Reflexive methodology - new vistas for qualitative research: Media Reviews

Preface (1999) Preface (1990) 1. Subjects of Sex/Gender/Desire I. 'Women' as the Subject of Feminism II. The Compulsory Order of Sex/Gender/Desire III. Gender: The Circular Ruins of Contemporary Debate IV. Theorizing the Binary, the Unitary and Beyond V. Identity, Sex and the Metaphysics of Substance VI. Language, Power and the Strategies of Displacement 2. Prohibition, Psychoanalysis, and the Production of the Heterosexual Matrix I. Structuralism's Critical Exchange II. Lacan, Riviere, and the Strategies of Masquerade III. Freud and the Melancholia of Gender IV. Gender Complexity and the Limits of Identification V. Reformulating Prohibition as Power 3. Subversive Bodily Acts I. The Body Politics of Julia Kristeva II. Foucault, Herculine, and the Politics of Sexual Discontinuity III. Monique Wittig - Bodily Disintegration and Fictive Sex IV. Bodily Inscriptions, Performative Subversions Conclusion - From Parody to Politics

Postmodern Subjects, Postmodern BodiesThinking Fragments: Psychoanalysis, Feminism, and Postmodernism in the Contemporary WestYearning: Race, Gender, and Cultural PoliticsGender Trouble: Feminism and the Subversion of Identity

Background
Psychotherapy is regarded as the first-line treatment for people with borderline personality disorder. In recent years, several disorder-specific interventions have been developed. This is an update of a review published in the Cochrane Database of Systematic Reviews in 2006.

Objectives
To assess the effects of psychological interventions for borderline personality disorder (BPD).

Search methods
We searched the following databases: CENTRAL 2010(3), MEDLINE (1950 to October 2010), EMBASE (1980 to 2010, week 39), ASSIA (1987 to November 2010), BIOSIS (1985 to October 2010), CINAHL (1982 to October 2010), Dissertation Abstracts International (31 January 2011), National Criminal Justice Reference Service Abstracts (15 October 2010), PsycINFO (1872 to October Week 1 2010), Science Citation Index (1970 to 10 October 2010), Social Science Citation Index (1970 to 10 October 2010), Sociological Abstracts (1963 to October 2010), ZETOC (15 October 2010) and the metaRegister of Controlled Trials (15 October 2010). In addition, we searched Dissertation Abstracts International in January 2011 and ICTRP in August 2011.

Selection criteria
Randomised studies with samples of patients with BPD comparing a specific psychotherapeutic intervention against a control intervention without any specific mode of action or against a comparative specific psychotherapeutic intervention. Outcomes included overall BPD severity, BPD symptoms (DSM-IV criteria), psychopathology associated with but not specific to BPD, attrition and adverse effects.

Data collection and analysis
Two review authors independently selected studies, assessed the risk of bias in the studies and extracted data.

Main results
Twenty-eight studies involving a total of 1804 participants with BPD were included. Interventions were classified as comprehensive psychotherapies if they included individual psychotherapy as a substantial part of the treatment programme, or as non-comprehensive if they did not.

Among comprehensive psychotherapies, dialectical behaviour therapy (DBT), mentalisation-based treatment in a partial hospitalisation setting (MBT-PH), outpatient MBT (MBT-out), transference-focused therapy (TFP), cognitive behavioural therapy (CBT), dynamic deconstructive psychotherapy (DDP), interpersonal psychotherapy (IPT) and interpersonal therapy for BPD (IPT-BPD) were tested against a control condition. Direct comparisons of comprehensive psychotherapies included DBT versus client-centered therapy (CCT); schema-focused therapy (SFT) versus TFP; SFT versus SFT plus telephone availability of therapist in case of crisis (SFT+TA); cognitive therapy (CT) versus CCT, and CT versus IPT.

Non-comprehensive psychotherapeutic interventions comprised DBT-group skills training only (DBT-ST), emotion regulation group therapy (ERG), schema-focused group therapy (SFT-G), systems training for emotional predictability and problem solving for borderline personality disorder (STEPPS), STEPPS plus individual therapy (STEPPS+IT), manual-assisted cognitive treatment (MACT) and psychoeducation (PE). The only direct comparison of an non-comprehensive psychotherapeutic intervention against another was MACT versus MACT plus therapeutic assessment (MACT+). Inpatient treatment was examined in one study where DBT for PTSD (DBT-PTSD) was compared with a waiting list control. No trials were identified for cognitive analytical therapy (CAT).

Data were sparse for individual interventions, and allowed for meta-analytic pooling only for DBT compared with treatment as usual (TAU) for four outcomes. There were moderate to large statistically significant effects indicating a beneficial effect of DBT over TAU for anger (n = 46, two RCTs; standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.43 to -0.22; I2 = 0%), parasuicidality (n = 110, three RCTs; SMD -0.54, 95% CI -0.92 to -0.16; I2 = 0%) and mental health (n = 74, two RCTs; SMD 0.65, 95% CI 0.07 to 1.24 I2 = 30%). There was no indication of statistical superiority of DBT over TAU in terms of keeping participants in treatment (n = 252, five RCTs; risk ratio 1.25, 95% CI 0.54 to 2.92).

All remaining findings were based on single study estimates of effect. Statistically significant between-group differences for comparisons of psychotherapies against controls were observed for BPD core pathology and associated psychopathology for the following interventions: DBT, DBT-PTSD, MBT-PH, MBT-out, TFP and IPT-BPD. IPT was only indicated as being effective in the treatment of associated depression. No statistically significant effects were found for CBT and DDP interventions on either outcome, with the effect sizes moderate for DDP and small for CBT. For comparisons between different comprehensive psychotherapies, statistically significant superiority was demonstrated for DBT over CCT (core and associated pathology) and SFT over TFP (BPD severity and treatment retention). There were also encouraging results for each of the non-comprehensive psychotherapeutic interventions investigated in terms of both core and associated pathology.

No data were available for adverse effects of any psychotherapy.

Authors' conclusions
There are indications of beneficial effects for both comprehensive psychotherapies as well as non-comprehensive psychotherapeutic interventions for BPD core pathology and associated general psychopathology. DBT has been studied most intensely, followed by MBT, TFP, SFT and STEPPS. However, none of the treatments has a very robust evidence base, and there are some concerns regarding the quality of individual studies. Overall, the findings support a substantial role for psychotherapy in the treatment of people with BPD but clearly indicate a need for replicatory studies.

/pdf/psychological-therapies-for-people-with-borderline-1e6z7epg5c.pdf

Psychological therapies for people with borderline personality disorder

Psychoanalysis, individual psychology, gestalt therapy, client-centered counseling, faith healing, hypnosis, encounter groups, transactional therapy, behavior modification, and existentialist analysis are some of the different treatments available for unhappy, fearful, and anxious sufferers. The proponents of each method offer a theoretical explanation of their rationale and report sizable numbers of successes. Which is the best method? Which is the most correct theory? Are any of them of any value? Or should everyone be treated with pills or diet or surgery? Jerome D. Frank, professor of psychiatry at Johns Hopkins, believes there is real value in psychotherapy, which he describes as treatment that "relies primarily on the healer's ability to mobilize healing forces in the sufferer by psychological means." However, he believes that the principal value lies not in the postulated theoretical bases but in factors that are common to all the various forms of therapy. He points out that all patients

Persuasion and Healing: A Comparative Study of Psychotherapy

Music In Everyday Life

Simon Procter is a music therapist working within non-medical mental health services in London, UK. He is Director of the national Nordoff Robbins training programme for musicians wishing to train as music therapists – the Master of Music Therapy (Nordoff Robbins): Music, Health, Society – with teaching bases in London and Manchester. He is also a member of the Sociology of the Arts (SocArts) group at Exeter University, led by Professor Tia DeNora.

Resource-Oriented Music Therapy in Mental Health Care

Background The perspective of mental health recovery is increasingly shaping mental health care policies. Current texts in music therapy identify the importance of this critical and user-oriented perspective, but the relevance and implications for music therapy need to be outlined. Objective This study explores service users' experiences of music therapy in mental health care, and the potential role of music therapy in the development of recovery-oriented service provision. Methods We conducted a qualitative meta-synthesis of studies examining service users' experiences in music therapy; included were 14 studies with a total of 113 participants. Both first-hand account of participants and the researchers' representations of such statements were taken into account in the analysis. Findings A taxonomy of four areas of users' experiences was identified: "having a good time;" "being together;" "feeling;" and "being someone." These core categories point towards music therapy as an arena that can be used by persons with mental health problems in their personal and social recovery process. Music therapy can contribute to the quality of mental health care by providing an arena for stimulation and development of strengths and resources that may contribute to growth of positive identity and hope for people with mental illness. Conclusions The findings from this meta-synthesis indicate that the provision of music therapy closely resembles recognized benefits of a recovery-oriented practice. Awareness of users' self-determination and the development of a strength-based and contextual approach to music therapy that fosters mutual empowering relationships are recommended.

/pdf/toward-understanding-music-therapy-as-a-recovery-oriented-4rcpoepd55.pdf

Toward Understanding Music Therapy as a Recovery-Oriented Practice within Mental Health Care: A Meta-Synthesis of Service Users' Experiences.

When doing a randomised controlled trial, concrete and observable a–priori definitions and descriptions of therapy procedures are usually considered necessary for study results to be replicable, and also to enable comparisons between different therapy approaches. However, most music therapy approaches in the field of mental health cannot be defined with a fixed therapy manual without serious danger of losing their therapeutic integrity. Manuals defining therapeutic principles which can be applied flexibly, rather than a fixed set of techniques, might be more appropriate. In this article we will present the rationale for a therapy manual developed for the purpose of a randomized controlled trial on a contextual approach to resource–oriented music therapy. The article focuses upon possible ways of dealing with the tensions and contrasts that exist between the contextual and resource-oriented perspectives and the need for pre–structured definitions to meet the standards of the rigorous quantitative research ...

Research Rigour and Therapeutic Flexibility: Rationale for a Therapy Manual Developed for a Randomised Controlled Trial

In this article the clinical and political implications of empowerment philosophy are elaborated with music therapy practices in mental health services as the point of departure. The concept and the philosophy of empowerment are discussed through a review of literature from community psychology, sociology and feminist psychology. Empowerment is connected to a resource–oriented perspective on music therapy that implies a focus upon the client's strengths and potentials and emphasizes the importance of collaboration and equality in the relationship between therapist and client.

Therapy as Empowerment

In this article the clinical and political implications of empowerment philosophy are elaborated with music therapy practices in mental health services as the point of departure. The concept and the philosophy of empowerment are discussed through a review of literature from community psychology, sociology and feminist psychology. Empowerment is connected to a resource-oriented perspective on music therapy that implies a focus upon the client's strengths and potentials and emphasizes the importance of collaboration and equality in the relationship between therapist and client.

Randi Rolvsjord

Papers

Resource-Oriented Music Therapy in Mental Health Care

Toward Understanding Music Therapy as a Recovery-Oriented Practice within Mental Health Care: A Meta-Synthesis of Service Users' Experiences.

Research Rigour and Therapeutic Flexibility: Rationale for a Therapy Manual Developed for a Randomised Controlled Trial

Therapy as Empowerment

Therapy as Empowerment: Clinical and Political Implications of Empowerment Philosophy in Mental Health Practises of Music Therapy