Adopting a balanced view

Child and family psychologist and JKP author of the bestselling A Short Introduction to Attachment and Attachment Disorder, Colby Pearce, on maintaining a balanced view when caring for children who have experienced trauma in their early lives.
This article first appeared on The Adoption Social‘s guest blog. 

I was born in January, which is the height of summer here in Adelaide, Australia. As such, I have always thought of myself as a “summer baby” and considered that this is why I enjoy the warmer months as opposed to the cooler months. I have a lifelong aversion to feeling cold and for many, many years I felt below my best during winter. I have questioned many people about this and have discovered that most people prefer either the warmer months or the cooler months. Many of them are just not happy until their preferred season returns.

About three years ago, and with the emergence of joint aches and pains during the colder months, I had the thought that it was a bit of nonsense really to consider myself a “summer baby” and defer happiness until it was warm again. I have always been a keen gardener and have a large hills garden. Looking after my garden is an act of looking after my self. Water is an issue as it is scarce and expensive, my garden is large and summer is hot (As I write this it is the fifth consecutive day of over 40C). So, I bought some rainwater tanks and now I pray for as much ‘bad’ weather as possible during the cooler months. I check the weather radar each day and feel let down if forecast wet and wintry weather blows south or north. I still have my aches and pains and look forward to the warmer months when they trouble me less, but I also look forward to cooler, wetter months now as it is a boon for my efforts to maintain a magnificent garden. And the garden? Well, with the additional water supply it has never looked better.

Strong FoundationsWhat has all this got to do with looking after children; particularly those children who experienced significant adversity in the first days, weeks, months and years of their precious lives? Well, it has to do with how we perceive them and the effects of this; both in terms of our own experience of caring for them and their experience of being cared for by us.
I am particularly interested in the idea of “self-­fulfilling ­prophecies”. In Psychology, these take the following form. I have a thought. My thought induces an emotion. My emotion activates a behavioural response. My behavioural response precipitates a reaction in others. The reaction of others often confirms my original thought.

Let’s try one. Thought: “nobody loves me”. A common feeling associated with this thought: hostility. Common behavioural responses to feelings of hostility: withdrawal and/or aggression. A common reaction to withdrawal and aggression: admonishments. An inevitable result: confirmation of the original thought.
Lets try another. He is damaged by his early experiences. I feel badly for him. I try to heal him. He keeps pushing me away. He is obviously damaged.
And, another: He is such a good artist. I am so proud of him. I support and encourage his interest in art. His skills develop and he is often affirmed for his artistic achievements. He is such a good artist!

Children who have experienced significant adversity at the beginning of their life are commonly referred to as “traumatised”. There is much literature about how early trauma impacts the developing child, including their acquisition of skills and abilities, their emotions, their relationships with others and even their brain. This literature focuses on the damage early trauma does and there is a risk that we, their caregivers, see these children as damaged.

One of my favourite allegories is the one that the author Paulo Coelho tells in his book, The Zahir. Coelho tells the story of two fire­fighters who take a break from fire fighting. One has a clean face and the other has a dirty, sooty face. As they are resting beside a stream, one of the fire­fighters washes his face. The question is posed as to which of the fire­fighters washed his face. The answer is the one whose face was clean, because he looked at the other and thought he was dirty.

The idea of the looking-­glass ­self (Cooley, 1902), whereby a person’s self-­concept is tied to their experience of how others view them, has pervaded my life and my practice since I stumbled across the concept as a university student. Empirical studies have shown that the self-­concept of children, in particular, is shaped by their experience of how others view them. In my work, this has created a tension between acknowledging the ill ­effects of early trauma and encouraging a more helpful focus among those who interact with so ­called ‘traumatised children’ in a caregiving role.

I am just as fallible as the next person, and I do not have all the answers. But as a professional who interacts with these children and their caregivers on a daily basis I strive to find a balance between acknowledging and addressing the ill­effects of early trauma and promoting a more helpful perception of these children. I strive to present opportunities to these children for them to experience themselves as good, lovable and capable; to experience me and other adults in their lives as interested in them, as caring towards them and as delighting in their company; as well as experiences that the world is a safe place where their needs are satisfied. I strive to enhance their experience of living and relating, rather than dwelling on repairing the damage that was done to them.

Most of all, I see precious little humans whose potential is still yet to be discovered. eyes

Eyes are mirrors for a child’s soul. What do children see in your eyes?

References
Coelho, P (2005), The Zahir. London. Harper Collins Cooley, C.H. (1902). Human Nature and the Social Order. New York. NY: Scribner
Publishers

Prepared for The Adoption Social by Colby Pearce (Clinical Psychologist and Author), ©2014
You can read the original blog post here.
You can keep up with Colby’s blog posts on his website, here.
You can also follow him on Twitter @colbypearce

 

Assessing emotional awareness after trauma

Grasso_Clinical-Exerci_978-1-84905-949-7_colourjpg-webThis extract taken from Clinical Exercises for Treating Traumatic Stress in Children and Adolescents by Damion J. Grasso gives practical guidance to assessing and enhancing a child’s emotional awareness and vocabulary prior to therapeutic exposure.
‘These skills are essential for fully engaging in the therapeutic exposure and for processing the emotional content of the trauma memory.’

Read the extract here

 

How well do you know yourself?

Bolton_Writers-Key_978-1-84905-475-1_colourjpg-webWe make assumptions about ourselves all the time, but how much do we really know?

As Gillie Bolton says in the opening chapter of her new book The Writer’s Key, ‘The simple action of putting words on a page can begin to help us find out what we think, believe and know’.

This exercise taken from the book is a great way to begin to explore ourselves through writing; our worries, our fears, our hopes, and our aspirations.

All you need to have a go is a pen and a piece of paper. You might be surprised by what you discover!

Download the free writing exercise here

 

 

New Video – Sue Cottrell talks to her son Lloyd about learning to control his stammer

In this video Sue Cottrell, author of Can I tell you about Stammering/Stuttering?, talks to her 15 year-old son Lloyd about how his stammer affects his daily life, particularly at school whilst he is feeling stressed about exams. Lloyd reflects on footage of himself speaking as a 13 year-old and discusses how the techniques he has learned since have enabled him to control his stammer and become a more confident speaker.

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Identify the signs of OCD at school

Jassi_Can-I-tell-you_978-1-84905-381-5_colourjpg-webAmita Jassi, author of ‘Can I tell you about OCD?’ explains some of the common obsessions and compulsions experienced by people with the disorder and how this could effect children at school.

OCD is an anxiety disorder characterised by unpleasant and recurring thoughts, images, doubts or urges (called obsessions) and repetitive and irrational behaviours (called compulsions). Compulsions, also known as rituals, may be observable behaviours (such as washing or tapping) or mental rituals (such as thinking a good thought to cancel out a bad thought). Compulsions are usually carried out as a way of reducing the distress caused by obsessions. OCD takes many different forms and can range from mild to severe. When children are troubled by OCD they can experience very high levels of anxiety and distress and find that it can take up a lot of their time.

Some common obsessions are:

  • Fears about dirt or contamination
  • Worries about harm coming to yourself or others
  • Unwanted sexual thoughts
  • Thoughts about doing something forbidden or embarrassing
  • Discomfort if things are not symmetrical or even
  • Needing to tell, ask or confess
  • Fears of losing important things

Some common compulsions are:

  • Checking things over and over again
  • Touching or tapping things
  • Seeking reassurance
  • Hoarding or collecting things that are useless
  • Arranging things so that they are ‘just right’
  • Washing and cleaning
  • Counting, repeating and re-doing things

The good news is that OCD can be successfully treated and recent evidence shows that the sooner it is tackled the better the treatment outcomes are likely to be.  The recommended treatment for OCD by the Department of Health is a talking therapy called Cognitive Behaviour Therapy (CBT). It is also recognised that some children may also benefit from treatment with medication from the group called selective serotonin re-uptake inhibitors (or SSRIs). It is clear therefore that young people should not have to struggle with OCD without any support and treatment. The UK’s largest charity for OCD, OCD Action, wants young people, their parents and their school to take action now.

What are the signs of OCD at School?

OCD can affect many areas of a young person’s life, including school life. It is important to remember that OCD affects people in many ways however some of the signs that you may observe in school include:

  • Poor attention and concentration due to distraction from unwanted thoughts or the need to perform rituals
  • Extreme tiredness due to being up late at night doing rituals or the overall exhaustion caused by the constant battle with OCD
  • Frequent or prolonged toilet visits due to completing cleaning rituals
  • An inability to touch objects, materials or other people due to possible contamination fears
  • Excessive questioning and need for reassurance
  • Messy work due to having to repeat rituals such as rewriting or erasing words
  • Repeated lateness as a result of being delayed by rituals
  • Late handing in work due to being slowed down by obsessions and/or compulsions
  • Arranging items on a desk, shelf or classroom so that objects are aligned
  • Repetitive behaviours such as getting up and down from a desk or opening and closing the door
  • Low self-esteem and difficulty with peer relationships
  • Reduction in grades or decline in school performance

It may also be helpful to be aware that OCD can be associated with other disorders such as depression, Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorders (ASDs) and Tourette Syndrome.

Where else can I find information about OCD?

For more information on OCD and young people, see ‘Can I tell you about OCD?’ or refer to the OCD Action website: www.ocdaction.org.uk or OCD-UK: www.ocduk.org

 

 

Unlocking potential with dynamic assessment

Lauchlan-Carrig_Improving-Learn_978-1-84905-373-0_colourjpg-webFraser Lauchlan, co-author of ‘Improving Learning through Dynamic Assessment’, explains how the approach was first developed and how using this method of assessment can lead to effective intervention for many children with learning and behavioural challenges. 

I first became aware of dynamic assessment 15 years ago as a doctoral research student. It was very much a new ‘thing’ then, considered cutting edge and innovative, but not a lot was known about it in the UK. Since then it has grown in popularity and is used mainly by educational psychologists when assessing children’s learning and behavioural difficulties. However it is also used by other professional groups such as speech and language therapists and those working in the area of learning support, such as special educational needs coordinators.

Dynamic assessment is based on Vygotskian principles, the Russian psychologist who died in 1934 but whose work was suppressed by the then Communist regime and eventually published in the West in the 1960s and 70s. Vygotsky’s ideas were considered fairly revolutionary and it was little wonder that his work was suppressed. One of his main arguments was that children should be assessed for their intellectual capacity when working with someone, for example an adult or a more able peer, rather than be assessed alone. This view was, and possibly still is, considered controversial, as it is commonly considered that in order to understand someone’s intellectual capacity you must assess what they can do on their own, for example on an IQ or similar test. Vygotsky argued that it is just as, if not more important to see what a child can do with carefully guided assistance. This will give an idea of the learning potential of the child, and where the next steps of learning should be targeted (or the processes of learning), rather than concentrating on the products of that child’s learning (i.e. using a standardised test and focusing on where they are now).

These ideas were developed by several developmental psychologists in the 1970s and 80s. For example, the Israeli psychologist Reuven Feuerstein, well-known for his cognitive enrichment programme, ‘Instrumental Enrichment’, developed a dynamic assessment test called the ‘Learning Propensity Assessment Device’. Psychologists in the U.S.A., such as Ann Brown and Joseph Campione, developed a different, more structured approach to dynamic assessment. However, the truth was that in the UK at least, dynamic assessment didn’t really ‘take off’.

Part of the problem, in my view anyway, was that practitioners could not see how dynamic assessment could be easily integrated into practice. When I was trained in dynamic assessment in the mid-1990s, there were few psychologists in the UK trained in the approach, and so training was usually given by psychologists from Israel or the U.S.A. who were not familiar with the working environment of educational psychologists working in local authority settings in the UK. As the years passed it was becoming increasingly clear that professional psychologists in the UK were struggling to put the ideas underlying dynamic assessment into practice.

Improving Learning Through Dynamic Assessment, co-written with my colleague Donna Carrigan, is a culmination of 15 years work on developing the dynamic assessment approach, as both a researcher and a practitioner, and an attempt to bridge the gap between theory and practice. After completing my PhD that investigated the use of dynamic assessment in two different educational settings, I trained as an educational psychologist and worked for 10 years in a local authority setting.  It was as a practitioner, working daily with children who were encountering difficulties in learning, that the idea of putting together our development work in dynamic assessment in the form of a resource textbook first emerged. Donna and I started to document some of the case studies that we were working on, in order to gather together some useful resources and ideas that would form the basis of the book. We were working with children like James (name changed to ensure anonymity) who was referred to me in primary school for assessment as he was having severe difficulties in the classroom with all areas of the curriculum. The school admitted that they were at a loss as to where to go next, and had considered that a move to a special school might be the best option for James, where he would receive more intensive support and a curriculum more suited to his needs. James was from a socially disadvantaged, single-parent family and wasn’t receiving much support at home. His progress at school was certainly slow and the teachers felt there was little else they could do to help. Using dynamic assessment with James allowed me to explore his potential as a learner. He responded extremely well to the help and structured assistance, and was able to ‘internalise’ this support and work independently. James reached a high level on the tasks set. In collaboration with the school, it enabled us to consider the next steps of his learning and the areas that were most urgently in need of support. Having video-recorded the dynamic assessment I was also able to show his teacher and his mother the level that James could achieve. This alone was important in changing the lowered expectations of the teacher. While his learning difficulties did not disappear overnight, he did nevertheless make good steady progress and, most importantly, the teachers felt there was now a plan of how to address his learning challenges in a positive way. James completed his primary school education and went on to secondary school, where he was able to achieve some qualifications, something that would not have been thought possible when he was first referred to me in primary school.

We have written Improving Learning Through Dynamic Assessment to help practitioners, especially educational psychologists, put the powerful ideas of dynamic assessment into practice. The book is a step-by-step guide in how to undertake an assessment and how such an assessment can lead to effective intervention. By doing so, it is hoped that practitioners can help address the learning and behavioural challenges posed by many children, including children like James.

A case study extract from ‘Forensic Music Therapy’ – Working with Conflict

Stella Compton Dickinson, editor

This is an edited extract from Forensic Music Therapy: A Treatment for Men and Women in Secure Hospital Settings edited by Stella Compton Dickinson, Helen Odell-Miller and John Adlam. This case study comes from Chapter 7, ‘Working with Conflict: A Summary of Developments in the Long-term Treatment of a Man Suffering with Paranoid Schizophrenia Who Committed Manslaughter’, by Stella Compton Dickinson and Manjit Gahir.

Introduction

This chapter describes the process of long-term music therapy over seven years with a man who we shall call “Ewan.” Ewan has given informed consent for case material to be used in telling the story of his rehabilitation; his real name has not been used. Ewan suffered with paranoid schizophrenia and whilst actively psychotic with hallucinations and delusions, he killed a man.

Overview

Committed to hospital for an indefinite period after being convicted of the offence, Ewan spent ten years in high secure detention without undertaking therapy until he requested a referral to music therapy, “to learn to play the violin” as his grandfather had done. He engaged in music therapy as his main psychological treatment. The intervention and its impact were new to the clinical team who had to adjust to the fact that internal changes were starting to happen for a patient who they had known to be static for many years. Thus their own past experiences, their judgments of Ewan in the face of fear when he had erupted with violent outbursts, and their perceptions for his future were all challenged.

Music therapy

Ewan’s fundamentally chaotic presentation was marked by fixed perseveration, which is typical of schizophrenia. Notable in his early musical improvisations were repeated, stuck, desperate, and stabbing sounding attacks on the piano keys. This represented exactly his situation and offence: angry, locked in, stuck, as if he had nowhere to turn. The therapeutic work required orientation to the here and now, rather than unlocking too much past material at once. Nevertheless, Ewan recognized how he could receive rather than reject my non verbal musical support. This elicited a maternal transference. Towards the end of the second assessment session, Ewan rushed from the room, having exclaimed his recognition within our musical improvisation that “you are supporting me! I have not felt like that since I was with my mother.”

The significance of this was central to the therapy as Ewan had been unable to mourn the death of his biological mother. He returned explaining that this experience had “brought a tear to my eye.”

Starting the treatment process

Ewan had never experienced any previous psychological therapy at all, so the same weekly place and time was an entirely new experience for him, which he almost religiously observed. As the therapy progressed, he became more proactive in ensuring that regular physical health appointments were not timetabled to coincide, as nothing had to come between him and his music-making. Over time, as he became more trusting in the continuity of his life and less fearful of sudden abandonment, he gradually extended his range and felt safe to play the piano on his own rather than with me. Ewan began to take responsibility for his own actions rather than remaining over-identified with his own victim self-state.

The mother–child dyad and symbolic musical representations

In session 12, Ewan elucidated on his feelings of stupidity and how he played on these as a childhood strategy. He said he had taken to “acting stupid” whenever he felt threatened by his father. The mother–son relationship was enacted symbolically as a maternal transference developed. The merged relationship that developed between Ewan and his biological mother during childhood was cemented when both mother and son cowered from the violence and physical abuse of the father. This relationship was represented musically in session 2 in which initially Ewan played mournfully on the recorder, copying my choice of instrument, then merging with it and introducing a sensual, rocking rhythmic pulsation which indicated an as yet unconscious underlying erotic transference. The music then became violent and angry as Ewan repeatedly hit a small glockenspiel as if he was a frustrated child waiting for dinner. This had a direct correlation to verbal material in which Ewan described the intimacy and frustrations that he felt with his mother. After this the music became mournful and sad although it finished in a resolved, harmonious fashion.

The index offence: developing victim empathy

In reference to the man who he had killed, Ewan attempted to make an offering in musical terms by sitting at the piano to play a piece which he entitled “Requiem.” At the time this felt sincere but also very sad, as I perceived that Ewan felt very clumsy and inadequate in trying to address such a huge and tragic event. From this state, the first expressions of remorse at the magnitude of his violent act began to emerge. Perhaps the fluctuations between reflecting on his offence and reflecting on his childhood suggested how Ewan was trying to make links in understanding why he had committed his offence.

Conclusion

The individual music therapy was characterized largely by a positive transference. Ewan completed his mourning process in the following two years of group therapy where he discovered how to be part of a “family,” as well as how to feel included and valued by others. He remains in custodial care at a lower level of security. At his care program review as the therapy closed, he described his recovery process in music therapy as “akin to the raising of Lazarus.” This biblical reference to Christ’s greatest miracle probably says at least as much about Ewan’s internal morbid state of loss, including loss of hope prior to engagement in music therapy, as it does about his creativity and ability to express himself and to develop through music therapy in a way which, after ten years of stagnation, he may have felt was miraculous.

Copyright © Jessica Kingsley Publishers 2012

 

A celebratory evening at the 2012 BMA Medical Book & Patient Information Awards

Winner Charlotte Clarke with commissioning editor Rachel Menzies

The impressive BMA House in Tavistock Square, London, served as an excellent backdrop to an illuminating ceremony last night for the 2012 BMA Medical Book and Patient Information Awards.

We are thrilled to announce that first prize in the Health and Social Care category was awarded to the JKP title, Risk Assessment and Management for Living Well with Dementia, edited by Charlotte L. Clarke, Heather Wilkinson, John Keady and Catherine E. Gibb. The book is part of our well-established series, the Bradford Dementia Group Good Practice Guides.

Charlotte Clarke was at the ceremony to accept the award and was delighted to have been recognised by the British Medical Association for the editors’ collective achievements with the book.

Here is what one of the BMA reviewing panel said about the title:

“This is a novel and truly excellent book, made all the more acceptable by its brevity and clarity. It has certainly impressed me as an essential aid to those who care for people with dementia and it sets-out how risk should be assessed and managed in a clear and reassuring manner. It is an excellent slim book with a really helpful approach in an increasingly important field.”

Professor Averil Mansfield CBE, Chairman of the BMA Board of Science commented that it was “no mean feat to be shortlisted”, as they received several hundred individual entries for the book awards. Hearty congratulations must therefore go to the authors of the four Highly Commended titles from JKP and Singing Dragon, which are as follows:

After the Suicide by Kari Dyregrov, Einar Plyhn and Gudrun Dieserud – Health and Social Care category

Understanding Behaviour in Dementia that Challenges by Ian Andrew James – Health and Social Care category

Comforting Touch in Dementia and End of Life Care by Barbara Goldschmidt and Niamh van Meines – Popular Medicine category

Making Sense of Near-Death Experiences by Mahendra Perera, Karuppiah Jaghadheesan and Anthony Peake – Psychiatry category

The evening was attended by medical professionals, authors and publishers, of which editors Rachel Menzies and Emily McClave as well as marketing & publicity executive Ruth Tewkesbury were present on behalf of JKP. Books were judged on accuracy, appropriateness, quality of design and production, originality of content, approach and value for money.

 

Charlotte Clarke receiving her award from the BMA President, Professor Baroness Hollins, FRCPsych, FRCPCH, FRCP

Highly commended JKP author Ian Andrew James with winner Charlotte Clarke

 

Singing Dragon author Barbara Goldschmidt (second left) with JKP staff Emily McClave, Rachel Menzies and Ruth Tewkesbury

The full list of highly commended titles and award winners can be found here.

A great evening was had by all, and once again, congratulations everyone!

Ruth Tewkesbury
Marketing and Publicity Executive

“Asleep for ages”: Perspectives on sleep in history

Andrew Green, co-editor of Sleep: Multi-Professional Perspectives writes on how ideas about sleep have changed over time, and how sleep has been historically regarded in different ways.


Despite centuries of speculation and research, we still do not know what sleep really is, or exactly what it is for. Allan Rechtschaffen suggested that ‘If sleep does not serve an absolute vital function, then it is the biggest mistake the evolutionary process ever made’ (1971, p.88) and it does seem reasonable to conclude that unless it gave a species an advantage, sleep would have become extinct by now. Noting that all animals sleep, Paterson (2012) shows how the sleep of some animal species has adapted in surprising ways in order to meet to particular needs. She also discusses some of the functions that we now think sleep serves, although these modern ideas contrast with theories that have developed through the ages.

According to Scrivner (2012), in ancient Greek mythology sleep

“…was made the jurisdiction of anthropomorphic deities and weird demons whose actions determined both our shifting states of consciousness as well as the endless shift of day into night and back again. The Greek god of sleep, Hypnos, and Nyx, the goddess of the night, are chased away each morning by … Eos, the dawn” (Scrivner 2012, p.271).

However, in ancient Greek philosophy, in one of the earliest explorations or the causes and purposes of sleep Aristotle (384 BCE–322 BCE) made what now seems like a statement of the obvious:

“It is inevitable that every creature which wakes must also be capable of sleeping, since it is impossible that it should continue actualizing its powers perpetually. So, also, it is impossible for any animal to continue always sleeping.” (Aristotle)

He went on to explain how sleep relates to the cardinal humours (blood, phlegm, black bile and yellow bile) and to changes in body temperature that result from eating and digestion

“… in every animal the hot naturally tends to move […] upwards, but when it has reached the parts above [becoming cool], it turns back again, and moves downwards in a mass. This explains why fits of drowsiness are especially apt to come on after meals; […]. When, therefore, this comes to a stand it weighs a person down and causes him to nod, but when it has actually sunk downwards, and by its return has repulsed the hot, sleep comes on …” (Aristotle).

Zimmer (2005) shows how Thomas Willis, though a pioneer in neuroscience, was still a man of the mid-seventeenth century and held that sprits flowed through the nervous system; emotions were produced by movements of the sensitive soul (as opposed to the humours of the heart) and spirits, which expand in happiness, could not flow without rest – hence the need for sleep. Willis attributed narcolepsy (although it was not formally identified then) and sleepiness to an excess of blood in the brain which cramped the animal spirits, making them unable to flow; he prescribed bleeding and newly available coffee. Sleepwalking resulted from spirits travelling down the spine causing the person to walk. Although such ideas might seem quaint now, Willis, like Aristotle, was at least finding explanations for phenomena in sleep that excluded supernatural intervention.

In the nineteenth century Robert Macnish, a Scottish physician and surgeon, was referring to the phenomenon of night terrors – known then as nightmare (see Green 2012) – not as the visitation of evil spirits, but as an illusion; however, he noted that ‘Many a good ghost story has had its source in the illusions of nightmare’ (Macnish n.d., p.130; first published 1834). Evenso, while a rational scientist, Macnish still did not know what sleep was for:

“Sleep, being a natural process, takes place in general without any very apparent cause. It becomes, as it were, a habit, into which we insensibly fall at stated periods, as we fall into other natural or acquired habits” (Macnish n.d., p.17; first published 1834)

Early in the twentieth century Addington Bruce reviewed some of the theories about the function and causes of sleep. He observed that explanations had ‘usually resolved themselves into descriptions of states that accompany sleep rather than demonstrations of the factors that cause it’ (Bruce n.d., pp.2–3; first published 1915). For example, he noted that ‘deficiency of blood in the brain’ (p.3) did not signify a cause, but proved only that circulatory changes occur in sleep. Bruce also dismissed theories that sleep can be attributed to accumulation of toxins in the blood or that monotony (see Sidis 2010; first published 1909) was the cause. He asserted that sleep:

“…is an active positive, positive function, a protective instinct of gradual evolution … its object being not so much the recuperation of the organism … as to save [it] from the destructive consequences of uninterrupted activity” (pp.8–9).

He did, however, suggest that ‘most us sleep longer than is really necessary’ (p30).

While research on sleep flourished during the twentieth century, and into the twenty-first, – see Kroker (2007) for a detailed account – suggestions that we could sleep less, or barely at all, have persisted and the idea that sleep is a waste of time remains widespread. In the 1950s and 60s writers looked forward to times when we might sleep less – the most bizarre suggestion being the ‘electrosone’, a device that was to allow us to have only two hours’ sleep a night (see Green 2012a).

At the present time debate continues about unprescribed use of modafinil, a stimulant used for treatment of narcolepsy, and whether it can allow us to get by with less sleep (for example, see this Guardian article.) But whatever the short-term benefits may be, it seems unlikely that we can safely reduce our sleep substantially in the longer term.

We know that sleep is essential for memory, learning and performance of many activities (see Green 2012b, for example) and that the links between sleep and good health are many. Put one way, we might say that if the Good Lord did not intend us to sleep He would not have given us the night – or put another: millennia of evolution are unlikely to have got it so wrong.


References:

Aristotle (2011-09-30). On Sleep and Sleeplessness [Illustrated]. Kindle Edition.
Bruce, H.A. (n.d) Sleep and Sleeplessness. Kila, MT: Kessinger Publishing, LLC. (Original work published 1915).
Green, A. (2012a) ‘Sleeping on it.’ In A. Green and A. Westcombe (eds) Sleep: Multiprofessional Perspectives. London: Jessica Kingsley Publishers.
Green, A. (2012b) ‘A Question of Balance: The Relationship Between Daily Occupation and Sleep.’ In A. Green and A. Westcombe (eds) Sleep: Multiprofessional Perspectives. London: Jessica Kingsley Publishers.
Kroker, K. (2007) The Sleep of Others and the Transformations of Sleep Research. Toronto: Toronto University Press.
Macnish, R. (n.d.) The Philosophy of Sleep. Bibliolife. (Original work published 1834).
Paterson, L.M. (2012) ‘The Science of Sleep: What is it, What Makes it Happen and Why Do We Do it?’ In A. Green and A. Westcombe (eds) Sleep: Multiprofessional Perspectives. London: Jessica Kingsley Publishers.
Rechtschaffen, A. (1971) ‘The Control of Sleep.’ In W.A. Hunt (ed) Human Behavior and its Control. Cambridge, MA: Shenkman Publishing Company, Inc.
Scrivner, L. (2012) ‘That Sweet Secession.’ In A. Green and A. Westcombe (eds) Sleep: Multiprofessional Perspectives. London: Jessica Kingsley Publishers.
Sidis, B. (2010) An Experimental Study of Sleep (Kindle edition). Evergreen Review Inc. (Original work published 1909).
Zimmer, C. (2005) The Soul Made Flesh. London: Arrow Books.

Professional and Therapeutic Boundaries in Forensic Mental Health Practice

By Dr. Anne Aiyegbusi and Gillian Kelly, editors of the new volume in the Forensic Focus Series, Professional and Therapeutic Boundaries in Forensic Mental Health Practice.

Photo: Dr. Anne Aiyegbusi (left) and Gillian Kelly.

The word ‘boundaries’ is used a lot in forensic mental health practice. This is not surprising given that by definition the offender populations who constitute the client groups in forensic services have breached boundaries in serious ways. It is also clear that forensic populations include a large percentage of people who have also had their personal and bodily boundaries breached in traumatic ways during their early development. 

When groups of people with these backgrounds are locked up together in secure settings where they feel disempowered, restricted and themselves to be victims of the system, the task professionals have of establishing and maintaining safe boundaries is a challenging one. Although there is little research evidence available, a picture emerges from clinical practice that suggests there are complex gender issues at play with regard to boundary violations in forensic settings. Indeed, if we turn to newspaper reporting in the United Kingdom we will find that there are regular stories of female staff accused of sexual relationships with male patients in secure services. 

A complicating factor that emerges in forensic services is that clients have a combination of vulnerability and risk. Clients may be vulnerable to being abused and at risk of abusing. Sometimes it is not easy to separate vulnerability from risk, especially when clients are high profile or severe offenders. Working with this combination and maintaining balance is a particularly delicate task.

This book provides detailed accounts of therapeutic practice in all forensic settings, explaining exactly how clinicians from a range of different disciplines work with complex boundary phenomena in the context of nursing, psychotherapy, arts therapies, family therapy and psychology. Importantly, the perspectives of victims and perpetrators of professional boundary violations in psychological therapies are included in this book which provides an insight into the impact of professional corruption on clients who enter into therapy to recover but end up being used by their therapists. The perspective of perpetrators is included by reference to a service in the USA specifically for boundary violating professionals.

This book is important because establishing and maintaining professional and therapeutic boundaries in forensic mental health practice is crucial and yet shockingly there is little available literature to support clinicians in the complex task they have. In particular, there is a complete absence of guidance which elucidates the reality of day to day clinical work with its difficult balancing acts, slippery concepts, confrontation with offence paralleling  behaviours and being tested, pushed and pulled out of professional role. 

This book is a valuable resource for clinicians of all disciplines and grades who practice on the front line of forensic practice because it clarifies that they are not alone in facing the boundary challenges inherent in this work. The key roles played by supervision and reflective practice are emphasised throughout the book. Training in boundaries work is also referred to. These are the tools that enable effective clinical work which is important information for managers and academics organising services and providing education for front line workers in order that they ensure their products are sufficiently robust.