech with similar strategies to those used by ‘non‐delusional’ individuals; and third, that delusions are statements about the self and the world whose truth and falsity cannot be definitely settled in speech. All three claims are discussed through the analysis of extracts from two interviews with ‘delusional’ individuals, which focuses on the assumptions underlying the negotiation of claims on reality, the discursive strategies adopted in this negotiation and the way disputes on reality are conversationally produced and settled.
The personality and cognitive‐epistemological traits of cognitive‐behavioural and psychoanalytic psychotherapists
Authors: Arthur Andrew R.
Published: February 2003

This is an investigation into the personality and cognitive‐epistemological traits of psychotherapists from two major psychotherapeutic orientations. The purpose is to examine whether there are distinctive trait patterns associated with each orientation. Two hundred and forty‐seven psychotherapists from the psychoanalytic and cognitive‐behavioural orientations completed standardized personality and epistemological trait inventories. The results reveal significant differences on these measures between the two orientation groups, and suggest that different patterns of personality and cognitive‐epistemological traits are associated with practitioners from these two orientations. These trait findings are summarized into two comparative descriptions, which illustrate their differences.
Hospital adjustment in personality disorder patients admitted to a therapeutic community milieu
Authors: Chiesa Marco
Published: February 2003

This study investigated aspects of adjustment to the therapeutic community milieu in a group of personality disorder patients. Eighty‐one patients consecutively admitted to the Cassel Hospital for medium/long‐term residential treatment between April 1994 and October 1997 comprised the sample. The adjustment to the milieu was rated on the Hospital Adjustment Scale, while outcome was evaluated at 6‐monthly intervals using a battery of self‐rated and rater‐based instruments. The aims of the study were: (a) to identify demographic and pre‐admission clinical variables that would predict adjustment to the therapeutic regime; (b) to study the relationship between hospital adjustment and external social adjustment; and (c) to investigate the hypothesis that hospital adjustment and internally and externally directed aggression do not predict clinical outcome. The results showed that pre‐admission level of global functioning and a previous history of substance misuse are the most significant predictors of hospital adjustment. No significant association between hospital adjustment and external social adjustment was found. Neither hospital adjustment nor level of aggressiveness predicted outcome at 12 months. The implications of these results for therapeutic community treatment of personality disorder are discussed.
Religious commitment and the construal of sources of help for emotional problems
Authors: Mitchell Jane R. , Baker Martyn C.
Published: February 2003

Religious commitment as an influence upon seeking help for psychological problems has not received the same level of research attention as variables such as sex, ethnicity and cultural background. The construing of members of a group of committed UK Christians was investigated, regarding their receiving such help from a variety of different helpers, professional and non‐professional, secular and spiritual. Each participant was asked to interpret the factors statistically identified from construct and element relationships in a repertory grid that they had completed. Their commentaries formed the data for a qualitative thematic analysis, which gave rise to four main themes. From these, a tentative model is discussed. Possible implications for the acceptance of service provision by the substantial minority groups of religiouslycommitted people in the UK are considered in the light of this model‐and in the light of the further research that would be needed to establish it.
Ogden's matrix of transference and the concept of sign
Authors: Leiman Mikael
Published: February 2003

Ogden's concept of the matrix of transference as the inter‐subjective basis in psychotherapy and psychoanalysis is examined by using the notion of sign‐mediated activity. After an introduction to the concept of activity, Ogden's account of the autistic‐contiguous position and his restatement of the Kleinian paranoid‐schizoid and depressive positions as the three fundamental modes of generating psychic content are presented. Each is then examined as a specific kind of sign‐mediated activity where the semiotic register that mediates the ways events are construed determines the particular qualities of the position. It is argued that the ambiguities in Ogden's conception of the three positions that make up the matrix of transference arise from the lack of a distinct semiotic theory accounting for the intersubjective basis of symbol formation and communication.
Special Section, Counselling Psychology: An investigation of the effectiveness of a voluntary sector psychodynamic counselling service
Authors: Archer Ruth , Forbes Yvonne , Metcalfe Christopher , Winter David
Published: February 2003

Clients attending a London voluntary sector counselling centre completed assessments pre‐ and post‐psychodynamic counselling and at follow‐up. Although there was a very high attrition rate following initial assessment, this did not appear to affect adversely the representativeness of the sample completing the later assessments. Clients were found to improve in terms of psychological well‐being, control and various other aspects of their lives, and attributed many of the changes to counselling. Counsellors also rated the counselling as effective with most clients, and particularly those who were inner directed, had expectancies favourable towards psychotherapy, had greater perceived control over their lives, attended more sessions, and with whom an interaction/transference approach was taken. Clients with more severe problems showed less improvement in other areas of their lives. There was no difference in the outcome of clients seen by qualified and trainee counsellors.
Special Section, Counselling Psychology: A review of the scientist‐practitioner model: Reflections on its potential contribution to counselling psychology within the context of current health care trends
Authors: Corrie Sarah , Callahan Margie M.
Published: February 2003

Recent legislative changes in the National Health Service have resulted in the need to develop practices that are ‘evidence‐based’. The move away from opinion and experience in therapeutic decision‐making towards use of research in service planning poses challenges to the identity, activities and roles of counselling psychologists. This highlights the need for a clearly articulated framework of professional activity to protect and enhance the future of the profession. The scientist‐practitioner model is one such framework and despite its contentious history, it is argued that the difficulties traditionally associated with its implementation are largely owing to an outdated view of scientific activity which relies on a positivist philosophy of science. These themes are developed by exploring the historical context in which the scientist‐practitioner model evolved and by drawing upon psychological models of identity, change and loss. A more contemporary meta‐theoretical construction of science and scientific activity is also explored which offers a reformulation of the scientist‐practitioner model that could complement the quest for evidence‐based practice and is consistent with the philosophical underpinnings of counselling psychology. Critical questions for future research in this area are identified.
A pilot study of the relationship between problem‐solving skills and outcome in major depressive disorder
Authors: Garland Anne , Harrington Jill , House Richard , Scott Jan
Published: February 2003

Three methods of assessing problem‐solving skills are described in the literature: questionnaires, self‐report inventories and verbal assessment of the resolution of problem scenarios. These three approacheswere used to assess problem‐solving ability in a sample of 20 patients with unipolar major depressive disorder, who were treated with antidepressant medication alone at a hospital out‐patient clinic. It was found that baseline deficits in problem‐solving skills were significantly associated with prognosis at 3‐ and 6‐month follow‐up. Self‐ratings of perceived self‐control and confidence rather than subjective problem‐solving effectiveness were important predictors of final outcome. Differences in perceived and actual problem‐solving ability emerged over time. The reasons for these differences in subjective and observer assessments are unclear. The data appear to demonstrate that problem‐solving deficits in depression represent both state and trait phenomena.
Managing the stresses of nursing people with severe and enduring mental illness: A psychodynamic observation study of a long‐stay psychiatric ward
Authors: Goodwin Anne M. , Gore Veronica
Published: February 2003

The task of nursing people with severe and enduring mental illness can evoke stresses and anxieties for staff which are not consciously known about, but which, nevertheless, impinge upon the quality of care delivered. As a way of exploring this issue, the interactions between staff and between staff and residents in long‐term residential care were observed. Alongside efforts to rehabilitate residents, nurses behaved in ways at variance with this task. These behaviours seemed to serve a function of protecting the staff group from the unconscious anxieties the work provoked. These can be understood interms of three fundamental anxieties regarding the client group, stemming from their mental illness (fears of ‘madness’ and loss of control), the severity of their disabilities (responsibility and vulnerability), and the chronicityof their difficulties (failure and despair). Better ways of managing these anxieties may be possible if they can be known and thought about.
Parents' constructions of professional knowledge, expertise and authority during assessment and diagnosis of their child for an autistic spectrum disorder
Authors: Avdi Evrinomy , Griffin Christine , Brough Sue
Published: February 2003

This paper presents a discourse analysis of parents' talk about the knowledge, expertise and authority of professionals, during assessment and diagnosis of their child for an autistic spectrum disorder at a Child Development Centre. Focusing on the positional level of analysis, it was suggested that parents' constructions of professional expertise and authority were inherently ambivalent and at times contradictory. It was further argued that this ambivalence is also reflected in an ideological dilemma between equality and expertise, regarding the role and positioning of ‘human relations experts’. Discourse analysis was found to be a particularly useful tool in investigating aspects of the parents' talk relating to authority, knowledge and expertise. It is suggested that acknowledging this ambivalence and scrutinizing one's assumptions and practice, rather than denying the authoritarian aspects of health care, would provide the basis for more ethical and respectful clinical practice.
Reduplication phenomena: Body, mind and archetype
Authors: Garner Jane
Published: February 2003

The many biological and few psychodynamic explanations of reduplicative syndromes tend to have paralleled the dualism of the phenomenon with organic theories concentrating on form and dynamic theories emphasising content. This paper extends the contribution of psychoanalytic thinking to an elucidation of the form of the delusion. Literature on clinical and aetiological aspects of reduplicative phenomena is reviewed alongside a brief examination of psychoanalytic models not overtly related to these phenomena. The human experience of doubles as universal archetype is considered. There is an obvious aetiological role for brain lesions in delusional misidentifications, but psychological symptoms in an individual can rarely be reduced to an organic disorder. The splitting and doubling which occurs in the phenomena have resonances in cultural mythology and in theories from different schools of psychodynamic thought. For the individualpatient and doctor, it is a diverting but potentially empty debate to endeavour to draw strict divisions between what is physical and what is psychological although both need to be investigated. Nevertheless, in patients in whom there is clear evidence of an organic contribution to aetiology a psychodynamic understanding may serve to illuminate the patient's experience. Organic brain disease or serious functional illness predispose to regression to earlier modes of archetypical and primitive thinking with concretization of the metaphorical and mythological world. Psychoanalytic models have a contribution in describing the form as well as the content of reduplicative phenomena.
Hypochondriacal concerns, somatosensory amplification, and primary and secondary cognitive appraisals
Authors: Ferguson Eamonn , Swairbrick Rebecca , Clare Sara , Robinson Elisabeth , Bignell Christopher J. , Anderson Catriona
Published: February 2003

This paper uses data from four studies (N = 150, 150, 154 and 79) to examine the associations between hypochondriacal concerns (HCs) and stress appraisals (primary and secondary). A search activity account of HCs suggests that increased levels of HCs should be associated with positive appraisals of a stressful situation (i.e., increased levels of perceived challenge and perceived control). However, the results indicated that in terms of primary appraisals, increased perceptions of threat and not challenge were consistently associated with increased levels of HCs. Further, the results indicated that the association between threat and HCs is mediated by somatosensory amplification. Consistent with the search activity account it is shown that increased levels of perceived control (secondary appraisals) are associated with increased levels of HCs. The association for perceived control remains once variance due to somatosensory amplification is partialled and generalizes to a sample of patients with a sexually transmitted infection. The results are interpreted in relation to the transactional model of the stress process.
Industrial mass psychogenic illness: The unfashionable diagnosis
Authors: Magnavita Nicola
Published: February 2003

Two previously unpublished outbreaks of Mass Psychogenic Illness (MPI) in Italy are reported. The first outbreak involved 427 female workers at an electro‐mechanical plant. Workers complained of work‐related stressors, and high levels of conflict between their job and home duties. We conclude that the episode resulted from the interaction of environmental and work‐related factors, the persons and the social organization of the workplace. The second case is one in which risk of MPI developing seems to have been successfully prevented. An effective stress coping strategy, coupled with workplace improvement, may have succeeded in eliminating cases of illness and preventing an outbreak of MPI.
A psychotherapist in the house: A service for distressed junior doctors
Authors: Mushet Greta , Donaldson Liam
Published: February 2003

A service set up specifically for junior doctors is described. Doctors used the confidential psychotherapy service for both work‐related and personal issues. Job‐related issues predominated. Common psychodynamic problems underlying relationship difficulties and workload pressures are described and lessons learned from the experience noted.
Attitudes towards emotional expression: Factor structure, convergent validity and associations with personality
Authors: Laghai Alexander , Joseph Stephen
Published: February 2003

The aim of the present study was to investigate the structure of the Attitudes towards Emotional Expression scale (AEE), its convergent validity with the Ambivalence over Emotional Expressiveness Questionnaire (AEQ), and its association with the Big 5 personality dimensions. The AEE was found to consist of four clearly identifiable factors, which loaded together on a higher order single factor. Higher scores on the AEE were associated with higher scores on the AEQ. Regression of scores on the AEE onto the Big 5 personality dimensions showed that scores on the AEE were associated with agreeableness, extraversion, and openness to experience.
Personality disorders and the interpersonal octagon
Authors: Birtchnell John , Shine John
Published: February 2003

The interpersonal octagon is a theoretical structure, similar to the interpersonal circle, within which a person's relating tendencies can be defined. It is constructed around a horizontal axis, concerning relating either closely or distantly, and a vertical one, concerning relating either downwardly or upwardly. The Person's Relating to Others Questionnaire ‐ Revised Version (PROQ2) was designed to measure relating within the octagon. To test the validity of the proposed location of the 10 DSM‐IV personality disorders within the octagon, the PROQ2 was administered, together with the DSM‐IV version of the Personality Diagnostic Questionnaire (PDQ‐IV), to a series of 107 men admitted to a therapeutic prison. The mean PROQ2 scores of the prisoners fell mid‐way between those of male students and psychotherapy patients. High intercorrelations were found between the scale scores of both the PROQ2 and the PDQ, and there was a high correlation between total scores of the two instruments. All disorders were highly correlated with the lower close scale of the PROQ2. The locations of some disorders corresponded well with the pre‐study predictions, and those of others came close. Those of a few came far from what was predicted, and some explanations for this are offered.
Interpreting the Inventory of Interpersonal Problems: A rejoinder to Riding and Cartwright
Authors: Startup Mike
Published: February 2003

Recently Riding and Cartwright (1999) have advocated eight new subscales of the Inventory of Interpersonal Problems, to be derived from a 40‐item short‐form (the IIP‐40). The aims of this rejoinder are to examine critically the rationale given by Riding and Cartright for constructing new subscales based on Birtchnell's interpersonal octagon, the methods they used for the construction, and the evidence they provided for validity. The conclusions of this examination are that the rationale is weak and that the evidence is against the validity of the IIP‐40.
Brief report: Poor metabolic control during menstruation and sexual abuse issues in an adolescent with diabetes
Authors: Geffken Gary R. , Zelikovsky Nataliya , Clark‐Rudman Judith E. , Silverstein Janet H. , Drobes David
Published: February 2003

A case study is presented that describes the deterioration of a patient's diabetes control during her menstrual cycle in terms of her psychological functioning and family context. Therapeutic interventions pertinent toward improving diabetes control, resolving issues of abuse, and increasing family communication are addressed. The outcome of this case study supports the contention that psychological factors can impact diabetes control significantly during menstruation in young women.
An investigation of the attachment organization of clinical psychologists and its relationship to clinical practice
Authors: Leiper Rob , Casares Philippa
Published: February 2003

Recent research on attachment theory as a model for understanding adult relationships and for psychotherapy suggests that the attachment organization of therapists could influence their approach to therapeutic work. A postal questionnaire including two measures of current adult attachment and one of early loss experience, together with measures of current clinical practice, was completed by 196 British clinical psychologists (40.4% return rate). Seventy per cent of the sample rated themselves as secure (a greater proportion than in the general population). The sample as a whole scored higher on the attachment pattern of ‘compulsive care‐giving’ than on any of the other insecure patterns of attachment. A number of significant differences were found between the secure and insecure groups in approach to work, interest in working with different clients and difficulty experienced in therapeutic practice. A relationship was found between the amount of early loss experienced and current attachment style, therapeutic orientation and experience of therapy. Implications for the training and development of psychologists are considered and directions for future research are suggested.
A conflict of responsibilities: A grounded theory study of clinical psychologists' experiences of client non‐attendance within the British National Health Service
Authors: Tweed Alison E. , Salter Denis P.
Published: February 2003

Within psychotherapy process research, the effects of client non‐attendance upon therapists has been neglected. The present study interviewed six clinical psychologists concerning their experiences of client non‐attendance in health service practice in the UK. Their accounts were analysed using a grounded theory method. A core category was identified and termed ‘responsibility’. This highlighted conflicting relationships between participants' responsibilities in several areas. A process model pertaining to non‐attendance was also developed. Client non‐attendance was seen to produce a level of disruption, experienced as an affective reaction and often experienced in terms of negative affect. In response, re‐organizational strategies were used to restore equilibrium. Reasons are suggested as to why negative affective reactions were experienced. These include factors concerning therapeutic competency, but also reflect upon the profession's espousal of an ‘all‐knowing’ expert identity. This is seen to be incongruent to the complexities of clinical practice.
Does the ICD 10 classification accurately describe subtypes of borderline personality disorder?
Authors: Whewell P. , Ryman A. , Bonanno D. , Heather N.
Published: February 2003

The aim of the paper is to explore whether the division of borderline personality disorder, as described in the DSM classification, into impulsive and borderline subtypes of emotionally unstable personality disorder in the ICD classification of personality disorder, is a valid division. The self‐report questionnaire responses of 288 referrals to a personality disorder service were rated on each of the eight criteria for DSM‐III‐R diagnosis of borderline personality disorder. Factor analysis identified two factors; factor one closely corresponds with the borderline subtype of ICD10, whilst factor two closely corresponds with the impulsive subtype of ICD10. Criteria common to both factors ‐ unstable relationships and identity confusion ‐ were considered core features of borderline personality disorder. The pattern of occurrence of the two factors was similar to the complex binary picture described by ICD10. However there were also differences. Firstly, identity confusion is found to be a core feature of both our factors, and this does not conform to the restriction of identity confusion to the borderline subtypes in ICD10. Secondly, we found a residual pool of undifferentiated borderline patients and a small group of pure non‐impulsive borderline patients who are not currently accommodated within the ICD10 emotionally unstable personality disorder. We conclude that future classifications of this disorder should accommodate four subtypes, and suggest these subtypes have implications for treatment and further research.
Attitudes to self‐injury within a group of mental health staff
Authors: Huband Nick , Tantam Digby
Published: February 2003

Background: Self‐wounding is a behaviour which remains poorly understood and which can evoke strong reactions from clinical staff. Such reaction may adversely influence treatment outcome and there have been calls for changes in the attitudes of professional staff towards this client group through improved training and awareness. There has, however, been little systematic study of how clinicians perceive those who self‐injure or of how their attitudes are modified by training and other factors. Method: This study aims to identify and explore factors governing professional attitude towards self‐injury through postal survey of a large group of mental health staff. The survey assessed attitudes towards a representative case described in a vignette. Results: Five key factors were identified, with perception of control being the most dominant. Attitudes of clinical staff who had obtained additional qualification in counselling or psychotherapy differed significantly from those who had not. In contrast, no effect was found for specific training in handling self‐injury. Attitude to the selfwounding woman was unaffected by gender, but was affected by age and work setting. The innate potential for the sample to self‐polarize was examined statistically; a line of cleavage emerged between less tolerant staff who perceived her to have more control and to be more difficult to understand and those with opposing views. Conclusion: Qualification in counselling or psychotherapy may modify attitude by reducing defensive attribution, allowing staff improved containment of their anxiety; alternatively, pre‐existing attitudes may encourage certain staff to obtain such qualification.
‘Platonic jealousy’: A conceptualization and review of the literature on non‐romantic pathological jealousy
Authors: Hill Robert , Davis Paul
Published: February 2003

Romantic jealousy has long been of interest to psychodynamically oriented clinicians. More recently empirical investigations have emerged into the causes and treatments of romantic jealousy. What has not kept pace with this interest is a wider research agenda into non‐romantic forms of jealousy. While work has appeared in relation to specific groups or topics, such as sibling rivalry, no attempt has been made to draw together the material on non‐romantic jealousy. In this paper the theoretical and empirical material on non‐romantic jealousy is reviewed in order to answer two fundamental questions. Firstly, is non‐romantic jealousy necessarily pathological? Secondly, to what extent is it helpful to subsume all forms of non‐romantic jealousy under one term? It is suggested that while non‐romantic jealousy is not always pathological, the term non‐romantic jealousy may be a useful differentiating term, not least in highlighting an important area for future research.