RESUMO
OBJECTIVE: To examine the treatment of gender dysphoria described in Bell v Tavistock (UK 2020). Bell documents the treatment and sequelae of a 16-year-old adolescent referred to the Tavistock with gender dysphoria. Her case highlights contrasts between gender affirming care and comprehensive care. CONCLUSIONS: Consistent with other western centres, in the 2010s, the Tavistock began treating patients with gender dysphoria under the 'Dutch protocol' for gender affirming care. Bell reveals concerning lapses of clinical governance influenced by activists and linked to patient harm. The recent suspension of a senior child psychiatrist from an Australian public hospital service after questioning the evidence base and ethical foundation of gender affirming care underlines the need to resolve these uncertainties to address the crisis in the treatment of gender dysphoria.
Assuntos
Disforia de Gênero , Adolescente , Feminino , Humanos , Austrália , Disforia de Gênero/terapia , Identidade de Gênero , Assistência à Saúde Afirmativa de Gênero , Doença Iatrogênica , PsiquiatrasRESUMO
OBJECTIVE: To explore some of the emerging complexities in the management of childhood gender dysphoria. CONCLUSION: The authors raise questions about the gender-affirmation approach and highlight concerns about informed consent and research ethics.
Assuntos
Disforia de Gênero/diagnóstico , Disforia de Gênero/terapia , Consentimento Livre e Esclarecido , Psiquiatria/ética , Procedimentos de Readequação Sexual/ética , Austrália , Criança , Humanos , Sociedades MédicasRESUMO
OBJECTIVES: First, to outline the paradigm change of the past 20 years that has transformed the theory and practice of child and adolescent psychodynamic psychotherapy; second, to update aspects of the current Practice Parameters for Psychodynamic Psychotherapy with Children to align with the paradigm change driven by the principles of regulation theory, relational trauma and repair, and the critical need for clinicians' self-care in trauma informed psychotherapy. CONCLUSION: The emerging neuroscience-driven paradigm of psychotherapy poses challenges for the child and adolescent psychotherapist: to embrace the new conceptual reference points as organising principles leads to an urgent need to rethink traditional diagnostic formulations and time-honoured techniques for intervention. Our child patients and their families are entitled to benefit from the translation of the new research evidence from attachment regulation theory to clinical psychotherapy. Our clinical psychotherapy should sustain the 'best-interest-of-the-child' standards for well-being while also heeding Frances Tustin's warning for therapists to avoid the 'perpetuation of an error' by overlooking recent developments from allied fields in developmental psychology and the neurosciences.
Assuntos
Psiquiatria do Adolescente/métodos , Psiquiatria Infantil/métodos , Psicoterapia Psicodinâmica/métodos , Adolescente , Psiquiatria do Adolescente/tendências , Criança , Psiquiatria Infantil/tendências , Humanos , Psicoterapia Psicodinâmica/tendênciasRESUMO
OBJECTIVE: The aim of this paper was to assess the value of a psychodynamic formulation masterclass. METHOD: Formal feedback from the presenters at a masterclass at the 2010 RANZCP Congress was obtained and arranged under different themes. RESULTS: The importance of counter-transference, reevaluating the case and supervision, witnessing the skill of an expert, the sense of containment and validation, and the importance of formulation were significant themes that emerged. CONCLUSIONS: The results provided evidence both for the importance of psychodynamic formulation and for the use of a psychodynamic formulation masterclass.
Assuntos
Psicoterapia/educação , Competência Clínica , Contratransferência , Currículo , Humanos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Planejamento de Assistência ao Paciente , Teoria Psicanalítica , Reprodutibilidade dos TestesAssuntos
Pessoas Famosas , Holocausto/história , Holocausto/psicologia , Judeus/psicologia , Suicídio/psicologia , Humanos , MasculinoRESUMO
Current controversy about diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) reflects the divergence between developmental and non-developmental approaches. While there is growing evidence for biological vulnerabilities associated with ADHD, we believe that environmental factors, including early problems in parental attachment, are also important in determining the type and timing of deficit that a child develops, the risk to academic and social performance and eventual outcome. We warn against labelling children with ADHD simply because they fulfil the cross-sectional diagnostic symptom criteria of the Diagnostic and statistical manual of mental disorders - 4th edition (DSM-IV). We advocate an integrated biopsychosocial approach to diagnosis and management with a thorough developmental assessment to identify developmental factors, such as deficits in early attachment, contributing to the presentation.