"Did I bring it on myself?" An exploratory study of the beliefs that adolescents referred to mental health services have about the causes of their depression

The causal beliefs which adults have regarding their mental health difficulties have been linked to help-seeking behaviour, treatment preferences, and the outcome of therapy; yet, the topic remains a relatively unexplored one in the adolescent literature. This exploratory study aims to explore the causal beliefs regarding depression among a sample of clinically referred adolescents. Seventy seven adolescents, aged between 11 and 17, all diagnosed with moderate to severe depression, were interviewed using a semi-structured interview schedule, at the beginning of their participation in a randomised controlled trial. Data were analysed qualitatively using framework analysis. The study identified three themes related to causal beliefs: (1) bewilderment about why they were depressed; (2) depression as a result of rejection, victimisation, and stress; and (3) something inside is to blame. Although some adolescents struggled to identify the causes of their depression, many identified stressful life experiences as the cause of their current depression. They also tended to emphasise their own negative ways of interpreting those events, and some believed that their depression was caused by something inside them. Adolescents' causal beliefs are likely to have implications for the way they seek help and engage in treatment, making it important to understand how adolescents understand their difficulties.

Natural and unnatural oil slicks in the Gulf of Mexico

When wind speeds are 2-10 m s-1, reflective contrasts in the ocean surface make oil slicks visible to synthetic aperture radar (SAR) under all sky conditions. Neural network analysis of satellite SAR images quantified the magnitude and distribution of surface oil in the Gulf of Mexico from persistent, natural seeps and from the Deepwater Horizon (DWH) discharge. This analysis identified 914 natural oil seep zones across the entire Gulf of Mexico in pre-2010 data. Their ∼0.1 µm slicks covered an aggregated average of 775 km2. Assuming an average volume of 77.5 m3 over an 8-24 h lifespan per oil slick, the floating oil indicates a surface flux of 2.5-9.4 × 104 m3 yr-1. Oil from natural slicks was regionally concentrated: 68%, 25%, 7%, and <1% of the total was observed in the NW, SW, NE, and SE Gulf, respectively. This reflects differences in basin history and hydrocarbon generation. SAR images from 2010 showed that the 87 day DWH discharge produced a surface-oil footprint fundamentally different from background seepage, with an average ocean area of 11,200 km2 (SD 5028) and a volume of 22,600 m3 (SD 5411). Peak magnitudes of oil were detected during equivalent, ∼14 day intervals around 23 May and 18 June, when wind speeds remained <5 m s-1. Over this interval, aggregated volume of floating oil decreased by 21%; area covered increased by 49% (p < 0.1), potentially altering its ecological impact. The most likely causes were increased applications of dispersant and surface burning operations.

Findings of the first ANZICS conference on the role of intensive care in Rapid Response Teams

Rapid Response Teams (RRTs) are specialised teams introduced into hospitals to improve the outcomes of deteriorating ward patients. Although Rapid Response Systems (RRSs) were developed by the intensive care unit (ICU) community, there is variability in their delivery, and consultant involvement, supervision and leadership appears to be relatively infrequent. In July 2014, the Australian and New Zealand Intensive Care Society (ANZICS) convened the first conference on the role of intensive care medicine in RRTs in Australia and New Zealand. The conference explored RRSs in the broader role of patient safety, resourcing and staffing of RRTs, effect on ICU workload, different RRT models, the outcomes of RRT patients and original research projects in the area of RRSs. Issues around education and training of both ICU registrars and nurses were examined, and the role of team training explored. Measures to assess the effectiveness of the RRS and RRT at the level of health system and hospital, team performance and team effectiveness were discussed, and the need to develop a bi-national ANZICS RRT patient database was presented. Strategies to prevent patient deterioration in the 'pre-RRT' period were discussed, including education of ward nurses and doctors, as well as an overarching governance structure. The role of the ICU in deteriorating ward patients was debated and an integrated model of acute care presented. This article summarises the findings of the conference and presents recommendations on the role of intensive care medicine in RRTs in Australia and New Zealand.

"Just like talking to someone about like shit in your life and stuff, and they help you": Hopes and expectations for therapy among depressed adolescents

OBJECTIVE

To explore hopes and expectations for therapy among a clinical population of depressed adolescents.

METHOD

As part of a randomized clinical trial, 77 adolescents aged 11-17, with moderate to severe depression, were interviewed using a semi-structured interview schedule. The interviews were analysed qualitatively using framework analysis.

RESULTS

The findings are reported around five themes: "the difficulty of imagining what will happen in therapy," "the 'talking cure,'" "the therapist as doctor," "therapy as a relationship," and "regaining the old self or developing new capacities."

CONCLUSIONS

Differing expectations are likely to have implications for the way young people engage with treatment, and failure to identify these expectations may lead to a risk of treatment breakdown.

Countertransference before Heimann: an historical exploration

Received wisdom on the history of countertransference rests on two assumptions: Freud said little about countertransference, and what he did say focused on its role as an impediment to analytic work; the emergence in the 1950s of a conception of countertransference as a crucial beneficial component of psychoanalysis was revolutionary and innovative. Both assumptions are questionable. Detailed examination of Freud's public and private discussions of countertransference reveals that he recognized much of its potential value, as well as its pitfalls, and suggested that the analyst's contributions should be based on spontaneous affect, measured out consciously. He was aware of the problematic nature of countertransference, calling for a paper on countertransference even while cautioning against its public presentation. His remarks, particularly in letters, taken together with the work of Ferenczi and other early contributors, show that the pre-1950s literature on countertransference prefigured much current debate on the topic.