Tavistock Institute

Abstract This chapter suggests that people inhabit living bodies that are dynamic systems developing in relationship with their social and historical context. There is a live relationship between societal norms and expectations of how our bodies are defined, what we do with them, and how power is exercised. Throughout history different practices have been variously criminalized, pathologized, marginalized, celebrated, and legitimized. Current debate creates a dichotomy between personal relationships based on individual choice rather than on gendered roles. The former risks ignoring societal and political power dynamics, and the latter perpetuates norms established within the heterosexual nuclear family. Meg-John Barker’s reworking of Gayle Rubin’s charmed circle offers a more progressive, less reductionist model. This chapter argues that sexuality and gender have not always attracted the attention and the debate they require within the cognitive analytic therapy (CAT) community. A substantial shift is critical for CAT therapists to develop specific and up-to-date competencies in this field. An approach informed by diversity, and intersectional thinking and adopting affirmative practice provides the foundation. Understanding the relationship to these issues enables the therapist to be consciously aware of what they are bringing to the therapeutic process and of how different factors intersect in shaping the relationships of power in the therapy room. There is a need to promote collaborative, consensual practices that normalize differences without invalidating the unique ways in which people define and express their embodied presence in the world.

How to Be Intimate with 15,000,000 Strangers is an investigation into how the fields of mental health and media can work together more collaboratively. Drawing upon his extensive experience in media psychoanalysis, Brett Kahr explores how a rich collaboration with radio, television, film, and other forms of public outreach can be accomplished while also embracing the weight and gravitas of depth psychology. In addition to describing his work as Resident Psychotherapist at the B.B.C., Kahr also examines the ways in which references to the media enter the consulting room and provide clinicians with important insights about hidden aspects of the minds of their patients. Moreover, he investigates the historical hesitancy of psychoanalysts – experts in confidentiality – to engage with such a public arena as the media, thus providing important insights about how one can collaborate broadly and loudly while also maintaining one’s ethical commitment to silence and privacy. This book will be of interest to psychoanalysts, psychotherapists, and anyone intrigued by the intersection between media and psychoanalysis.

The question of working psychotherapeutically with high conflict and domestically abusive couples is one that continues to raise anxieties within the field. Embracing a relational approach offers an alternative perspective to the more familiar individual-based treatment interventions. Drawing on my therapy with a married couple who presented in a crisis following an abusive incident, I will outline how I approached the assessment, my understanding of their presenting problem and the basis on which the therapy was conducted. During the eight months of treatment, the couple had frequent breakdowns in communication, and I found myself drawing on a range of mentalization-based techniques that supported and maintained the working alliance. Helping the couple break the damaging effects of the abuse, which was seriously affecting them and impacting their children, provides a particular focus for this submission. The rationale for undertaking couple therapy in situations of domestic violence and abuse was examined. The dynamic elements of theory underpinning practice, together with mentalization-based techniques designed to tackle disregulated states of mind that may lead to violent and abusive exchanges, were considered through the presentation of a case example.

Since the 1990s, the framework of Theory of Change has been used to address complex contexts of intervention especially in relation to planning and evaluating social practice. Theory of Change can be defined as the systematic and cumulative study of the links between the activities, outcomes, and context of an intervention. The aim of this paper is to explore through a case study whether Theory of Change can support more strategic approaches in design. In particular, the paper examines how Theory of Change was applied to DESIGNSCAPES - a project oriented, among other things, toward offering a supporting service for all those city actors interested in using design to develop urban innovation initiatives that tackle complex issues of broad concern.

ABSTRACT Drawing upon his work with psychotic and disabled patients, the author explores the often shocking and, at times, nauseating ways in which extremely traumatised individuals will communicate through the evacuation of bodily fluids such as mucus, spittle, urine, menstrual blood and, even, semen and faeces. Richly illustrated with several clinical vignettes, the author proposes a four-stage model, outlining the ways in which each psychotherapist must survive his or her countertransferential reaction of stupefaction and then navigate towards a state of toleration. Subsequently, each practitioner must develop the capacity to formulate an interpretation of the unconscious meaning of bodily communication, while, ultimately, working towards an eventual psychological resolution.

AimTo report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with pseudoexfoliative glaucoma (PXG).MethodsProspective, interventional, non-comparative case series. A total of 103 eyes from 84 patients with PXG were enrolled to undergo a 360-degree ab interno trabeculotomy with gonioscopic assistance using either a 5.0 polypropylene suture or an illuminated microcatheter with up to 24 months of follow-up. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, success rate (IOP reduction ≥20% from baseline or IOP between 6 and 21 mm Hg, without further glaucoma surgery) and complication rate.ResultsMean preoperative IOP was 27.1 mm Hg (95% CI 25.5 to 28.7) using 2.9 (SD 1.1) glaucoma medications which decreased postoperatively to 13.0 mm Hg (95% CI 11.5 to 14.4) and 1.0 (SD 1.1) medications at 24 months (p<0.001). Success rate was 89.2% at 24 months of follow-up, and complication rate was 2.9%.ConclusionAt 24 months of follow-up, our results for GATT in PXG demonstrate that this conjunctival sparing procedure effectively lowers IOP and reduces the medications with a low complication rate, in this relatively aggressive glaucoma subtype.

This article explores the usefulness of Contribution Analysis to understand and assess the outcomes and impacts of emergent, large-scale and transformational change processes. As these take place over long periods of time and at national if not supra-national scale, they amplify some of the key challenges complex interventions pose to evaluators, most notably that of the emergence of activities and outcomes. While Contribution Analysis is discussed in the literature as useful for the evaluation of complex change processes, it is not usually recommended for experimental and emergent interventions. This article draws on the authors’ experience of using Contribution Analysis in one such case and explores the relative merits of the method for large-scale/transformational change interventions generally.

The dynamics of change in urban systems are observed interrogating how the interplay between design and the urban dimension can contribute to sparking or fastening the various pathways of innovation. Embedment is a key concept to understand those processes, which unfold mainly as co-evolution processes. The act of embedding represents a design endeavour complementing and empowering the efforts on the innovation axes of meaning and function (see the 3D model), which generates value by infrastructuring practices (design-enabled resource aggregation) targeting critical challenges and problems of the contemporary (urban) world.