‘Momma bear wants to protect’: Vicarious parenting in practitioners working with disturbed and traumatised children

Skills and knowledge therapists need to work with foster youth and families: According to key stakeholders in child welfare

The current study relied on community-based participatory action research and qualitative methodology to explore the necessary skills and knowledge psychotherapists need to work effectively with foster youth and their families. In this study, the research team conducted interviews and focus groups with stakeholders (n = 48) in child welfare to learn how to support therapeutic relationships with foster youth clients. Using qualitative content analysis, the research team identified eight categories for needed knowledge and/or skills, such as collaboration with and inclusion of others in a client's system; flexibility and open-mindedness to individualize care follow the client's lead; and a solid understanding of trauma and attachment supported by therapist training and regular consultation specifically around foster care. These findings offer tangible suggestions for skills that psychotherapists can learn and practice in order to support beneficial mental health services for foster youth.

Ingredients of successful therapeutic relationships with foster youth according to key stakeholders in child welfare: A grounded theory analysis

Foster youth reportedly have a significant need for mental health services and the quality of the therapeutic relationship can influence service engagement. We employed grounded theory methods to conduct interviews and focus groups with 48 key stakeholders in child welfare to deepen our theoretical understanding of therapeutic relationships with foster youth. The central theory that emerged was that a successful therapeutic relationship is an essential ingredient of the healing process for current and former foster youth. Participants identified hindrances to a successful therapeutic relationship, such as when therapist mishandles countertransference or inappropriately uses self-disclosure, as well as what therapists can do to build a successful therapeutic relationship, such as when a therapist fosters a secure attachment and promotes client agency. The findings offer insight into some of the important facets of building and maintaining a trusting and successful therapeutic relationship with current and former foster youth.

Working Relationally with Adolescents Who Have Experienced Complex Interpersonal Trauma: an Interpretative Phenomenological Analysis

The study explores practitioners' experiences of working with adolescents with complex interpersonal trauma. Five mental health professionals were recruited via purposive and snowball sampling. Semi-structured interviews were conducted, audio-recorded and transcribed. Interpretative phenomenological analysis was employed to identify themes related to the research question. Three superordinate themes emerged: "The distance-relationship dynamic"; "The unknown self"; "Practitioners' presence". Participants reported the fragility of their relationships with clients, enhanced awareness of their professional and personal identity, and highlighted the importance of meeting their clients as persons. Results are discussed within the literature that considers the role of the person of the therapist to foster therapeutic change. Future research could explore the role of therapeutic distance, the interplay between transference-countertransference and attachment dynamics, and the relevance of practitioners' playfulness with traumatised youth. Finally, this study proposes a model of use of self as "compassion-in-action" to express practitioners' 'response-ability' to their clients' trauma as commitment to social justice.

Applying critical systems thinking to social prescribing: a relational model of stakeholder "buy-in"

BACKGROUND

Social prescribing (SP) allows health professionals to refer primary care patients toward health and wellbeing interventions and activities in the local community. Now widely implemented across the UK and adopted in other nations, questions arise concerning the modelling of present and future schemes, including challenges to full engagement encountered by stakeholders, which lie beyond the scope of traditional evaluations. Critical Systems Thinking (CST) allows for holistic analysis of fields where multiple stakeholders hold diverse interests and unequal power.

METHODS

We use CST to (a) critically examine a developing rural social prescribing scheme from multiple stakeholder perspectives and (b) present a relational model for local social prescribing schemes. Our fieldwork included 24 in-depth interviews, regular planning meetings with key stakeholders, and discussions with those involved with national and international SP landscaping. A modified grounded theory approach was used for the analysis, and to consider the core elements of social prescribing sustainability.

RESULTS

Our study confirms that local social prescribing schemes must operate with numerous stakeholder interests in mind, seeking to address real life social complexity and offer integrated solutions to multifaceted issues. Three main areas are discussed: holistic vision and boundary judgments; barriers and facilitators; relational issues and "emotional buy in". Problems for staff include selecting suitable clients, feedback and technological issues and funding and evaluation pressures. Barriers for clients include health, transport and expense issues, also lack of prior information and GP involvement. Emotional "buy-in" emerged as essential for all stakeholders, but hard to sustain. Based on our findings we propose a positive relational model comprising shared vision, confidence and commitment; motivation and encouragement, support and wellbeing focus, collaborative relationships, communication and feedback, access to information /resources, learning in and from action, with emotional "buy-in" at its heart.

CONCLUSION

Those implementing social prescribing in different localities inevitably face hard choices about what and whom to include. Research on the sustainability of social prescribing remains limited, studies are required to ascertain which "holistic" models of social prescribing work best for which communities, who are the main beneficiaries of these approaches and how "buy-in" is best sustained.