Reflective Practice: Psychodynamic Ideas in the Community

Reflective Practice
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How can I make a difference in the world? What is reflective practice? It also allows for the exploration of broader questions, such as: What are the paradigms that shape not just our own actions, but development as a whole? How does our position relate to the assumptions we make?

Are these constructive or destructive to our goals?

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How are our goals themselves limited by our paradigms? What use is reflective practice to a development professional? How can I use reflective practice in my work? Reflective practice, whether named as such or not, is already an important dimension of participatory and qualitative research gender and power analysis social constructivism and feminist standpoint theory methods of facilitation and community development work monitoring and evaluation organisational learning and change, and capacity development attention to power and relationships in aid.

Methods for reflective practice Reflective journals Keeping a reflective journal — sometimes also called a learning journal — is a way to reflect through documenting ideas, feelings, observations and visions. Keeping a reflective journal can help you to focus your thoughts and develop your ideas develop your voice and gain confidence experiment with ideas and ask questions organise your thinking through exploring and mapping complex issues develop your conceptual and analytical skills reflect upon and make sense of experiences and the processes behind them express your feelings and emotional responses become aware of your actions and strategies develop your writing style and skills, and explore different styles of writing develop a conversation with others.

Peer groups and Co-operative Inquiry A group of peers who meet on a regular basis to learn and reflect together can be a powerful supporting element of individual reflective practice. Methods from research and other fields Reflective practice, reflexivity and first person inquiry are used in research to explore issues of power and positionality and to make the role and assumptions of researchers more explicit and integral to their analysis. Hello I have been using and adapting the Personal Learning Journal in my work inside organisations to build reflective practice.

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Introduction to Reflective Practice

To do this, the idea of 'milieu' therapy is useful, this uses the contacts and routines of daily living and learning to establish such relationships. The task in many ways is one of 're-education', in which the emphasis is on the positive and safe nature of care, education and recreation. This difficult and lengthy task will also rely on the individual and group of staff challenging and interrupting unacceptable behaviour. As Arthur Barron writes:- The work of the child care staff in the living group is to give the boys and girls experiences of emotional living which will help them to understand themselves and others and to move onto family life, friendships, sexual partnership and parenthood.

In ed. Living experience therapy relies on the establishment of, and skilful use of working relationships. From the moment he or she steps into the establishment, the main worker has consciously to set about the task of providing the child with his emotional and other needs. This requires a continuous state of Winnicott's 'maternal preoccupation' with the child. Similarly, ventilation of feeling and insight giving are not of great value in themselves alone; their relevance depends on how the feeling is received and on how insight is given by the worker.

Berry , p. However, 1 would prefer to use the idea of a 'reflective' practice as it indicates the reciprocal nature of such communications. Some meanings of the term 'reflection': The word 'reflection' and the idea of a 'reflective' practice have several meanings, some of which may overlap. I will define here some of the most relevant forms of the term 'reflective' practice. These definitions are based on unpublished notes by Adrian Ward, July , with permission of the author. This seems to be a key definition.

This suggests the idea of a worker being prepared to learn about him or herself in relation to others, within the experience of the group care environment. This gives credence to that environment itself being a creative and supportive one.

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Is this what you really mean? This is a complex and powerful phenomenon and the focus of much diagnostic and interventive effort in 'therapeutic community' work. This involves the realisation, verbalisation and ultimate resolution of what has or is being enacted. These five definitions of reflective practice combine to cover what l believe to be the most relevant to individual and group work.

During the course of this dissertation the use of the term 'reflective' 19 For example, in chapters two and three, 1, 2, 3 and 4 are particularly relevant, in chapters four and five, the 'matching principle' is emphasised. Summary of Chapter This chapter has explored Winnicott's theory of early emotional development and shown its application to developing therapeutic practices in group care, particularly residential child care.

The chapter has also defined different ideas involved in the concept of a 'reflective' practice. For a further understanding of these ideas, it will be useful to explore some of the unconscious processes that occur within them. The psychoanalytic concepts of transference, counter- transference, and projective identification are particularly useful. To define counter-transference it is first necessary to define transference.

Transference, Counter-transference and Projective Identification Janet Mattinson uses the following definition of transference:- The experiencing of feelings, drives, attitudes, fantasies and defences towards a person in the present which do not befit that person but are a repetition of reactions originating in regard to significant persons of early childhood, unconsciously displaced on to figures in the present.

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Prodgers , p. This is not to say that all the worker's feelings are necessarily based on a counter-transference response. Beedell writing about transference and counter-transference, claims three reasons why these unconscious dynamics are likely to be enacted within group care:- 21 The child is to some extent separated from his home base and often resentful and pained by this so that he is likely to transfer some of his angry feelings towards his 'absent' parents or to those nearest to him, i. Beedell , p.

Psychodynamic Psychotherapy in South Africa: Contexts, Theories and Applications

She proposed that the emotional response of the therapist to the patient gave clues to the internal world of the patient's 'object relations' how the 'subject' person relates to another 'object' person and the relationship between them, this may be based on an 'internal' or 'external' perception , and commented:- The analyst's counter-transference is an important instrument of research into the patient's unconscious.

In Preston-Shoot and Agass , p. According to Preston-Shoot and Agass :- Personal counter-transference is close to Freud's original meaning and describes those reactions which are determined by the worker's own personal history and current emotional experience. On the concept of 'normal' counter-transference, Money-Kyrle started his research with the role of the therapist and wrote:- Concern for the patient's welfare comes, I think, from the fusions of two other basic drives; the reparative, which counteracts the latent destructiveness in all of us, and the parental.

Meltzer , p. I think the analyst is most aware of projective phase Meanwhile the patient is receiving effective interpretations, which can help him respond with further associations that can be understood. As long as the analyst understands them, this Klein describes this as one of the defence mechanisms active in the 'paranoid-schizoid phase' of normal 23 The infant splits off the 'hated' it follows that positive aspects are also projected parts of the self and projects them onto the mother, so that she becomes identified with them.

This process of projection is maintained in a modified form throughout a person's life, but it may become more apparent when working with clients who may be emotionally arrested at early stages of development. Such a client group may project 'bad' or unacceptable parts of themselves onto staff members, and apply pressure for them to experience the projection as 'real', or act it out impulsively.

This is not necessarily a negative phenomena, Wilfred Bion put the case that projective identification by the child, and introjective identification by the parent are both parts of the process of normal development. Within group care with a disturbed client group, these processes will be an inevitable part of treatment, and it is important that workers are able to reflect on such phenomena, and understand them.

Projective identification is then, an important aspect of such interactions. Rycroft defines projective identification as:- The process by which a person imagines himself to be inside some object external to himself. Preston Shoot and Agass , p. Three Examples This section looks at practical applications of the theories of counter-transference and projective identification.

If the disturbance of the client can be understood by using the diagnostic aspects of counter-transference, it can be 'reflected back' allowing for further understanding and emotional growth. Example 1: Counter-transference Within Psychotherapy The following example is drawn from work by a trained child psychotherapist, and gives an impression of the strength of feeling that can be created within therapy by counter-transference phenomena.

The first account by Anne Alvarez describes a therapy session with a twelve year old boy:- He began a frenzy of destructiveness unleashed mostly on the room and the furniture, only rarely on me. Gradually the hallucinations and cogwheels left him, the aggression towards the room diminished and he began to concentrate his destructive efforts more on me and my person.

But the cruelty and torture were not physical, they were mental. I had to watch him pry faeces out of his bottom and shove them up his nose. He glared into my face when he did this, and I did watch. I felt appalled, disgusted and absolutely hopeless. I think he was projecting hopelessness into me but mostly of what Money-Kyrie calls a desperate motive rather than a destructive one.

I had not sorted out these differentiations in these years, but I did make myself watch him, and so perhaps to an extent he did feel I contained some of his hopelessness for him. The severe emotional pressure that Alvarez is subjected to is managed by a personal understanding of the concepts of projection and counter-transference. This child is similar to many within group care. For workers then, there is a need for a high level of self-awareness.

The following case study from group care gives a similar example of this process. Example 2: Counter-transference in Group Care 25 The following example is taken from an account of the treatment of 'Warren' at 'Peper Harow'. In this case Warren's placement ended because staff were unable to safely contain him. Recently, a young boy whose terrifying, sadistic behaviour towards others was about to culminate in his suspension, disappeared to the art room and idly drew the picture uppermost in his mind. The picture, in red ink, was of a wolf-like head with a dagger plunged through its neck, and with tears of blood spurting from its eyes.

It was the nearest he could come to describing the confused fantasies, which in turn expressed his own fear of his uncontrolled metamorphosis into a dangerous 'wolf', his sorrow at such an identity, and his supposition that such a beast had to be destroyed. If that very limited selection of his complex feelings could be explored, many further issues would emerge from them alone.

They could concern his ambivalence about his wanting to live or die; be about his ability to confuse himself with his victims and would question whether he could only feel significant when making others feel afraid of him.

At one level of awareness, expressed through his drawing, Warren was actually communicating about his inner world. Yet, his compulsive and repeatedly sadistic behaviour towards others seemed unceasing and intolerable So, once more, he was about to be driven away by those he had frightened too often.

Rose, in ed. In keeping with the definition of counter- transference it could be said that here the staff team as 'therapist' were unable to cope with the emotional response to the patient Warren. By being unable to firstly contain their feelings, and then reflect them back, the potential for helping Warren work through his disturbance was reduced, and led to the ending of Warren's treatment. Interestingly, it would seem that in hindsight, the writing up of these events allowed a counter-transference response to develop.

Hinshelwood writes an account of a staff meeting which starts in the following way:- The general impression of disorder was intense. In the course of pouring out coffee one of the members of the team, Rose, had to go to the kitchen for some milk. On returning she complained that the kitchen staff and been disobliging and unorganised! Sheila then recalled that was not the only case of that happening recently.

Thelma said that she knew that one of the domestic staff in the 26 By this time the character of the staff meeting had changed completely. There was a unified concentration on the topic The efficiency of the group could hardly have been greater. Possible tension and difficulties which might have beset the kitchen staff were isolated and discussed. Hinshelwood , p. This was a projective identification. The staff continued to identify the troubled feelings but they no longer had to own them. Winnicott's ideas give a theory base for understanding early emotional development, and the problems created when emotional holding is insufficient.

The examples of counter-transference and projective identification, give an impression of some of the unconscious processes at play within inter- personal relationships, and may facilitate workers understanding of certain forms of individual and group behaviour within group care. The ability to contain these feelings will depend on the state of mind Bion described as 'Maternal Reverie'.

This requires the mother to deal with, and reflect on the projections. Bion"developed the idea from Melanie Klein, that a baby's original capacity for primitive thought, arises from the experience of separation from the mother's breast. The baby's first experience of loss and pain, comes from this experience of the absence of the breast 'inside it'. This can only happen in the interaction between baby and care giver. Bion calls this process 'containment'. Bion created the concept of the baby developing a capacity for 'alpha function', which, he describes, produces formative psychic development and structuring.

This becomes 'instilled' in the baby. Defining alpha function Bion writes:- It seemed convenient to suppose an alpha-function to convert sense data into alpha elements and thus provide the psyche with material for dream thoughts and hence the capacity For Bion, the mother's task is to bring the real breast to meet with the infant's preconception of it, so that the baby experiences a 'realisation'.

This account is similar to Winnicott's use of 'transitional space' in which the baby develops a creative interplay between the reality and fantasy of the breast, which ultimately helps it develop a sense of itself as a boundary between inner and outer worlds. According to Bion, then, psychic structuring only really develops with the absence of the breast. This first experience of separation and loss is a challenge to the baby's omnipotence. The infant's solution to the problem of 'no breast inside', is to project the experience into the mother, according to Brookes:- A mother with an inner world in which experiences can be contained, symbolised, dreamed and thought about, in other words, in which there is alpha-function is able to contain her experience of 'no breast inside' within this inner world by means of a process which Bion calls her 'maternal reverie.

The baby's experience is then held in the maternal psyche, where experience has long been made to make sense - presumably by every sort of psychic processing from the most primitive splitting to the most mature working through. Maternal reverie is a psychic realm where thoughts have been generated and necessitated thinking, and therefore psychic structure; and after a sojourn there, the infant's projection is transformed and can be re- introjected composed of completely different 'elements'. Brookes , p. The process of containment between mother and baby, therefore, facilitates psychic growth and development.

The application of the Theory to Group Care Settings This prototype has been applied to the formation of other relationships, e. First, containment must refer to a situation in which painful feelings, associated with unconscious fantasy, are conveyed to a worker by a client through an unconscious process of projective identification; this can be used by the worker as counter-transference information In order to help with his pain and symptoms, the worker cultivates psychic awareness of her counter-transference feelings and their possible means for her client, and links them with his past.

They both seek consciously and unconsciously to make the fantasy apparent in their relationship, where it can be seen, tolerated and thought about. For example, when a social worker has a painful experience of attack by an angry client, and is left feeling a failure, the client may unconsciously be communicating to the worker something of his own experience of personal failure, and his feelings about it. A worker trained, or helped to think, and to respond to counter-transference phenomena is in a better position to hold and reflect back the feelings of the client.

The concepts of containment and counter-transference then, become vital tools for those engaged with an emotionally damaged client group.

Quick Overview

She must be able to feel and then think consciously about what the client is communicating unconsciously. She must ask: What are my counter-transference feelings? How are they being expressed in the relationship between us? How could they link to my client's present and past? Client and worker may have to wait some time before the painful unconscious 'thought' analogue of the infantile experience of 'no breast inside' becomes apparent between them and can be talked about.

To be supported and trained properly the worker must be in a system that encourages and develops the discipline of a 'reflective' practice. In a stressful and difficult holding situation a worker must feel that the holding environment of the agency is reasonably supportive before she can create a 'thinking space' Oliver-Bellasis and Vincent in which to contain the client.

Without holding in Winnicott's sense there can be no containment in Bion's sense. For the individual worker and the team as 'therapist', an understanding of the processes of emotional containment, internal diagnosis and 'reflecting back', are critical components of effective therapeutic work. Summary of Chapter This chapter has covered aspects of the psychoanalytic theories of Klein and Bion.

I have suggested that these are relevant for an understanding, and treatment of, emotional disturbance. Examples of these processes have been presented. The next chapter explores some roles and functions of supervision and consultation, and looks at these in relation to issues of power, prejudice and dependency.

It also looks at models of supervision which are relevant to group care. In order to develop this process I felt it was important to clarify my ideas by gaining some direct insight. Consequently, I asked two practising Consultants, Dr. Eric Miller of the Tavistock Institute, and Dr. Alejandro Reyes, a psychotherapist and paediatrician, for feedback on some of the issues.

I also asked them a series of questions, some of which have been used in this section. Both Dr. Reyes have experience of working in group care settings using a psychodynamic approach see previous definition. Supervision and Consultation, Definitions, Role and Function There is general agreement between most writers that Supervision has three main functions:- a Managerial b Supportive c Educational This view is shared, for example, by Brown , and Hawkins and Shohet For the purpose of this dissertation the following definition by James Atherton is useful:- The process of talking to someone else involved in the same system about what one is doing in order to do it better.

In contrast to this, the role of the Consultant in this dissertation is that of the model of 'external staff Consultant' Millard This differentiation of 'internal' and 'external' roles is important, for reasons explained later in the thesis. Within the literature on consultation, this differentiation is sometimes blurred. For example, I would agree with Millard that Hinshelwood uses the term 'external supervisor', to describe a role which, as it is external to the organization, should be regarded as consultation. The following definition of consultation takes into account this 'external' nature, it is by Lippett :- Consultation, like supervision Supervisor is not selected by Consultant selected by consultee on supervisee, but by role in the the basis of having the relevant organization knowledge and skills Decision-making is a shared Responsibility for decisions rests responsibility with the consultee Continuous activity Time limited contract A 'free' service Sometimes a fee-paying service, or on some negotiated basis Both Lippett and Brown claim that there are differences in the power relationships between Consultants and Consultees and Supervisors with Supervisees.

These power relationships are based on the different roles and 'contracts' that both Supervisors and Consultants have with their client group. The following section explores issues of power as well as prejudice and dependency within supervision and consultation. Issues of Power, Dependency and Prejudice within Supervision and Consultation Ward draws attention to three key issues in group care work.

These are:- 4 Power 5 Prejudice 6 Dependency This chapter examines these issues within supervision and consultation. The Supervisor is usually a line manager to the Supervisee, thus there is a direct, 'managerial' function. Does this potential aspect of direct 'authority' within the relationship affect the supportive aspects of it? During my discussion with Dr. Miller we talked about this aspect of supervision.

He explained that there was a clear managerial function within supervision which literally implied overseeing the work of the worker by a senior member of staff. Using a comparison he explained that the function of supervision within industry was the same as that in the 'caring professions'.

Within industry, for example, the 'foreman' may oversee the work of the worker to make sure the job is done properly. An obstacle within the 'caring professions' is that this direct managerial function may become blurred, and consequently the power relationship is confused. This distorts issues of management and support for the worker, which may create an ambiguity of role that could be experienced as 'uncontaining' to the worker. Millard writes of this difference of power relationships between supervision and consultancy:- Most institutions have a staff hierarchy within which all staff have regular supervision with their seniors whether or not external consultancy occurs.

Thus, the kind of consultancy discussed in this paper is not a power relationship having any responsibility for the appointment grading, promotion or dismissal of staff members. Supervision has been described as being largely about containment of anxiety see Hinshelwood , p. Perhaps this suggests one of the differences in dynamic between supervision and consultation - Consultants may tend to be less possessive than Supervisors, because they are less influenced by anxiety about the impact on the organization of experienced workers moving on.

Workers may recognise this difference and respond differently to Consultants, creating both positive and negative effects in the 'matrix' of the organization. Another aspect of the potential 'limitations' of supervision worth exploring here, is that supervision 34 When a new worker joins an organization there is a clear supervision role such as explaining the way the place is run, what sort of clients are helped, how they are helped, who does what job, etc.

This means the Supervisor being responsible for the 'norms' of the organization. However, within a period of time, the team leader supervising the worker often needs to help the worker take several 'quantum leaps' ahead because of the immediate necessities of the demanding nature of the work. I reject practices that rely unnecessarily on the pathologising of individuals and families. I am also interested in work with adults, particularly that informed by recovery and narrative approaches. I am pursuing a closer engagement between clinical and community psychology and have come to believe that this can serve to rejuvinate both.

Community psychology is critical, given its role in social action, its cultural responsiveness and the fact that this tradition does not collude with neo-liberal individualism and a deficit model of psychology. Community psychology, when applied to mental health problems can support the development of participatory and emancipatory practices, beyond the individual therapy room. I am also part of a group that focusses on curriculum reform, centred around the decolonisation of clinical psychology practice and pedagogy.

We aim to acknoweldge cultures and ways of making-meaning that have been erased by the hegemony of Western approaches to therapy, particualrly by psychiatry and clinical psychology, and equip our students for allyship. Similar new collaborations are also beginning with leaders in cultural psychology, a wide field that relates intrapsychic phenomenon directly to time, place and culture. Our intrapsychic and relational experience is also a cultural, by the affective atmosphere of the street, suburbs, organisations and societies we live in.

Pathologising the sole agent within the confines of the therapy room fails to acknowledge the structural problem that are at play. Regardless, personal responsibility is still important, if not critical, in the forms of self-determination. As a teacher and supervisor I am conscious of the power differential between myself and my students and aim to foster learning and growth in a culture that is rigorous in scholarship, but also respectful and safe.

I expect my students to engage with learning at both a personal and philosophical level and at the level of technique and competence. Editorial Board, Human Arenas. An int erdisciplinary journal of psychology, culture, and meaning. This specific project is an interdisciplinary one, between clinical psychology and history. Studies that look at cultural issues related to 'mental health' or look at the relationship between culture and interiority, including ethnographic and collaborative ethnographic studies. I am interested in how culture and the psyche meet in the body, in the everyday, in cities.

In particular I am keen for research that explores these issues through novel ways of writing, including automatic and rhizomatic forms. I convene a group of academics and community members Community Psychology Advisory Panel who represent a wide variety of interests, including the following;. Hearing Voices Networks, Open Dialogue approach to 'mental health' in young people, Multiple Family Therapy for Anorexia, The Recovery Movement in mental health, participatory work with refugee communities.

I am keen to introdice new epistomologies and ideas regarding psychopathology and psychotherapy.. I am interested in a student who wants to explore how therapists use their physicality in the therapy roon. Studies that involve creative collaboration between qualitative research and art-based forms of dissemination. See here for free audio of April Philosophy lectures. I am also involved in a variety of informal and more formal groups, email me if your interested in joining. I am part of a panel developing University of Sydney-wide qualitative research coursework for Higher Degree Research students.

Anorexia, trauma and the body: A body-mapping study. Acculturation and distress in second generation Chinese Australians. Glassman, Buus, Rhodes. Listening to the darkness: Living with severe and enduring anorexia nervosa.

How do people experiencing an eating disorder interpret the meaning of chewing and spitting behaviour? Human Arenas, pp Human Arenas 1 2 , p Rhodes, et al. Human Arenas. First online pp Hodgkinson, Rhodes, et al. Qualitative Inquiry. September, Rhodes How family therapy stole my interiority and was rescued by open dialogue.

Krillich, Rhodes et al. Australian Psychologist.

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Issue Journal of Clinical Psychology doi Contemporary Family TherapyVolume 35 4 pp Huynh, L. Why do People Choose to Become Psychologists? A Narrative Inquiry of Aspiring Therapists. Psychology Teaching Review, 17 2 , Nge, C. Living and learning systemic: A qualitative exploration of the personal effects of family therapy training. Contemporary Family Therapy. Wyatt, Gale, Rhodes et al Deleuze and collaborative writing in the dance of activism. International Review of Qualitative Research Accepted.

Rhodes Why we should read qualitative inquiry. Rhodes, P. Reflections on Habib, C. Contemporary Family Therapy: Volume 34, 4 The Clinician, 2 1 , The Qualitative Report 23 1 7. Fennessey, Rhodes et al. Rhodes, Dickens, Donelly et al. Journal of Systemic Therapies. Rhodes, Donelly, Whatson et al.

Journal of Applied Research in Intellectual Disabilities. Rhodes P. Clinical Child Psychology and Psychiatry. Vol 10 3 , Journal of Intellectual and Developmental Disabilities, 28 1 , Parent experiences when adolescent distress persists after maudsley FBT. Journal of Eating Disorders Wallis, Rhodes, et as;. Clinical Child Psychology and Psychiatry 24 1 Richards, Rhodes, et al.

European Eating Disorders Review. Epub Dec Conti, Hewson, Rhodes Fink, Rhodes, MIskovec-Wheatley et al. Wallis,Miscovic-Wheatley, Madden, Rhodes et al. How does family functioning effect the outcome of Family Based Treatment for adolescents with severe anorexia nervosa? Wallis, Rhodes et al. Family functioning and relationship quality for adolescents in Family Based Treatment with severe anorexia nervosa compared with non-clinical adolescent. Jan;26 1 Wallis, Rhodes, Dawson et al.

Journal of Eating Disorders 5. White, Haycraft, Madden, Rhodes et al. A study of parental strategies used in the family meal session of family-based treatment. International Journal of Eating Disorders. Godfrey, Rhodes, Miscovik et al. Ellison, R. Do the components of manualized family-based treatment for anorexia nervosa predict weight gain?.

Journal of Family Therapy; Wallis A. European Eating Disorders Review, 13, The Parents Versus Anorexia Scale: A brief measure of parental efficacy in the family-based treatment of anorexia. Journal of Family Therapy, 27, HumanArenas , 2, Kezelman, Crosby, Rhodes, et al. Broomfield, Touyz, Rhodes. International Journal of Eating DisordersJun;50 6 Young, Touyz, et al. Relationships between compulsive exercise, quality of life, motivation to change and psychological distress in adults with anorexia nervosa. Young, S. The relationship between obsessive-compulsive personality disorder traits, obsessive-compulsive disorder and excessive exercise in patients with anorexia nervosa: a systematic review.

Kezelman, Rhodes, Hunt, et al. Advances in Eating Disorders. Validity of exercise measures in adults with anorexia nervosa: the EDE, Compulsive Exercise Test and other self-report scales. Advance online publication. Young, Rhodes, Hay Compulsive exercise across the lifespan in patients with anorexia nervosa: a narrative inquiry. Young, Rhodes, Touyz and Hay The relationship between obsessive-compulsive personality disorder traits, obsessive-compulsive disorder and excessive exercise in patients with anorexia nervosa: a systematic review.

Journal of Eating Disorders , Kezelman, Touyz, Hunt, Rhodes Does anxiety improve during weight restoration in anorexia nervosa? A systematic review Journal of Eating Disorders, 3, Young, Butow, Rhodes et al. White, Rhodes, et al.

Associate Professor Paul Rhodes

Qualitative Report, Vol 21, 2. DOI J Gambl Stud. Jan 9.

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