“I just can’t, I am frightened for my safety, I don’t know how to work with her” Practitioners’ experiences of client violence and recommendations for future practice

To what extent is the therapist-client relationship damaged following client perpetuated violence and what steps can we take to diminish its impact? Much of the information we have on client violence comes from multiple mental health disciplines in the US and the UK over the last 20-30 years and has formed a useful, though sometimes dated and sporadic, quantitative baseline to delineate a range of issues. However, there is limited systematic research on how practitioner psychologists process the violence in the course of their everyday practice and how this impacts the therapist-client dynamic. Using Interpretative Phenomenological Analysis (IPA), we explored seven therapists’ experiences of client violence across a range of work sites – acute psychiatric hospital wards, forensic hospital wards and community mental health teams. Three main themes were documented: processing the moment-to-moment experience of client violence; professional vulnerabilities and needs as a result of client violence; and the ruptured therapeutic relationship. Strategies for supporting practicing psychologists and providing continuing professional care for clients include challenging self-doubt and re-energizing professional competencies as well as repairing ourselves and repairing the therapeutic relationship. Recommendations for credentialing and regulatory bodies in relation to client violence are also highlighted.

Face matching impairment in developmental prosopagnosia

Developmental prosopagnosia (DP) is commonly referred to as ‘face blindness’, a term that implies a perceptual basis to the condition. However, DP presents as a deficit in face recognition and is diagnosed using memory-based tasks. Here, we test face identification ability in six people with DP, who are severely impaired on face memory tasks, using tasks that do not rely on memory. First, we compared DP to control participants on a standardised test of unfamiliar face matching using facial images taken on the same day and under standardised studio conditions (Glasgow Face Matching Test; GFMT). DP participants did not differ from normative accuracy scores on the GFMT. Second, we tested face matching performance on a test created using images that were sourced from the Internet and so vary substantially due to changes in viewing conditions and in a person’s appearance (Local Heroes Test; LHT). DP participants show significantly poorer matching accuracy on the LHT relative to control participants, for both unfamiliar and familiar face matching. Interestingly, this deficit is specific to ‘match’ trials, suggesting that people with DP may have particular difficulty in matching images of the same person that contain natural day-to-day variations in appearance. We discuss these results in the broader context of individual differences in face matching ability.

Are mental health services getting better at responding to abuse, assault and neglect?

Objective To determine whether staff responses to abuse disclosures had improved since the introduction of a trauma policy and training programme. Method The files of 250 clients attending four New Zealand mental health centres were audited. Results There was a significant improvement, compared to an audit prior to the introduction of the policy and training, in the proportion of abuse cases included in formulations, and, to a lesser extent, in treatment plans. There was no significant improvement in the proportion referred for relevant treatment, which remained at less than 25% across abuse categories. The proportion of neglect disclosures responded to was significantly lower than for abuse cases. Fifty percent of the files in which abuse/neglect was recorded noted whether the client had been asked about previous disclosure, and 22% noted whether the client thought there was any connection between the abuse/neglect and their current problems. Less than 1% of cases were reported to legal authorities. People diagnosed with a psychotic disorder were significantly less likely to be responded to appropriately. Conclusion Future training may need to focus on responding well to neglect and people diagnosed with psychosis, on making treatment referrals, and on initiating discussions about reporting to authorities.