The derivation and formulation of the population balance equation (PBE) is presented in this chapter. Various formulations such as the discrete, continuous, multidimensional and coupled PBEs are presented under a unifying framework and related to the problems that they can be applied to. The spatially dependent PBE and its coupling with fluid dynamics is also discussed.

Collaborative psychiatric management is founded on a person-centred, holistic assessment leading to a diagnostic formulation that guides decision making. Formulation around the individual person, including their unique history and worldview, can be described with presenting, precipitating, predisposing, perpetuating and protective factors as well as the life context for the individual patient. Allied with this, diagnosis – in which the patient’s unique presentation can be evaluated as sharing characteristics and patterns with other patients – can allow for the individual plan to be guided by a wider frame of reference and knowledge. Such diagnostic frameworks have been developed over millennia and across cultures. As well as being important for individual patient care, they are essential for research and service planning. The development of these diagnostic frameworks is discussed with particular reference to the main international classifications of ICD-11 and DSM-5. It is common for people to have more than one diagnosis, and diagnostic hierarchies are considered. Criticisms of the construct of psychiatric diagnosis are reviewed, and an approach to conducting and describing collaborative psychiatric assessment is described.

This chapter describes two types of projective identification, acquisitive and attributive, which dominate relating towards self and other in the most severe and complex interpersonal difficulties commonly diagnosed as ‘personality disorder’. These difficulties are defined in psychoanalytic terms as narcissistic. These two forms of projective identification result in a distorted psychosomatic sense of what belongs to whom in the internal world, relating to others and relating to the body. This leads to complex somatic symptoms such as eating disorders and psychosomatic presentations. They also drive the pattern of service use: acquisitive projective identification leading to a pattern of medical or mental health hospitalisation and a requirement for 24-hour care; and attributive projective identification resulting in disengagement and denial of need. The chapter describes the patterns of interpersonal engagement and conflict commonly found in those with the most severe and complex problems in inpatient settings. Furthermore, a psychodynamic formulation is provided to aid teams in understanding these interpersonal dynamics, provide clarity in planning long-erm care, and to identify adaptations of technique required in psychotherapeutic work.

The consultation is likely to be the first experience the patient has of a psychodynamic way of thinking and it has the potential to be an experience of being deeply heard and understood. In the consultation period the aim is for the therapist to have an experience of the internal world of the patient and the patient an experience of what the therapy will be like. A consultation over a series of meetings may even give the opportunity of developing a patient’s capacity to undertake therapeutic work. It is a complex process that often starts before the patient even enters the room. There are different approaches to the consultation process and some of these are discussed. Given that the psychodynamic consultation is an encounter which will, in all likelihood, create anxiety and a sense of vulnerability in the patient, we can expect to see defences emerging in the moment-by-moment interaction and these are considered. A tripartite structure of psychodynamic formulation is outlined as a helpful framework for picking out the relational dynamic

It is one of the remarkable but also unsettling characteristics of psychodynamic psychotherapy that its course is not rigidly predetermined; this allows things to emerge in therapy that neither the therapist nor patient could have anticipated. What focus the work takes and what therapeutic approaches are most useful for each patient need to be found out along the way. This does not however mean it is impossible to give direction or that there is no structure to therapy. In this chapter, we aim to provide orientation to clinicians who are embarking on their first courses of therapy. We integrate theory and technique to offer a longitudinal perspective on how matters can play out over a course of therapy. Firstly, we discuss the formation of the therapeutic alliance and the development of a psychodynamic formulation. The central part of this chapter looks at the therapeutic relationship as a vehicle for change. Finally, we discuss the late phase of therapy and the dynamics of separation from the therapist, and how this can be both a challenging but productive period.

The case of a patient who is receiving mentalization-based treatment (MBT) is described. All of the stages and interventions of MBT, including interventions for suicidality and violence, are illustrated across the patient’s treatment trajectory. The formulation agreed with the patient is the focus for treatment. Clinical examples are presented to illustrate how to implement the phases of MBT using the formulation. The chapter discusses working with the not-knowing stance, the mentalizing process, non-mentalizing modes, affective narratives, and relational mentalizing. Supervision for the clinician is an essential part of MBT, and this is elaborated particularly in relation to its role in supporting the clinician to manage problematic counter-relational responses to the patient.

Chapter 8 begins by pointing out the current lack of collective clarity about the role of psychological care providers (PCPs) and suggests that researchers and practitioners make collective effort to develop the role of PCPs in sex development in future. Meanwhile it outlines the psychological consultation process that is generic and familiar to most PCPs. The author provides an initial assessment template and summarizes the popular psychotherapeutic interventions. The template is visible in several of the practice vignettes in the ensuing chapters of the book. The author ends the chapter by arguing that the tertiary environment is set up for diagnostic workup and treatment and unsuitable for the kind of ongoing psychosocial input that is needed by individuals and families living in their communities. The author makes a case for PCPs in DSD centers to collaborate with peer support workers to enable nonspecialist providers in the community to contribute to ongoing support for individuals and families.

In this chapter we describe the challenges faced by young people who experience an acquired injury to the brain, and explore how this can impact on attendance and engagement with education. The chapter aims to support teachers and other professionals to better understand acquired brain injury (ABI) and the ways in which this sudden, and often evolving, change in needs can affect a child’s education. In the first part of the chapter, we consider the practical challenges to school attendance in the early stages after ABI, and the individual impact on neuropsychological functioning. We go on to describe wider factors within the family, school and educational system that can affect attendance. The second part of this chapter addresses the support needed by young people to make it feasible for them to attend and participate in school life as normally, and successfully, as possible after an ABI. We are enthusiastic about the crucial role played by schools in a child’s rehabilitation after a brain injury, and share practical ideas and principles for maximising their recovery, reintegration and attendance.

While the role of intentions in the constitution of actions gives rise to complex and heavily controversial questions, it appears to be indisputable that action ascription in interaction mostly does without any overt ascription of intention. Yet, sometimes participants explicitly ascribe intentions to their interlocutors in order to make sense of their prior actions. The chapter examines intention ascriptions in response to a partner’s adjacent prior turn using the German modal verb construction willst du/wollen Sie (do you want). The analysis focuses on the aspect of the prior action the intention ascription addresses (action type, projected next action, motive etc.), the action the intention ascription performs itself, and the next action they make relevant from the prior speaker. It was found that intention ascriptions are used to clarify and intersubjectively ground the meaning of the prior turn, which seems otherwise underspecified, ambiguous or puzzling. Yet, they are also used to adumbrate criticism, e.g., that the prior turn projects a course of future actions which is considered to be inadequate, or to expose a concealed, problematic allegedly “real” meaning of the prior turn.