An exploratory study of the experiences of deceased-donor liver transplant recipients and their need for psychotherapeutic support

AIMS AND OBJECTIVES

This study aimed to explore the experiences of liver transplant recipients during their journey through the treatment and their need for psychotherapeutic support related to this process.

BACKGROUND

Over time, measures of survival and quality of life in liver transplant recipients have continued to improve but their emotional needs remain under explored. In the longer-term recovery from transplantation, the focus shifts from physical health to psychological health. In the UK, there are no known embedded adult psychological services in liver transplant centres to react to this need.

DESIGN

A qualitative descriptive design was used.

METHODS

Grounded theory analysis was used to study the narratives of six adult liver transplant recipients. Through a process of coding, conceptual categories were established to describe the participant experiences. The study adhered to the EQUATOR checklist, SRQR.

RESULTS

Four categories emerged that were related to the experience of liver transplantation for the recipients. These were a process of adjustment, the phenomenon of waiting, liver transplant as a transformative experience and on the value of support. The participants identified a lack of psychotherapeutic support provided by the liver transplant service and felt that an embedded psychotherapeutic service would promote accessing such support during challenging times.

CONCLUSION

Through the process of liver transplantation, recipients experience challenges with adjustment, waiting, feeling transformed and they value support with these feelings. In correlation with other studies, the findings of this study highlight the need for providing psychotherapeutic support within liver transplant services.

RELEVANCE TO CLINICAL PRACTICE

The study provides evidence to support recommendations for a conjoined psychotherapy service within liver transplant services to support patients with their holistic needs.

Constructing positive narrative identities in a forensic setting: a single case evaluation of phototherapy

PURPOSE

The purpose of this paper is to evaluate the use of a phototherapeutic technique called "Talking Pictures" within the forensic setting. This approach involves the use of a set of photographs to facilitate clients' disclosure, self-growth and promote the development of positive self-narratives. The use of art therapies and the construction of adaptive identity narratives have been proven to support desistance and increase resocialization in the prison population.

DESIGN/METHODOLOGY/APPROACH

A 42-year-old Italian male offender was met for six therapy sessions and invited to talk about his past, present and future through the use of photographs. Session transcripts were analysed using the software for linguistic analysis T-LAB.

FINDINGS

Results show a progression in the language used during the sessions: in the beginning the client uses a denotative language with many concrete nouns and no emotional words, in subsequent sessions his speech begins to assume more symbolic connotations and emotional words are used to describe past traumas as well as to find new meanings to present events. Moreover, the fixity of the client's self-image is contrasted with the emergence of new sides to his personality encompassing agency and self-worth.

RESEARCH LIMITATIONS/IMPLICATIONS

The study is based on a single case, therefore results cannot be generalised to the prison population; moreover, the absence of any follow-up and standardized measurements of the client's progression should be addressed by future research by both involving larger samples and including follow-up and quantitative measures of the study results.

PRACTICAL IMPLICATIONS

The paper provides details on an innovative technique that might be used to explore the offenders' goods and values and to develop truly redemptive rehabilitation programmes.

ORIGINALITY/VALUE

This paper adds to the scant literature on phototherapy in prisons and connects it with a reflection on desistance indicating that phototherapeutic interventions might be used to promote positive self-narratives, thus increasing desistance.

Psychotherapy and despair in the prison setting

PURPOSE

The purpose of this paper is to outline research which aimed to explore psychotherapists' experience of working with despair, in the UK prison setting, through a qualitative phenomenological approach. Within the forensic psychological literature, despair is considered a pathology, associated with suicide and self-harm, resulting from the prisoners histories and the coercive prison setting. In turn, therapeutic writings outline the importance of therapy in the prison setting with despair in providing coping skills, containment and learning opportunities for the prisoners involved.

DESIGN/METHODOLOGY/APPROACH

Within the study, ten psychotherapists were interviewed as to their experience of working with clients in despair in the prison setting. The data were analysed via the phenomenological research method Empirical Phenomenological Analysis (EPA), and a secondary analysis through reverie.

FINDINGS

Through the analysis by EPA, despair emerged in the prison setting as a destabilising phenomenon to which there was no protocol for working with it. Participants also described the prisoners' despair and the despairing prison setting, touching on their own sense of vulnerability and despair. However, drawing on the secondary analysis by reverie, the researcher also became aware of how the phenomenon of despair emerged not simply through the said, but also through the intersubjective.

ORIGINALITY/VALUE

It was therefore through the secondary analysis by reverie that the importance of the attendance to aspects of intersubjectivity in prison research emerged. This paper contributes to the therapeutic writings on despair in the prison setting, alongside holding implications for qualitative research in the prison setting.

The implications of Kristeva's notion of the abject in understanding the significance of therapeutic knowledge and practice in mental health nursing

Mental health nursing knowledge is largely excluded in certain key clinical guideline groups despite nursing practice being so important to service users. This exclusion may be because mental health nurses work close to what cannot be spoken of easily, or at all--the abject. Good mental health nursing practice depends on the individual person of the mental health nurse rather than any knowledge frameworks. Education should focus on relational aspects of practice to develop this and to define the core identity of mental health nursing as a therapy. This paper discusses therapeutic knowledge and practice in mental health nursing through Kristeva's notion of the abject as that which is the other side of language, closely linked to the feminine space of the chora. The chora is a provisional, stable space, associated with the mother's body, where the first possibility of signification can take place. Mental health nursing is a therapeutic practice that draws on knowledge that is practical, tacit, empirical, embodied and intuitive, as well as knowledge that is regarded here as beyond the tacit; the latter indicating an encounter with the abject. Mental health nursing as a practice potentially places an extraordinary ethical onus on the individual nurse in his/her relations with patients and indicates that it is the person of the nurse who is therapeutic rather than any knowledge framework, with major implications for education and professional identity. The presence of mental health nursing practice at the heart of the mental health care system, while effectively being ignored as a treatment by the National Institute for Health and Care Excellence, embodies a critique of the currently dominant evidence-based paradigm.

Working with despair: a phenomenological investigation

OBJECTIVES

Psychotherapy as an appropriate treatment for clients in despair is an important area of inquiry, particularly given its problematic nature in the therapy and the resulting impact on the therapeutic relationship. This study aimed to explore how psychotherapists experience working with a client in despair through a phenomenological investigation.

DESIGN

A phenomenological epistemology and methodology was adopted as the study was focused on understanding the phenomenon in terms of the participant's meanings of the lived situation.

METHOD

In-depth, semi-structured interviews were conducted with eight accredited psychotherapists who had worked with clients in despair. The interviews were transcribed and analysed using the method of Empirical Phenomenological Analysis (EPA).

RESULTS

Four main themes emerged from the analysis: Psychotherapist's experience of client's despair, Evocation in the psychotherapist, Therapeutic ways of responding, and Supporting the psychotherapist.

CONCLUSIONS

The phenomenological findings inform and support the idea of a client's despair as something that challenges the psychotherapist personally and professionally. With implications for practice, the findings also suggest that in order to prevent the despair from encompassing the psychotherapist, they must locate a therapeutic balance; one that allows them to be with the client's despair, whilst allowing a certain degree of distance from the despair which may enable the psychotherapist to consider hope and to see the client's situation from different perspectives.