European Journal Of Psychotherapy & Counselling, Jan 2, 2017
Abstract This paper explores critical incident management in an Irish adult public mental health ... more Abstract This paper explores critical incident management in an Irish adult public mental health services with a population catchment area of approximately 245,000 people. Data were collected by non-participant observation, informal opportunistic interviews and formal psychoanalytic interviews. The amassed data were analysed using a Freudian/Lacanian framework. Findings indicated that due to the unconscious influence of the group, some critical incidents arise from staffs’ lack of consistent engagement with patients and failure to recognise or tolerate overwhelming levels of anxiety. Some critical incidents were managed by the imposition of restrictions or pseudo-treatment reflecting impatience, guilt, hatred and despair which compromises care. Incidents of acting out by service occupants were a consequence of the failure to work with transference. Staff interventions mirror patient and their family’s behaviours resulting in rejection, dismissal and banishment. Critical incidents may be more manageable if staff were provided with appropriate supports enabling them to operate differently: by better accepting negative feeling towards patients and learning transference management skills. The patient–staff relationship needs to be reconsidered in the light of two conclusions: firstly, that all staff are suffering from a constitutional lack to utilise their natural qualities to manage transference or more likely, membership of the group unconsciously prohibits the use of this natural skill.
European Journal Of Psychotherapy & Counselling, Jul 3, 2018
Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicid... more Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicide and pose a range of challenges for clinicians. Targeted interventions are required. Acceptability, the perceived appropriateness of an intervention, is associated with successful implementation, engagement and effectiveness of interventions. Despite the advantages of group interventions, there is limited research into the acceptability of groups with this population. Using Interpretative Phenomenological Analysis, this paper reports on facilitators' experiences (n = 9) of the acceptability of a therapeutic group intervention (PISAa Psychoeducational/psychosocial Intervention for persons who make recurrent Suicide Attempts). Analysis of focus group data revealed how involvement with the intervention profoundly influenced facilitators' perceptions of and approach to their work with this client group. They embraced the model, developed a deeper appreciation of clients' resources and became unburdened from sole responsibility for the clients, the therapeutic process and outcomes. PISA provided a model that helped facilitators to work in a focused, compassionate and creative manner as they addressed the central concern of these clients, their suicidal desire, with newly found confidence and eagerness. PISA was experienced as acceptable to facilitators as it was useful to them and deemed appropriate and beneficial to the target population.
Despite the important role psychotherapy supervision plays in the professional development of psy... more Despite the important role psychotherapy supervision plays in the professional development of psychotherapists, research has proven supervision to be, at times, problematic and challenging (Ladany et al., 2013). There are different conceptualisations around problematic supervision (Gray et al., 2001; Nelson & Friedlander, 2001; Ramos-Sanchez et al., 2002). A widely researched notion of problematic supervision, proposed by Ellis (2001) and Ellis et al. (2014), considers problematic supervision to be inadequate or harmful. Inadequate supervision occurs when the supervisor is unable to promote the supervisee's professional functioning and the supervision is therefore ineffective, while harmful supervision may result from inappropriate actions by the supervisor that may cause psychological and emotional harm to the supervisee (Ellis, 2010). Evidence shows that problematic supervision is internationally common among psychotherapists. A comparative, cross-cultural study (Ellis et al., 2015), focused on supervisees involved in the mental health context (e.g. counselling/psychotherapy), found that 69% and 79% of supervisees in the United States (US) and the Republic of
This study explored psychoanalytic supervisees’ conceptualization of good supervision. Fourteen r... more This study explored psychoanalytic supervisees’ conceptualization of good supervision. Fourteen registered psychoanalytic psychotherapists recognized by the Irish Council for Psychotherapy were int...
in Ireland and Evidence from the International LiteratureDublin Published by the Stationery Offic... more in Ireland and Evidence from the International LiteratureDublin Published by the Stationery Office. To be purchased directly from the
This paper examines the subject of division in contemporary Ireland. Contrasting recent legalisat... more This paper examines the subject of division in contemporary Ireland. Contrasting recent legalisation regarding same-sex marriage and abortion in the Republic with the socio-political approach to these matters in Northern Ireland provides an opportunity to analyse how past conflicts structure the sociopolitical landscape and are manifested in political division and social unrest. The impact of Brexit incited instability and a possible return of the border between the Republic and Northern Ireland, putting immense pressure on the political point de capiton of the Good Friday Agreement. The border that previously divided the island and had a significant impact on its inhabitants can be compared with the psychical division of a conscious/ unconscious split subject. This invites scrutiny through reading these contemporary events through a Lacanian understanding of how speaking subjects are colonized by discourses and language in a way that can symbolically oppress individuals and groups. This paper demonstrates how unconscious psychical divisions can manifest and be visible in divisive oppressive laws and can trigger a return to acrimonious conflict and violence when signifiers fail to represent past trauma. By symbolically addressing trauma, there are opportunities for conflicting political parties to coherently articulate these divisions and demonstrate unity in this period of potential transformation, paving the way to stability.
The study explored whether there are key skills that staff use to relate to service users which h... more The study explored whether there are key skills that staff use to relate to service users which help with the formation of social bonds, which in turn leads to increased levels of service user engagement and retention. Data for the study was collected through a literature review, ethnographic observation, interviews and focus groups with staff and service users. The findings showed that staff are successful at engaging and retaining service users and it is their ability to form strong social bonds which is the key to its success. This is achieved through the philosophy of the project which is made up of three central tenets: a non-punitive approach, person-centred care and trauma informed care. The person-centred care approach facilitates the formation of a partnership between staff and service users in which they work together to achieve personalised recovery goals unique to each individual service user. The non-punitive approach stipulates that service users are not punished or ju...
This paper examines the subject of division in contemporary Ireland. Contrasting recent legalizat... more This paper examines the subject of division in contemporary Ireland. Contrasting recent legalization of same-sex marriage and abortion in the Republic with the socio-political approach to these matters in Northern Ireland provides an oppor-tunity to analyse how past conflicts structure the sociopolitical landscape and are manifested in political division and social unrest. The impact of Brexit incited instability and a possible return of the border between the Republic and Northern Ireland, putting immense pressure on the political point de capiton of the Good Friday Agreement. The border that previously divided the island and had a significant impact on its inhabitants can be compared with the psychical division of a conscious/unconscious split subject. This invites scrutiny by reading these contemporary events through a Lacanian understanding of how speaking subjects are colonized by discourses and language in a way that can symbolically oppress individuals and groups. This paper demonstrates how unconscious psychical divisions can manifest and be visible in divisive oppressive laws and can trigger a return to acrimonious conflict and violence when signifiers fail to represent past trauma. By symbolically addressing trauma, there are opportunities for conflicting political parties to coherently articulate these divisions and demonstrate unity in this period of potential transformation, paving the way to stability.
This study aims to identify the health and social care needs of people with dual diagnosis and to... more This study aims to identify the health and social care needs of people with dual diagnosis and to identify the services provided to those with dual diagnosis across the addiction and mental health services in Ireland. The research was carried out in three distinct phases. Firstly a literature review identified the needs of people with dual diagnosis and examined best practice in treatment and service management. Secondly, and open forum, comprising of people and agencies involved in the care of people with dual diagnosis, was convened to consider the findings of the literature review in the light of their experience of dual diagnosis. Thirdly, a national survey was developed to review how mental health and addiction services manage dual diagnosis. The study found that there was no systematic co-ordination of care evident in any health board area, with 76% of services failing to offer a specific service for people with dual diagnosis. 75% of survey respondents support a fully integra...
Abstract This paper explores critical incident management in an Irish adult public mental health ... more Abstract This paper explores critical incident management in an Irish adult public mental health services with a population catchment area of approximately 245,000 people. Data were collected by non-participant observation, informal opportunistic interviews and formal psychoanalytic interviews. The amassed data were analysed using a Freudian/Lacanian framework. Findings indicated that due to the unconscious influence of the group, some critical incidents arise from staffs’ lack of consistent engagement with patients and failure to recognise or tolerate overwhelming levels of anxiety. Some critical incidents were managed by the imposition of restrictions or pseudo-treatment reflecting impatience, guilt, hatred and despair which compromises care. Incidents of acting out by service occupants were a consequence of the failure to work with transference. Staff interventions mirror patient and their family’s behaviours resulting in rejection, dismissal and banishment. Critical incidents may be more manageable if staff were provided with appropriate supports enabling them to operate differently: by better accepting negative feeling towards patients and learning transference management skills. The patient–staff relationship needs to be reconsidered in the light of two conclusions: firstly, that all staff are suffering from a constitutional lack to utilise their natural qualities to manage transference or more likely, membership of the group unconsciously prohibits the use of this natural skill.
Moore Gerard a Psychoanalytic Investigation of Transference Management in the Irish Adult Public Mental Health Services Phd Thesis Dublin City University, Nov 1, 2012
... To estimate the extent of the affected population likely to respond to, and participate in ..... more ... To estimate the extent of the affected population likely to respond to, and participate in ... Health Care Staff and Voluntary Sector Personnel on counselling and prison-based addiction treatment. ... Not everyone who applies to get on the treatment programme will be successful. ...
Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicid... more Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicide and pose a range of challenges for clinicians. Targeted interventions are required. Acceptability, the perceived appropriateness of an intervention, is associated with successful implementation, engagement and effectiveness of interventions. Despite the advantages of group interventions, there is limited research into the acceptability of groups with this population. Using Interpretative Phenomenological Analysis, this paper reports on facilitators’ experiences (n = 9) of the acceptability of a therapeutic group intervention (PISA – a Psychoeducational/psychosocial Intervention for persons who make recurrent Suicide Attempts). Analysis of focus group data revealed how involvement with the intervention profoundly influenced facilitators’ perceptions of and approach to their work with this client group. They embraced the model, developed a deeper appreciation of clients’ resources and became unburdened from sole responsibility for the clients, the therapeutic process and outcomes. PISA provided a model that helped facilitators to work in a focused, compassionate and creative manner as they addressed the central concern of these clients, their suicidal desire, with newly found confidence and eagerness. PISA was experienced as acceptable to facilitators as it was useful to them and deemed appropriate and beneficial to the target population.
European Journal Of Psychotherapy & Counselling, Jan 2, 2017
Abstract This paper explores critical incident management in an Irish adult public mental health ... more Abstract This paper explores critical incident management in an Irish adult public mental health services with a population catchment area of approximately 245,000 people. Data were collected by non-participant observation, informal opportunistic interviews and formal psychoanalytic interviews. The amassed data were analysed using a Freudian/Lacanian framework. Findings indicated that due to the unconscious influence of the group, some critical incidents arise from staffs’ lack of consistent engagement with patients and failure to recognise or tolerate overwhelming levels of anxiety. Some critical incidents were managed by the imposition of restrictions or pseudo-treatment reflecting impatience, guilt, hatred and despair which compromises care. Incidents of acting out by service occupants were a consequence of the failure to work with transference. Staff interventions mirror patient and their family’s behaviours resulting in rejection, dismissal and banishment. Critical incidents may be more manageable if staff were provided with appropriate supports enabling them to operate differently: by better accepting negative feeling towards patients and learning transference management skills. The patient–staff relationship needs to be reconsidered in the light of two conclusions: firstly, that all staff are suffering from a constitutional lack to utilise their natural qualities to manage transference or more likely, membership of the group unconsciously prohibits the use of this natural skill.
European Journal Of Psychotherapy & Counselling, Jul 3, 2018
Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicid... more Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicide and pose a range of challenges for clinicians. Targeted interventions are required. Acceptability, the perceived appropriateness of an intervention, is associated with successful implementation, engagement and effectiveness of interventions. Despite the advantages of group interventions, there is limited research into the acceptability of groups with this population. Using Interpretative Phenomenological Analysis, this paper reports on facilitators' experiences (n = 9) of the acceptability of a therapeutic group intervention (PISAa Psychoeducational/psychosocial Intervention for persons who make recurrent Suicide Attempts). Analysis of focus group data revealed how involvement with the intervention profoundly influenced facilitators' perceptions of and approach to their work with this client group. They embraced the model, developed a deeper appreciation of clients' resources and became unburdened from sole responsibility for the clients, the therapeutic process and outcomes. PISA provided a model that helped facilitators to work in a focused, compassionate and creative manner as they addressed the central concern of these clients, their suicidal desire, with newly found confidence and eagerness. PISA was experienced as acceptable to facilitators as it was useful to them and deemed appropriate and beneficial to the target population.
Despite the important role psychotherapy supervision plays in the professional development of psy... more Despite the important role psychotherapy supervision plays in the professional development of psychotherapists, research has proven supervision to be, at times, problematic and challenging (Ladany et al., 2013). There are different conceptualisations around problematic supervision (Gray et al., 2001; Nelson & Friedlander, 2001; Ramos-Sanchez et al., 2002). A widely researched notion of problematic supervision, proposed by Ellis (2001) and Ellis et al. (2014), considers problematic supervision to be inadequate or harmful. Inadequate supervision occurs when the supervisor is unable to promote the supervisee's professional functioning and the supervision is therefore ineffective, while harmful supervision may result from inappropriate actions by the supervisor that may cause psychological and emotional harm to the supervisee (Ellis, 2010). Evidence shows that problematic supervision is internationally common among psychotherapists. A comparative, cross-cultural study (Ellis et al., 2015), focused on supervisees involved in the mental health context (e.g. counselling/psychotherapy), found that 69% and 79% of supervisees in the United States (US) and the Republic of
This study explored psychoanalytic supervisees’ conceptualization of good supervision. Fourteen r... more This study explored psychoanalytic supervisees’ conceptualization of good supervision. Fourteen registered psychoanalytic psychotherapists recognized by the Irish Council for Psychotherapy were int...
in Ireland and Evidence from the International LiteratureDublin Published by the Stationery Offic... more in Ireland and Evidence from the International LiteratureDublin Published by the Stationery Office. To be purchased directly from the
This paper examines the subject of division in contemporary Ireland. Contrasting recent legalisat... more This paper examines the subject of division in contemporary Ireland. Contrasting recent legalisation regarding same-sex marriage and abortion in the Republic with the socio-political approach to these matters in Northern Ireland provides an opportunity to analyse how past conflicts structure the sociopolitical landscape and are manifested in political division and social unrest. The impact of Brexit incited instability and a possible return of the border between the Republic and Northern Ireland, putting immense pressure on the political point de capiton of the Good Friday Agreement. The border that previously divided the island and had a significant impact on its inhabitants can be compared with the psychical division of a conscious/ unconscious split subject. This invites scrutiny through reading these contemporary events through a Lacanian understanding of how speaking subjects are colonized by discourses and language in a way that can symbolically oppress individuals and groups. This paper demonstrates how unconscious psychical divisions can manifest and be visible in divisive oppressive laws and can trigger a return to acrimonious conflict and violence when signifiers fail to represent past trauma. By symbolically addressing trauma, there are opportunities for conflicting political parties to coherently articulate these divisions and demonstrate unity in this period of potential transformation, paving the way to stability.
The study explored whether there are key skills that staff use to relate to service users which h... more The study explored whether there are key skills that staff use to relate to service users which help with the formation of social bonds, which in turn leads to increased levels of service user engagement and retention. Data for the study was collected through a literature review, ethnographic observation, interviews and focus groups with staff and service users. The findings showed that staff are successful at engaging and retaining service users and it is their ability to form strong social bonds which is the key to its success. This is achieved through the philosophy of the project which is made up of three central tenets: a non-punitive approach, person-centred care and trauma informed care. The person-centred care approach facilitates the formation of a partnership between staff and service users in which they work together to achieve personalised recovery goals unique to each individual service user. The non-punitive approach stipulates that service users are not punished or ju...
This paper examines the subject of division in contemporary Ireland. Contrasting recent legalizat... more This paper examines the subject of division in contemporary Ireland. Contrasting recent legalization of same-sex marriage and abortion in the Republic with the socio-political approach to these matters in Northern Ireland provides an oppor-tunity to analyse how past conflicts structure the sociopolitical landscape and are manifested in political division and social unrest. The impact of Brexit incited instability and a possible return of the border between the Republic and Northern Ireland, putting immense pressure on the political point de capiton of the Good Friday Agreement. The border that previously divided the island and had a significant impact on its inhabitants can be compared with the psychical division of a conscious/unconscious split subject. This invites scrutiny by reading these contemporary events through a Lacanian understanding of how speaking subjects are colonized by discourses and language in a way that can symbolically oppress individuals and groups. This paper demonstrates how unconscious psychical divisions can manifest and be visible in divisive oppressive laws and can trigger a return to acrimonious conflict and violence when signifiers fail to represent past trauma. By symbolically addressing trauma, there are opportunities for conflicting political parties to coherently articulate these divisions and demonstrate unity in this period of potential transformation, paving the way to stability.
This study aims to identify the health and social care needs of people with dual diagnosis and to... more This study aims to identify the health and social care needs of people with dual diagnosis and to identify the services provided to those with dual diagnosis across the addiction and mental health services in Ireland. The research was carried out in three distinct phases. Firstly a literature review identified the needs of people with dual diagnosis and examined best practice in treatment and service management. Secondly, and open forum, comprising of people and agencies involved in the care of people with dual diagnosis, was convened to consider the findings of the literature review in the light of their experience of dual diagnosis. Thirdly, a national survey was developed to review how mental health and addiction services manage dual diagnosis. The study found that there was no systematic co-ordination of care evident in any health board area, with 76% of services failing to offer a specific service for people with dual diagnosis. 75% of survey respondents support a fully integra...
Abstract This paper explores critical incident management in an Irish adult public mental health ... more Abstract This paper explores critical incident management in an Irish adult public mental health services with a population catchment area of approximately 245,000 people. Data were collected by non-participant observation, informal opportunistic interviews and formal psychoanalytic interviews. The amassed data were analysed using a Freudian/Lacanian framework. Findings indicated that due to the unconscious influence of the group, some critical incidents arise from staffs’ lack of consistent engagement with patients and failure to recognise or tolerate overwhelming levels of anxiety. Some critical incidents were managed by the imposition of restrictions or pseudo-treatment reflecting impatience, guilt, hatred and despair which compromises care. Incidents of acting out by service occupants were a consequence of the failure to work with transference. Staff interventions mirror patient and their family’s behaviours resulting in rejection, dismissal and banishment. Critical incidents may be more manageable if staff were provided with appropriate supports enabling them to operate differently: by better accepting negative feeling towards patients and learning transference management skills. The patient–staff relationship needs to be reconsidered in the light of two conclusions: firstly, that all staff are suffering from a constitutional lack to utilise their natural qualities to manage transference or more likely, membership of the group unconsciously prohibits the use of this natural skill.
Moore Gerard a Psychoanalytic Investigation of Transference Management in the Irish Adult Public Mental Health Services Phd Thesis Dublin City University, Nov 1, 2012
... To estimate the extent of the affected population likely to respond to, and participate in ..... more ... To estimate the extent of the affected population likely to respond to, and participate in ... Health Care Staff and Voluntary Sector Personnel on counselling and prison-based addiction treatment. ... Not everyone who applies to get on the treatment programme will be successful. ...
Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicid... more Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicide and pose a range of challenges for clinicians. Targeted interventions are required. Acceptability, the perceived appropriateness of an intervention, is associated with successful implementation, engagement and effectiveness of interventions. Despite the advantages of group interventions, there is limited research into the acceptability of groups with this population. Using Interpretative Phenomenological Analysis, this paper reports on facilitators’ experiences (n = 9) of the acceptability of a therapeutic group intervention (PISA – a Psychoeducational/psychosocial Intervention for persons who make recurrent Suicide Attempts). Analysis of focus group data revealed how involvement with the intervention profoundly influenced facilitators’ perceptions of and approach to their work with this client group. They embraced the model, developed a deeper appreciation of clients’ resources and became unburdened from sole responsibility for the clients, the therapeutic process and outcomes. PISA provided a model that helped facilitators to work in a focused, compassionate and creative manner as they addressed the central concern of these clients, their suicidal desire, with newly found confidence and eagerness. PISA was experienced as acceptable to facilitators as it was useful to them and deemed appropriate and beneficial to the target population.
This paper explores critical incident management in an Irish adult public mental health services.... more This paper explores critical incident management in an Irish adult public mental health services. Data was collected by non-participant observation and psychoanalytic interviews and analysed using a Freudian/Lacanian framework. Critical incidents arise from staffs' lack of engagement with patients and failure to tolerate anxiety which evokes omnipotence and aggression. The study found that critical incidents are managed by the imposition of restrictions or pseudo-treatment reflecting impatience, guilt, hatred, and despair which compromises care. Incidents of acting-out by service occupants are a consequence of the failure to work with transference. Staff activities are designed to keep patients at bay and once they reach intolerable levels they stimulate patients to act-out. Staff interventions mirror patient and their family's behaviours resulting in rejection, dismissal and even banishment of the patient. Critical incidents are reducible if staff operated differently; firstly learning the skills to manage transference and secondly learning to better accept negative feeling to patients. The patient/staff subject/Other relationship needs to be reconsidered in the light of two conclusions; firstly that all staff are suffering from a constitutional lack to utilise their natural qualities to manage transference or more likely, membership of the group unconsciously prohibits the use of this natural skill.
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Papers by Gerard Moore