War and political atrocity are endemic, and the denial of what has befallen survivors who become refugees has both therapeutic and human rights dimensions. The work described in this article considers the psychological and political aspects of the suppression of memory and culture and how psychotherapy engages with these processes. Narrative, in its customary form as the creation of stories, is discussed as one of the ways of enabling survivors to be given a voice that allows them to process events of atrocity, displacement and exile. The usefulness of psychoanalytic ideas and their integration with systemic practice is demonstrated. The interplay between difficult psychotherapeutic material, the patient or family and the therapist is shown and the use of supervision noted. The discussion is exemplified with descriptions of therapeutic work with individuals, families and small groups. The thinking that emerges is applicable not only to work with survivors but has general implications for systemic work in general as it struggles with its contemporary identity.The work described in this article was carried out at the Medical Foundation for the Care of Victims of Torture, London, where I work as a psychotherapist with families, couples, individuals and groups. The Medical Foundation offers holistic psychosocial help to survivors of torture and organized violence. The majority of people who seek our help are refugees and asylum seekers, although we also work with former prisoners of war, aid workers and travellers who have been abducted.

This paper describes work with families who have been subjected to torture and atrocity and forced into political exile. Exile is described as a state of limbo which may be resolved by involving families in rituals which reconnect them to communal life. Therapeutic dilemmas when working with families affected by torture and atrocity are discussed. 'The culture of refugee families is a resource which can be used to enable them to integrate experiences of atrocity and adapt to life in exile. Therapeutic strategies are discussed through case histories.

Purpose -The purpose of this paper is to describe the attempts by one youth homeiessness service to impiement the conceptuai ideas of the psychoiogicaiiy informed environment (PiE) into a practicai and beneticial service for very challenging young peopie who have been homeiess, are leaving care or have left custody Design/methodology/approach -The approach of the paper is descriptive, outiining the thinking behind a PiE with young people and the operationaiising of this understanding in the day-to-day practice of the service. Findings -Aithough homelessness and housing support staff are not therapists, the nature of the work entails a need for understanding and sensitivity, and the activities ot the service are designed to create positive opportunities and relationships. Retiective practice, supervision and evaiuation are then essentiai tools in deveioping a "learning organisation", where the collective dynamics at an organisationai level support the psychologicai work of the PiE. Research limitations/implications -The impiications for homeiessness work that can be drawn trom the outcome of this project is to better understand how the PIE linked to the concept ot a learning organisation can provide a truly robust framework tor providing a service that can evoive harmoniousiy tying in disparate funding streams to otter very chailenging young peopie an outstanding service that addresses their homeiessness and its underlying causes. Practical impiications -The practicai impiications shown are the psychological skiiis that can be deveioped in housing workers; the iimits ot those skiiis and how they are complemented by partnership work with other voiuntary sector organisations and mainstream heaith providers; how the ideas of the iearning organisation can naturaiiy underpin the work of the PIE. Originality/value -The combination ot the concept ot the iearning organisation, refiective practice and the PiE provides a highiy original and truly robust framework tor providing housing workers with the psychoiogicai toois to make a transformative difference in the iives of especially vulnerable young homeless people.

The qualifying level of training in family therapy at Bristol University requires trainees to attend three ‘therapeutic consultations’ with their families with a recognized systemic practitioner, to consider issues pertinent to their development as therapists. This innovation is synchronic with the course philosophy which foregrounds the training in the development of ‘self’. Survey results on the consultations suggest that trainees report significant ‘news of difference’ and all recommend it as a mechanism for other trainees. The consultants also affirmed the value of the sessions they have facilitated. The paper describes the practicalities of how the consultations are organized.

The concept of consent to treatment is increasingly becoming contested in United Kingdom courts of law. Any practitioners who cannot demonstrate that a patient has properly consented to treatment are laying themselves open to litigation. This paper demonstrates that valid consent is not as straightforward as may be assumed and that a patient can easily challenge a standardised approach to obtaining consent. Current Department of Health guidelines on obtaining consent are discussed, and changes in the USA. Europe and Australia are brought into focus with regard to the situation in the UK.