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Psychotherapy
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 Oxford Specialist
Handbooks
in Psychiatry
Medical
Psychotherapy
Edited by

Jessica Yakeley James Johnston

Fellow of the British Consultant Psychiatrist in
Psychoanalytical Society, Psychotherapy, Leeds and York
Consultant Psychiatrist in Partnership NHS Foundation
Forensic Psychotherapy, Portman Trust, Leeds, UK; British
Clinic, Director of Medical Psychoanalytic Council Registered
Education and Associate Medical Member, North of England
Director, Tavistock and Portman Association of Psychoanalytic
NHS Foundation Trust, London Psychotherapists (NEAPP),
UK; Editor of Psychoanalytic UK; Visiting Lecturer, Tavistock
Psychotherapy, UK and Portman NHS Foundation
Trust, London, UK; Chair, Royal
Gwen Adshead College of Psychiatrists Medical
Psychotherapy Faculty Education
Consultant Forensic Psychiatrist and Curriculum Committee
and Psychotherapist, Southern 2011–​2015; Member of the
Health Foundation Trust, UK Association for Psychoanalytic
Psychotherapy in the NHS, UK
Laura Allison
Consultant Psychiatrist, South
London and Maudsley NHS
Foundation Trust, London, UK

1
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 v

Foreword

This book comes to birth at a propitious moment. Its cradle, to use

the authors’ metaphor borrowed from Bevan’s founding vision for the
NHS, is beset by a series of interlinked crises, affecting medicine, psychi-
atry, and indeed books themselves. For all its spectacular advances—to
some extent a product of them—medicine is increasingly fragmented
and super-specialized. The role of the physician with a synoptic and on-
going relationship with her patient—a deep knowledge of the strengths
and vulnerabilities of the individual in a family and social context—is
evanescent. Even in a free at the point of access service, consultation
is increasingly viewed as a quasi-commercial transaction, in which the
patient is a ‘customer’ for whom doctors proffer a ‘service’—rather
than an attachment relationship based on security, sensitivity, continuity,
and epistemic trust. There is a consequent plague of over-diagnosis and
over-treatment. Prevention and health promotion are downgraded and
starved of funds. The pervasiveness of chronic illness is unmatched by
appropriate theory and practice.
Psychiatry has not been immune to these changes. Lip service is played
to continuity of care, but the reality is a plethora of teams, professions,
and special interests. Patients move—are passively ‘moved’—from one
clinical encounter to another, with little acknowledgement of the speci-
ficity of the attachment relationship, or the inevitability of grief on sepa-
ration. Flanked by the rival disciplines of neurology/neuroscience and
clinical psychology, psychiatry struggles to define its unique role. A life-
course, developmental perspective fades in a culture that favours fiscal
‘illness-episodes’ over the uniqueness of the individual. The protesting
user’s voice is increasingly heard, but responses are typically superficial
and dismissive.
Medical psychotherapy—psychotherapeutic psychiatry—has suffered
its own wounds in this maelstrom. Psychotherapy services have become
marginalized within the psychiatric family, depicted as ‘soft’, ‘Freudian’
(i.e. antediluvian), and lacking an evidence base. Without a clearly identi-
fiable client group (the claim that psychotherapy is relevant to all aspects
of psychiatric work merely provokes all-things-to-all-men dismissal),
managers cut psychotherapy and psychotherapists with impunity, bet-
ting that protest will be muted and can be dubbed as self-interest. Some
wounds have been self-inflicted. Compared with the USA and Germany,
UK medical psychotherapists have been slow to engage in research or
penetrate academe; psychoanalytic psychotherapists, the majority of the
workforce, have been at best ambivalent about admitting their CBT and
systemic colleagues into the fold; the need for free and respectful com-
munication with other psychiatric colleagues has been neglected; cases
cherry-picked; the cabal of true believers has sometimes perversely cel-
ebrated marginalization rather than facing up to its weaknesses.
But, as this book so brilliantly exemplifies, crisis also equates to oppor-
tunity. Here, I believe, spelt out in magnificent detail, lies the psychiatry,
vi FOREWORD

not just the medical psychotherapy, of the future. Its practitioners claim
legitimacy through triple expertise in medicine, psychiatry, and psycho-
therapy. Developmental perspectives and doctor–patient collabora-
tion come as second nature. The individual life-history is paramount.
Psychological therapies’ robust evidence base equals or surpasses that of
pharmacotherapy, and has remarkable ‘sleeper’ effects which mean that
its benefits accrue well beyond therapy completion. Internecine wars—
Freud’s ‘narcissism of minor differences’—finally overcome, the different
schools of psychotherapy work respectfully together. Medical psycho-
therapy has an essential role in helping people suffering from personality
disorders. Consultation-liaison and group therapy skills, together with a
specialized understanding of developmental processes, mean that medi-
cal psychotherapy can contribute directly or indirectly (through staff sup-
port) to the entire spectrum of psychiatric illnesses.
Finally, Gutenberg outlives its obituarists: there is confirmation here
of the extraordinary staying-power, virtue, and value of ‘the book’. This
future Bible for psychiatric trainees comprehensively brings together
in-depth theoretical exposition, amusing cartoons, exam-friendly lists,
touching case histories, and fluid communication amongst psychothera-
peutic modalities and psychiatric specialisms. All this is done in ency-
clopaedia format in which the four editors and 56 contributors remain
individually anonymous, yet speak with a collective voice of reason,
authority, and hope. This lovely volume is a true phoenix, and one which
all psychiatrists and psychotherapists should and will have open on their
desks for a generation.
Jeremy Holmes, MD FRCPsych,
Visiting Professor,
School of Psychology,
University of Exeter, UK
 vii

Preface

Listening with medicine in mind

The Oxford Specialist Handbook of Medical Psychotherapy aims to evoke
the experience of listening to patients with medicine in mind. What do
medicine and mind have in common? What do doctors and psychothera-
pists have in common? Why is it helpful to be a medically qualified profes-
sional when working with psychological distress?
In this book, we will argue that the medical approach to studying the
body and its disorders has much in common with the psychothera-
pist’s approach to the study of mind and psychological distress, and
vice versa. In general practice, it is well known that the psychological is
closely related to the physical; general physicians and even surgeons are
now accepting that the study of the mind is crucial to working with the
body. Psychotherapists too need to pay close attention to diagnosis and
symptoms, and to the careful exercise of technical skill in helping people
recover.
The common values of medicine and psychotherapy lie in trying to
understand a patient’s problems within the limitations imposed by the
ailment and the patient’s own capacities. The therapeutic medical atti-
tude is not unique to the practice of psychotherapy—​it is the quotidian
medical skill of the doctor, within the doctor–​patient relationship, which
defines psychotherapeutic medicine.
When a doctor can move from their skill in the identification of the
medical or psychiatric problem to identification with the person with
the problem, not being bound in this identification or spellbound by
the problem, moving in mind reflexively between the external and
internal problem, they are embodying psychotherapeutic medicine.
Psychotherapeutic medicine is the guiding principle of this book, with
medical psychotherapy expressing the integration of the values of the
importance of the doctor–​patient relationship and psychotherapeutic
psychiatry. The OSH of Medical Psychotherapy connects psychiatrists and
therapists with medical psychotherapy, exemplifying the relationship
between the body of medicine, the mind of psychiatry, and the spirit of
psychotherapy.
Who is this book for?
The book is a unique compendium of psychotherapies commonly deliv-
ered in the NHS by medical psychotherapists, psychotherapists, psy-
chologists, and psychiatrists. It is aimed at the ‘cradle to grave’ range of
nascent, newly qualified, training, and senior doctors—​an audience of
medical students, foundation year doctors, core and advanced psychia-
try trainees, consultant psychiatrists, GPs, specialty doctors in psychia-
try, and academics. It will also be of interest to professionals from other
disciplines practising within the fields of health and social care such as
nurses, psychologists, counsellors, child psychotherapists, social work-
ers, and many others, as well as carers, patients, and service users,
viii   PREFACE

many of whom may have experienced some form of talking therapy

first-​h and.
What we hope will connect all of the patients, doctors, profession-
als, and members of the public who read this book will be an inter-
est in contemporary psychotherapies and seeking to learn about their
distinctive, and their overlapping, theories, concepts, training, and
research evidence, and how the therapies are applied in practice, illus-
trated by anonymous case vignettes. The OSH of Medical Psychotherapy
is written by therapeutic specialists in their fields in a house style which
aims to be succinct, accessible, and evocative—​a n echo of what a ther-
apist might try to offer the person or people with whom they seek to
communicate.
Why is this book important?
The importance of the OSH of Medical Psychotherapy lies in its attempt to
offer an overview of psychotherapies under the umbrella of the ontology
of medical psychotherapy. It provides a link between different profes-
sions and ways of thinking about the problems of being human, without
synthesis and without becoming a Tower of Babel with a confusion of
tongues. Each therapy is given its own voice, and the reader is invited to
hold in mind, and to integrate, the disparate array of myriad ways of heal-
ing minds. The illustrations by James Johnston, introducing and linking
the twelve chapters of the Handbook, aim to be emotionally evocative,
drawing from life in ways which echo the text they mirror.
Origins of this Handbook
The book has had a long gestation—​from James Johnston’s initial idea
of the book in 2008 conceived in the confluence of a past comforting
memory in anxious moments of the need for the Oxford Handbook of
Clinical Medicine in his white coat pocket as a house officer and present
extinction anxiety about the disappearance of medical psychotherapy,
another vital vade mecum needed in uncertain times …
The OSH of Medical Psychotherapy would not exist without the recep-
tivity to its conception by the Oxford University Press Commissioning
Editor Chris Reid who was unfamiliar with the world of medical psycho-
therapy, more used to publishing the work of other medical specialists,
including anaesthetists. James joked that perhaps his welcome support
for this book was because he was used to doctors who work with the
unconscious.
The first editorial group led by James (Gwen Adshead, Chess Denman,
Chris Mace, and Stirling Moorey) was reduced to James and Gwen, fol-
lowing Chris’s untimely death in 2010. After Chess and Stirling stepped
down, Gwen’s experienced tenacity helped keep the idea of the book
alive, inspiring James to form a new editorial group with Jessica Yakeley
as a tireless and thoughtful lead editor and Laura Allison as an editor rep-
resenting the vitality of younger and more recently qualified consultant
medical psychotherapists. The OUP staff Pete Stevenson and Lauren
Dunn reassured us that this long gestation is not unusual—​a s a symbol of
the survival of medical psychotherapy, we hope the book inspires thera-
peutic development in psychiatrists, other doctors, and others.
 PREFACE  ix

We are indebted to our sixty contributors who have written the

individual sections which make up each of the 12 main chapters of the
Handbook. Many of our authors are senior specialists in their fields, but
others, of equal importance, are higher trainees in medical psychother-
apy who represent the voices of the future.
The OSH of Medical Psychotherapy, like therapy, like life, like the cradle
to grave career of a doctor, is a work in progress. It reflects the human
diversity in which there can be no way of settling on a consensus of what
makes for a good life or a good therapy. We hope that readers will find
it useful in their work as psychotherapists, wherever they are, and that
they will contribute to future editions.
JY, JJ, GA, LA, 2016
 xi

Contents

Contributors xii
Symbols and abbreviations xix

1 Introduction   1
2 Concepts and models   13
3 General therapeutic competencies   95
4 Assessment 109
5 Treatment 153
6 Problems through life 283
7 Psychotherapy and psychiatric disorders 313
8 Personality disorder 377
9 Ethics and boundaries 441
10 The system 461
11 Psychotherapy research 507
12 Psychiatric specialties: medical psychotherapies,
applications, and research 543
Appendix: Key UK-based psychotherapy
organizations 581

Index 586
xii

Contributors

Gwen Adshead Jan Birtle

Consultant Forensic Psychiatrist Consultant Psychiatrist, Medical
and Psychotherapist, Southern Psychotherapy Tutor, and
Health Foundation Trust, UK Associate Medical Director,
Chapter 2: Group therapy and Worcestershire Health and Care
group analysis Trust, Malvern, UK; Honorary
Chapter 5: Group therapy and Senior Lecturer, University of
group analysis Worcester, UK
Chapter 8: Theories of personality Chapter 5: Therapy in clinical
development practice
Chapter 9: Ethics and boundaries Chapter 12: Rehabilitation and
social psychiatry: psychotherapies,
Laura Allison applications, and research
Consultant Psychiatrist, South
London and Maudsley NHS Julia Bland
Foundation Trust, London, UK Consultant Psychiatrist in
Chapter 6: Problems through life Psychotherapy, Maudsley
Hospital, London, UK
Penelope Aspinall Chapter 2: Systemic family and
Head of Counselling, University couple therapy
of Bradford, UK Chapter 5: Systemic family and
Chapter 2: Counselling couple therapy
Chapter 5: Counselling
Jane Blunden
Jina Barrett Consultant Psychiatrist
Adult Psychotherapist and in Psychotherapy and
Organisation Consultant, The Psychotherapy Tutor, Sussex
Tavistock and Portman NHS Partnership NHS Foundation
Foundation Trust, Portman Clinic, Trust, Sussex, UK
London, UK Chapter 2: Cognitive analytic therapy
Chapter 6: Older adults Chapter 5: Cognitive analytic therapy
Chapter 7: Dementia
Luigi Caparrotta
Dinesh Bhugra Fellow British Psychoanalytical
Professor of Mental Health and Society, Consultant Psychiatrist
Cultural Diversity, Section of in Psychotherapy, Camden &
Cultural Psychiatry, Institute of Islington Psychodynamic
Psychiatry, London, UK Psychotherapy Service,
Chapter 7: Sexual dysfunction Camden and Islington Foundation
Trust, St Pancras Hospital,
London, UK
Chapter 6: Problems through life
Chapter 7: Psychotherapy and
medication; Anxiety and anxiety
disorders
 CONTRIBUTORS xiii

Anne Cooper Catherine Goodwin

Consultant Psychiatrist in CBT, Dramatherapist, Avon and
Leeds and York Partnerships Wiltshire Mental Health
Foundation Trust, Leeds, UK Partnership NHS Trust, Secure
Chapter 2: Cognitive behavioural Services LDU, Bristol, UK;
therapy Visiting Lecturer, Dramatherapy
Chapter 4: Cognitive behavioural MA, Department of Psychology,
assessment and formulation University of Roehampton,
Chapter 5: Cognitive behavioural London, UK
therapy Chapter 2: Drama therapy
Chapter 5: Drama therapy
Sandra Evans
Consultant Psychiatrist/​Senior Else Guthrie
Lecturer in Psychiatry, East Consultant in Psychological
London Foundation NHS Trust, Medicine and Honorary Professor
Vice Chair, Faculty of Old Age of Psychological Medicine,
Psychiatry, Royal College of Manchester Mental Health and
Psychiatrists, London, UK; Social Care Trust, Manchester
Associate Dean for Psychiatry Royal Infirmary, Manchester, UK
and Deputy Dean for Students, Chapter 2: Psychodynamic
Barts & the London SMD, interpersonal therapy
London, UK Chapter 5: Psychodynamic
Chapter 12: Psychiatry of old age: interpersonal therapy
psychotherapies, applications, and Chapter 12: Liaison psychiatry:
research psychotherapies, applications,
and research
Gearóid FitzGerald
Consultant Psychiatrist in Rex Haigh
Psychotherapy, Leeds and York Consultant Psychiatrist in Medical
Partnerships NHS Foundation Psychotherapy, Berkshire
Trust, Leeds, UK Healthcare NHS Foundation
Chapter 10: Balint groups Trust, Bracknell, UK; Professor
of Therapeutic Environments
Christian Foerster and Relational Health, School
Charité –​Universitätsmedìzin of Sociology and Social Policy,
Berlin, Germany Nottingham University, UK
Chapter 7: Sexual dysfunction Chapter 2: Therapeutic
communities
Rachel Gibbons Chapter 5: Therapeutic
Consultant Psychiatrist in communities
Psychiatry and Psychotherapy,
Complex Care Service, Az Hakeem
Halliwick, St Ann’s Hospital, Consultant Psychiatrist and Medical
Barnet Enfield & Haringey MHT, Psychotherapist, The Priory
London, UK Hospital Roehampton, London,
Chapter 10: Teaching UK; Visiting Professor of Psychiatry
­psychotherapy to mental and Applied Psychotherapy,
health professionals University of Bradford, UK
Chapter 7: Gender dysphoria and
intersex conditions
xiv CONTRIBUTORS

Rob Hale Jason Hepple

Honorary Consultant Chair of the Association for
Psychotherapist, Portman Clinic, Cognitive Analytic Therapy,
Tavistock and Portman NHS Consultant Psychiatrist in
Foundation Trust, London, UK Psychological Therapies,
Chapter 6: Suicide and self-harm Somerset Partnership NHS
Foundation Trust, UK
Donna Harrison Chapter 2: Cognitive analytic
Forensic Psychologist in therapy
Training, Partnerships in Care, Chapter 5: Cognitive analytic
Nottinghamshire, UK therapy
Chapter 2: Dialectical behaviour
therapy Jeremy Holmes
Chapter 5: Dialectical behaviour Visiting Professor, School of
therapy Psychology, University of
Exeter, UK
Angela Hassiotis Foreword
Professor of Psychiatry of
Intellectual Disability, UCL James Johnston
Division of Psychiatry, London, Consultant Psychiatrist in
UK; Consultant Psychiatrist, Psychotherapy, Leeds and
Camden Learning Disability York Partnership NHS
Service, London, UK Foundation Trust, Leeds, UK;
Chapter 7: Intellectual disability British Psychoanalytic Council
Chapter 12: Psychiatry of intellectual Registered Member, North
disability: psychotherapies, applica- of England Association of
tions, and research Psychoanalytic Psychotherapists
(NEAPP), UK; Visiting
Nick Hayman Lecturer, Tavistock and
Music Psychotherapist, Avon Portman NHS Foundation
and Wiltshire Mental Health Trust, London, UK; Chair,
Partnership NHS Trust, Royal College of Psychiatrists
Bristol, UK Medical Psychotherapy Faculty
Chapter 2: Music therapy Education and Curriculum
Chapter 5: Music therapy Committee 2011–​2 015;
Member of the Association for
Kevin Healy Psychoanalytic Psychotherapy in
Consultant Psychiatrist in Medical the NHS, UK
Psychotherapy, New Dawn NHS Chapter 1: Psychotherapeutic
England Commissioned Inpatient m­edicine: thinking cradle to
Tier 4 Assessment, Treatment grave
and Consultation Service for Chapter 4: Consultation
Women with a Diagnosis of Chapter 7: Integrating
Severe Personality Disorders, psychotherapy in psychiatry
Cygnet Healthcare, Ealing, UK; Chapter 10: Reflective practice
Independent Practitioner in groups
Private Practice, London, UK Chapter 12: General adult
Chapter 11: Neuroscience and ­psychiatry: medical psychotherapies,
psychotherapy applications, and research
 CONTRIBUTORS xv

William Rhys Jones Kath Lovell

Consultant Psychiatrist, Yorkshire Managing Director, Emergence
Centre for Eating Disorders, CIC, London, UK
Leeds and York Partnership Chapter 10: Service user
NHS Foundation Trust, Seacroft involvement
Hospital, Leeds, UK
Chapter 7: Eating disorders Vikram S Luthra
Consultant Psychiatrist, Becklin
Ian Kerr Centre, Leeds, UK; Hon.
Honorary Consultant Psychiatrist Lecturer, University of Leeds,
and Psychotherapist, NHS Leeds, UK
Lanarkshire, Coathill Hospital, Chapter 4: Is my patient suitable
Coatbridge, Scotland for psychotherapy?
Chapter 2: Cognitive analytic therapy
Chapter 5: Cognitive analytic therapy Paul MacAllister
Consultant Psychiatrist in
Wale Lagundoye Forensic Psychotherapy,
Clinical Director and Consultant Wells Road Centre for
Addiction Psychiatrist, Sheffield Community Forensic Psychiatry,
Health & Social Care NHS Nottingham, UK
Foundation Trust, Sheffield, UK Chapter 8: Personality disorder
Chapter 7: Substance misuse services
Chapter 12: Psychiatry of
­addictions: psychotherapies, Brian Martindale
­applications, and research Consultant Psychiatrist,
Nuffield Health Newcastle
Roslyn Law upon Tyne Hospital,
Consultant Clinical Psychologist, Newcastle-​upon-​Tyne, UK
IPT Lead, Anna Freud Centre, Chapter 7: Psychoses
London, UK; Assistant
Director of Psychology and Tristan McGeorge
Psychotherapies, South Consultant Forensic Psychiatrist,
West London and St George’s Central and North West
Mental Health NHS Trust, London NHS Foundation Trust,
Springfield Hospital, London, UK London, UK
Chapter 2: Interpersonal Chapter 8: Psychological therapy
psychotherapy in secure settings
Chapter 5: Interpersonal psychotherapy
Anuradha Menon
Alessandra Lemma ST8 Dual Trainee in
Professor of Psychological Psychoanalytic Psychotherapy
Therapies, Tavistock and and General Adult Psychiatry,
Portman NHS Trust/​Essex Leeds and York Partnerships
University, UK; Visiting NHS Foundation Trust,
Professor, Psychoanalysis Department of Psychotherapy,
Unit, University College Leeds, UK; Department of
London, UK Liaison Psychiatry, Leeds General
Chapter 2: Dynamic interpersonal Infirmary, Leeds, UK
therapy Chapter 3: General therapeutic
Chapter 5: Dynamic interpersonal competencies
therapy
xvi CONTRIBUTORS

Marilyn Miller Shari Mysorekar

Art Psychotherapist, Complex Consultant Forensic Psychiatrist
Psychological Interventions Team, and Medical Psychotherapist,
Bristol Mental Health, Avon and Stockton Hall Hospital, York, UK
Wiltshire NHS Mental Health Chapter 3: General therapeutic
Trust, Bath, UK competencies
Chapter 2: Art psychotherapy
Chapter 5: Art psychotherapy Anton Obholzer
Emeritus Consultant, Tavistock
Sue Mizen
and Portman NHS Foundation
Consultant Psychiatrist in Trust, London, UK; Senior
Medical Psychotherapy Devon Faculty, INSEAD French
Partnership NHS Trust, Wonford International Business School
House Hospital, Exeter, UK; Global Leadership Centre,
Chair of the Psychotherapy Fontainebleau, France
Faculty Exec., Royal College of Chapter 10: Psychotherapeutic
Psychiatrists, UK understanding of organizational
Chapter 8: Personality disorders processes
John Morgan
Phil Osborne
Consultant Psychiatrist, Yorkshire
Centre for Eating Disorders, Consultant Psychiatrist in
Leeds, UK; Senior Lecturer in Medical Psychotherapy,
Eating Disorders, St George’s Specialist Psychotherapy Service,
University of London, UK Stockton-​on-​Tees, Tees Esk and
Chapter 7: Eating disorders Wear Valleys NHS Foundation
Trust, UK
Lou Morgan Chapter 4: Formulation
Executive Director, Emergence
CIC, London, UK Zoe Otter
Chapter 10: Service user Forensic Psychologist in
involvement Training, Partnerships in Care,
Nottinghamshire, UK
Mary Murphy-​Ford Chapter 2: Dialectical behaviour
Consultant Child and Adolescent therapy
Psychiatrist, Tavistock and Chapter 5: Dialectical behaviour
Portman NHS Foundation Trust, therapy
London, UK; Locum Consultant
Psychiatrist and Psychotherapist
in Perinatal and Parent-​Infant
Mental Health Service, Chelsea
and Westminster Hospital,
Central and North West
London NHS Foundation Trust,
London, UK
Chapter 6: Problems through life
Chapter 12: Child and adolescent
psychiatry: child and adolescent
psychotherapies, applications, and
research
 CONTRIBUTORS xvii

Aleksandar M Pavlovic Anna Seymour

Higher Trainee in Medical Senior Lecturer in Dramatherapy,
Psychotherapy and General Department of Psychology,
Adult Psychiatry, Leeds and York University of Roehampton,
Partnership NHS Foundation London, UK
Trust, Leeds Psychology and Chapter 2: Dramatherapy
Psychotherapy Service, Chapter 5: Dramatherapy
Leeds, UK
Chapter 4: What type of therapy?, Eman Shweikh
Assessing the course of therapy, Specialist Registrar (ST5) in
Assessing the outcome of therapy Forensic Psychiatry, Barnet,
Enfield and Haringey Mental
Giovanni Polizzi Health NHS Trust, London, UK
Consultant Psychiatrist in Medical Chapter 8: Psychological therapy
Psychotherapy, South London in secure settings
and Maudsley NHS Foundation
Trust, London, UK Dinesh Sinha
Chapter 2: Mentalization-based Consultant Psychiatrist in
treatment Psychotherapy, East London NHS
Chapter 5: Mentalization-based Foundation Trust, London, UK
treatment Chapter 10: Planning ­psychotherapy
services within psychiatric care,
Ruta Rele Psychotherapy and management
Consultant Psychiatrist in
Substance Misuse, Sheffield Gail Skillington
Health and Social Care NHS Consultant Forensic Psychologist,
Foundation Trust, Sheffield, UK Partnerships in Care,
Chapter 7: Substance misuse Nottinghamshire, UK
Chapter 12: Psychiatry of Chapter 2: Dialectical behavioural
addictions: psychotherapies, therapy
applications, and research Chapter 5: Dialectical behavioural
therapy
Florian Ruths
Consultant Psychiatrist & Cognitive Julian Stern
Therapist, South Lambeth Consultant Psychiatrist in
Assessment and Treatment Team, Psychotherapy, Adult Dept,
Mood, Anxiety & Personality Tavistock and Portman NHS
Clinical Academic Group, Trust, London, UK
London, UK Chapter 7: Medically unexplained
Chapter 2: Schema therapy, symptoms
Mindfulness-based interventions
and therapies
Chapter 5: Schema therapy,
Mindfulness-based interventions
and therapies
xviii CONTRIBUTORS

Jo Stubley Jessica Yakeley

Consultant Psychiatrist in Fellow of the British
Psychotherapy, Adult Dept, Psychoanalytical Society,
Tavistock and Portman NHS Consultant Psychiatrist in
Trust, London, UK; Clinical Forensic Psychotherapy, Portman
Lead, Adult Trauma Services, Clinic; Director of Medical
Tavistock and Portman NHS Education and Associate Medical
Trust, London, UK; Member Director, Tavistock and Portman
British Psychoanalytic NHS Foundation Trust, London
Society, UK UK; Editor of Psychoanalytic
Chapter 7: Trauma-related Psychotherapy, UK
conditions Chapter 1: Medical psychotherapy:
what is it?
Kristy Summers Chapter 2: Concepts and mod-
Forensic Psychologist in els: introduction, Psychoanalytic
Training, Partnerships in Care, psychotherapy
Nottinghamshire, UK Chapter 4: Psychodynamic
Chapter 2: Dialectical behaviour ­assessment and psychotherapy
therapy Chapter 5: Psychoanalytic
Chapter 5: Dialectical behaviour psychotherapy
therapy Chapter 6: Violence and aggression
Chapter 7: Paraphilias
David Taylor
Chapter 8: Antisocial personality
Visiting Professor, Psychoanalysis disorder, Narcissistic and histrionic
Unit, Research Department personality disorders
of Clinical, Educational & Chapter 11: Research in
Health Psychology, University psychotherapy
College London, UK; Honorary Chapter 12: Forensic psychiatry:
Consultant Psychotherapist, forensic psychotherapies, applica-
Tavistock and Portman NHS tions, and research
Foundation Trust, London, UK
Chapter 7: Affective disorders
Antonio Ventriglio
Section of Psychiatry, University
of Foggia, Department of Clinical
and Experimental Medicine,
Foggia, Italy
Chapter 7: Sexual dysfunction
 xix

Symbols and abbreviations

£ pound sterling
$ dollar
AAI Adult Attachment Interview
ACAT Association for Cognitive Analytic Therapy
ACT acceptance and commitment therapy
ADHD attention-​deficit/​hyperactivity disorder
A&E accident and emergency
AIS androgen insensitivity syndrome
AMT analytical music therapy
AN anorexia nervosa
APA American Psychiatric Association
APT adaptive pacing therapy
ASC altered state of consciousness
ASD acute stress disorder
ASPD antisocial personality disorder
AvPD avoidant personality disorder
BAAT British Association of Art Therapists
BABCP British Association of Behavioural and Cognitive
Psychotherapies
BACP British Association for Counselling and
Psychotherapy
BADth British Association of Dramatherapists
BAMT British Association of Music Therapists
BCT behavioural couples therapy
BDD body dysmorphic disorder
BDNF brain-​derived neurotropic factor
BED binge eating disorder
BMGIM Bonny Method of Guided Imagery and Music
BMI body mass index
BMT behavioural music therapy
BN bulimia nervosa
BPA British Psychoanalytic Association
BPAS British Psychoanalytical Society
BPC British Psychoanalytic Council
xx SYMBOLS AND ABBREVIATIONS

BPD borderline personality disorder

BPF British Psychotherapy Foundation
BPSD behavioural and psychological symptoms
of dementia
CAH congenital adrenal hyperplasia
CAMHS child and adolescent mental health services
CAT cognitive analytic therapy
CBT cognitive behavioural therapy
CBTp cognitive behavioural therapy for psychosis
CCRT Core Conflictual Relationship Theme
CCT Certificate of Core Training; Certificate
of Completion of Training
CFS chronic fatigue syndrome
CM contingency management
CMHT community mental health team
COPP Commission on Psychotherapy by Psychiatrists
CORE Centre for Outcomes Research and Effectiveness;
Clinical Outcomes in Routine Evaluation
CORE-​OM Clinical Outcomes in Routine Evaluation–​Outcome
Measure
CPA Care Programme Approach
CPD continuing professional development
CPN community psychiatric nurse
CRM comprehensive resource model
CROM clinician-​r ated outcome measure
DANOS Drug and Alcohol National Occupational Standards
DBT dialectical behavioural therapy
DEXA dual-​energy X-​r ay absorptiometry
DIP Drug Intervention Programme
DIT dynamic interpersonal therapy
DLB dementia with Lewy bodies
DNA deoxyribonucleic acid
DPD dependent personality disorder
DRA differential reinforcement of alternate behaviour
DRI differential reinforcement of incompatible behaviour
DRO differential reinforcement of other behaviour
DSM-​5 Diagnostic and Statistical Manual of Mental Disorders,
fifth edition
 SYMBOLS AND ABBREVIATIONS xxi

DSPD Dangerous and Severe Personality Disorder

DZ dizygotic
EBD emotional and behavioural difficulties
EBP evidence-​based practice
EFT energy-​focused therapy
EMDR eye movement desensitization and reprocessing
EPR embodiment– ​projection– ​role
FPS Forensic Psychotherapy Society
FSS functional somatic syndromes
GA group analysis
GAD generalized anxiety disorder
GET graded exercise therapy
GIM guided imagery and music
GLM Good Lives Model
GMC General Medical Council
GMP Good Medical Practice
GP general practitioner
GPSQ Gender Preoccupation and Stability Questionnaire
HCPC Health and Care Professions Council
HPC Health Professions Council
HPD histrionic personality disorder
IAFP International Association for Forensic Psychotherapy
IAPT Improving Access to Psychological Therapies
IBS irritable bowel syndrome
ICATA International Cognitive Analytic Therapy Association
ICD International Classification of Diseases
IDD intellectual and developmental disorder
IDTS Integrated Drug Treatment System
IGA Institute of Group Analysis
IPA International Psychoanalytic Association
IPAF interpersonal affective pattern
IPP Imprisonment for Public Protection
IPT interpersonal therapy
IQ intelligence quotient
JCHPT Joint Committee on Higher Psychiatric Training
kcal kilocalorie
kg kilogram
xxii SYMBOLS AND ABBREVIATIONS

KUF Knowledge and Understanding Framework

LHRH luteinizing hormone-​releasing hormone
LPPU London Pathways Progression Unit
LTC long-​term condition
m metre
MA Master of Arts
MAPPP multi-​agency public protection panels
MBCT mindfulness-​based cognitive therapy
MBI mindfulness-​based interventions
MBRP mindfulness-​based relapse prevention
MBSR mindfulness-​based stress reduction
MBT mentalization-​based treatment
MBT-​ASC MBT adherence and competence scale
MCI mild cognitive impairment
mg milligram
MHA Mental Health Act
MI motivational interviewing
mRNA messenger ribonucleic acid
MSc Master of Science
MSSM multiple self-​states model
MUS medically unexplained symptoms
MZ monozygotic
NCD mild neurocognitive disorder
NHS National Health Service
NICE National Institute for Health and Care Excellence
NMDA N-​methyl-​D -​a spartate
NMT neurologic music therapy
NPD narcissistic personality disorder
OCD obsessive– ​compulsive disorder
OMPFC orbitomedial prefrontal cortex
OPCD obsessive–​compulsive personality disorder
OSAP Offender Substance Abuse Programme
OSFED other specified feeding or eating disorder
OT occupational therapy/​therapist
PBE practice-​based evidence
PCL-​R Psychopathy Checklist-​Revised
 SYMBOLS AND ABBREVIATIONS xxiii

PCPCS Primary Care Psychotherapy

and Consultation Service
PET positron emission tomography
PFC prefrontal cortex
PhD Doctor of Philosophy
PICU psychiatric intensive care unit
PIPE Psychologically Informed Planned Environment
PIT psychodynamic interpersonal therapy
PPD paranoid personality disorder
PROM patient-​reported outcome measure
PRU pupil referral unit
PSI psychosocial interventions
PSQ Personality Structure Questionnaire
PTSD post-​traumatic stress disorder
QALY quality-​adjusted life-​year
RCT randomized controlled trial
RMO resident medical officer
RNR risk– ​need– ​responsivity
RR reciprocal role
RRP reciprocal role procedure
SCIE Social Care Institute for Excellence
SCM structured clinical management
SD somatization disorder
SDR sequential diagrammatic reformulation
SFT solution-​focused therapy
SIG Special Interest Group
SIGN Scottish Intercollegiate Guidelines Network
SMC specialist medical care
SMI serious mental illness
SOTP Sex Offender Treatment Programme
SPD schizoid personality disorder
SSRI selective serotonin reuptake inhibitor
StPD schizotypal personality disorder
TC therapeutic community
tf-​CBT trauma-​focused cognitive behavioural therapy
TFP transference-​focused psychotherapy
TPP target problem procedure
xxiv SYMBOLS AND ABBREVIATIONS

UK United Kingdom
UKCP United Kingdom Council for Psychotherapy
USA United States
USP unique selling point
VBP values-​based practice
VCM vulnerable child mode
VRAG Violence and Risk Appraisal Guide
WEMSS Women’s Enhanced Medium Secure Services
WFMT World Federation of Music Therapy
WMA World Medical Association
WPF Westminster Pastoral Foundation
YSQ Young Schema Questionnaire
ZPD zone of proximal development
 Chapter 1 1

Introduction

Medical psychotherapy: what is it? 2

Psychotherapeutic medicine: thinking cradle to grave 8
Exploring the Variety of Random
Documents with Different Content
 'T)IG MACK," the Wild Irishman of the Wildcat -*— '
Division, won thirty-four official matches, winningover every division
of the A. E. F. except the 42d (Rainbow) Division, without the aid of
a trainer or medical adviser. He holds second prize for wrestling in
the A. E. F., and the medal for the wrestling championship of the
81st Division, Eighth Army Corps, the S. 0. S., First Army and Third
Army. Sergeant Mcintosh's wrestling tour took him through the
principal cities of England, Belgium, Germany, Switzerland, Italy,
Spain and France. His last match was staged in the Monte Carlo
Casino before 7,000 spectators. Single-handed and unaided,
Sergeant Mcintosh fought his way to the A. E. F. finals.
 AFTER THE ARMISTICE burlesque on Southern dialect and
droll manner produced an uproar every time he came on the stage.
One of his song hits was: Down where the watermillon grows, How I
love her, nobody knows; I allers go to see her in my Sunday meetin'
clothes, Down where the watermillon grows. Other songs that made
a hit in this play were : "I 'Wanta' Go Back," by Clyde Hooper, and
"We Are Awfully Glad We Are Soldiers," by Joe Goodwin. "The
Bloody War," by Sergt. H. G. Reagan, of the 321st, was perhaps the
most popular song of the play. A few verses of this song follow : THE
BLOODY WAR. I was a simple country boy, I lived out on the farm; I
never even killed a flea, Or done nobody harm. It's bloody war, it's
bloody war. One day the sheriff caught me, He says, "Come with me,
my son; Your Uncle Sammy needs you, To help him 'tote' a gun." It's
bloody war. . . They took me to the train next day The crowd it was
immense; I never could get with my girl, But I kissed her through
the fence. It's bloody war. . . [85]
 THE 321ST INFANTRY When I first landed at the camp, I
certainly did feel blue; My sergeant says, "Cheer up, old boy, We'll
make a man of you." It's bloody war. . . They fed me on potatoes,
And beans, three times a day; It must be all the hogs are dead, And
the hens, they never lay. It's bloody war. . . They punched my poor
arm full of holes, They vaccinated me; The Doc thought it was
funny, But the joke, I failed to see. It's bloody war. . . They tried to
teach me how to drill, I did the best I could; But my captain told me
to my face, My head was made of wood. It's bloody war. . . They
sent me out on the range, To hear the bullets sing; I shot and shot
for one whole day, And never hit a thing. It's bloody war. . . My
captain said to "shoot at will," I says "Which one is he?" That made
my captain angry, And he fired his gun at me. It's bloody war. . .
They moved me away from camp, I landed o'er in France; [86]
 AFTER THE ARMISTICE I didn't like the idea much, But
thought I'd take a chance. It's bloody war. . . Now, when I struck
that foreign shore, I looked around with glee; But rain and
kilometers Were all that I could see. It's bloody war. . . I ran all over
Europe, Fighting for my life; Before I'll go to war again, I'll send my
darling wife. It's bloody war. . . — Sergt. H. G. Reagan, 321st
Infantry. The following list of men who played leading roles in "0. U.
Wildcats" shows that the 321st was well represented on our
divisional show: Private Ed Hearne, Corp. Horald A. Lane, Sergt.
Grady Reagan, Private Warren W. Glaspey (Stage Manager), Private
William Drovetta (Asst. Stage Carpenter). Much of the credit for the
success of "O. U. Wildcats" is due Mr. E. J. Newbegin, director of the
Y. M. C. A. entertainment work for the 81st Division. But the most
popular play with the 321st was our own play, "Homeward Bound."
Like "0. U. Wildcats," the 321st show was clean throughout and of a
very high order. It compared favorably with best divisional shows,
and was considered by some critics to be the best regimental show
in the A. E. F. [87]
 THE 321ST INFANTRY Program 321st Infantry Play. The
321st Players Present "HOMEWARD BOUND" "A Little Bit of
Everything" Under Direction Private Raymond J. McDevett, Corp.
Ivan Reid, Musical Director; Private Frank Teed, Manager Supervised
by Lieut. Percy F. "White, Lieut. Ridgley Hunt ACT I "HOMEWARD
BOUND" Scene: On Board the Transport Olympic Characters Red
Cross Nurse Private Francis R. Hay Banjo Lewis Private Kenny J.
Lewis Soldiers — Bugler Donna, Corps. Harry Roberts, Ranson C.
Weatherman, Timothy D. Sullivan, Private First Class Frank Watson,
Privates Arthur Ryan, Douglas Dean, J. Paul Carrigan, O. K.
Wainscott and Bugler Holcombe. A Voice from Over the Sea . . Sergt.
Norman G. LaMotte Uncle Sam Private J. Paul Carrigan Sailor Private
O. K. Wainscott Soldier Corp. Harry Roberts Soldier Private Charles
Fawkner ACT II "Drums of Oude" (By Special Permission of Charles
Frohman) Scene: Somewhere in India Characters Sentry Private
John Beard Captain McGregor Sergt. Norman G. LaMotte Lieutenant
Hartley Private Charles Fawkner Sergeant McDougal Private Charles
Orton Pirst Sergeant Sergt. Eugene Messmer Second Sergeant Corp.
Arthur Strube [88]
 AFTER THE ARMISTICE Mrs. Jack Clayton Private Francis R.
Hay Sepoy Private Raymond J. McDevett ACT III Scene: Somewhere
in America Characters Tillie Twinkletoes . . .Private First Class Frank
Watson Pittsburg Kate Private 0. K. Wainscott A Waiter Private
Douglass Dean A Rube Private J. Paul Carrigan A Drunk Private
Arthur Regan Porter Private Kenny J. Lewis Detective Corp. Ransom
Weatherman Waiter Private Raymond J. McDevett Salvation Nell
Private Francis R. Hay Colonel Private Charles Orton Orderly Corp.
Harry Roberts Orchestra Corp. Ivan Reid Musical Director Clyde C.
Pegram First Violin James M. Perryman Cornet James C. Teague
Clarinet Sergt. A. F. Charles Cornet Albert Perez Trombone Alexander
Lohse Cello Corp. Talmadge Linville Basoon Steve Hutchinson Drum
Stage Crew Private Ernest Berg, Bugler Holcombe, Private Richard H.
Blevins, Private Lichtenstein, Private George Fahrig, Private Joseph
A. Gourdier. Scenery Painted by Private George W. Loehr, Assisted by
Private Ralph Shea "They fought their fight with courage bright, And
'carried on* with purpose grand; Now give them that which is their
right, Bring back the Yanks to Yankee Land." [89]
 THE 321ST INFANTRY These special features of the spring
program helped greatly to cure our homesickness and relieve the
tedium of the daily military routine. For weeks after we first went to
our after-war training area there was absolutely nothing in the way
of amusement or entertainment. The war was over. All incentive for
further training and preparation for war was gone. The inevitable
reaction that follows a period of intensive effort under high tension
had come. We were obsessed with the sole thought of going home.
All duty was irksome. The void and emptiness of our waking hours
when off duty was proving fatal. The lack of any recreational activity
or stimulating amusement was producing dire results. The Y. M. C.
A. and Other Welfare Organizations. In the light of these conditions
one can appreciate what a tremendously important service the Y. M.
C. A. and other welfare organizations rendered our outfit through
the educational, athletic and entertainment programs just described.
In our regiment the welfare organizations were ably assisted in the
execution of these programs by our officers, who were quick to
appreciate how vital and essential such activities were to morale and
to the general happiness [90]
 AFTER THE ARMISTICE and well-being of the men. As soon
as these activities were introduced into the regular training schedule
and into the "Y" huts during the evenings, the morale and general
good feeling throughout the camp increased fifty per cent.
Notwithstanding the harsh criticism and general "cussing out" that
these welfare organizations got ; yet there was a hearty response to
all these activities, and a universal use of all privileges they offered.
In our clamor for the things we couldn't get, we sometimes forgot to
say "Thank you" for the many things we did get. The welfare
workers and the chaplains were untiring in their efforts to serve us in
every way possible. We shall often think of these men, and
particularly the heroic little women, who served us so generously
and unselfishly day and night. King and Queen of Belgium Review
81st Division. About the middle of March it was announced that on
March 20 the 81st Division would be reviewed by the King and
Queen of the Belgians. During the next five days every camp
throughout the division was astir with preparations for this review.
Nothing was left undone that would improve the appearance of the
men or their equipment. But after standing in the [91]
 THE 321ST INFANTRY snow, rain and hail for several hours
that day and tramping around in the mud for several more hours,
our appearance was not as immaculate as desired. Neither were we
in the mood to be presented to a king and queen. Reviews on such
days were not conducive to a gracious, affable disposition. Yet we
looked our best and did our best for the sake of the flag we followed
and the country we represented. We found King Albert and the
Queen very democratic and cordial. The King and Queen,
accompanied by General Pershing and the divisional staff, walked
through the ranks. Some of the men claim the honor of shaking
hands with the King and Queen and having remarks addressed to
them personally. This was a red-letter day in the history of the
321st. General Pershing Reviews 81st Division for Last Time. Another
red-letter day soon followed this, when General Pershing himself
reviewed the 81st Division on April 10. The two reviews were very
much alike and the weather conditions about the same. But the
impossible happened that day. The men came back singing and
rejoicing. A review had never before produced such an effect on the
men. But it wasn't the review. It was something General Persh[92]
 AFTER THE ARMISTICE ing said in his speech about an
"early return home" that put the men in such good spirits. This was
the first definite information we had had regarding the time of our
return to the States. General Pershing will never know, perhaps, how
he gladdened the hearts of the Wildcats that day. General Pershing
is not an orator, but he speaks with such an intelligent, sympathetic
interest in the men and evinces such a high idealism and bigness of
heart that his hearers are irresistibly drawn to him. Stalwart and
knightly in appearance, soldierly in bearing and kindly in
countenance, the Commander in Chief of the American
Expeditionary Forces is a masterful leader of men. Extracts from
General Pershing's speech before the 81st Division at Chatillon-Sur-
Seme, France, on occasion of the review, April 10, 1919: "It has
seldom been my privilege to review an entire division as carefully as
I have this one — one that is booked for an early departure home. I
felt that I could not allow the division to go home without telling you
of my thoughts regarding your deeds over here. How I must thank
you for your deeds over here! How I must thank you for your spirit,
your morale, and your ability to stand the hardships that make up
the soldier's life during a campaign in modern warfare. Some
divisions that comprise the [93]
 THE 321ST INFANTRY A. E. F. saw more actual fighting
than others. That is because the opportunity was theirs, and not
because any one division possessed more fighting ability. The
modern army is a vast machine. Every unit must play its part. The
cog is worthless if one tooth is broken. The bolt is worthless without
the nut. Each of you has played his part and played it well. From the
highest rank to the lowest, you have done your appointed tasks in
making war on a foe that would trample humanity under his iron
heel. "It is the opinion of the Allied Higher Command that it was the
American army that turned the tide of battle toward the Allied cause.
There is no question regarding this. In the operation at St. Mihiel,
the largest army ever assembled took part. The dogged
aggressiveness at Argonne Forest cleared that thorn in the side of
the Allied army. Chateau-Thierry demonstrated to the enemy that
their cause was lost, and the American army was the factor that
caused this feeling. When you go home you will have just cause for
pride in your deeds over here. They will welcome you, for they have
followed you through all the trying days. "Finally, I want to thank
you for your cleanliness, your morals while in France. I am proud,
very proud, to be in command of the world's finest army — the
American Expeditionary Force." [94]
 AFTER THE ARMISTICE Wildcat Veterans" Association. No
better evidence of the fine esprit de corps of the 81st Division is
needed than the hearty and cordial reception accorded the idea of a
veterans' association. Once a "Wildcat" always a "Wildcat" was the
spirit that characterized the boys of the 321st, and they fell for the
"Wildcat Veterans' Association" almost to a man. It was easy for
Lieutenant Colonel Schucker and his team of speakers, Paul Barry
and Walter E. Burnett, to convince us that we should have a
divisional organization which would foster the splendid spirit of
comradeship that had made us all feel like buddies, perpetuate those
high ideals of service and citizenship that had actuated us in our
overseas service, and arrange for conventions. The following poem
portrays the comradeship that the Wildcat Vets have for each other :
"NOW THAT IT'S ALL OVER." Did you ever hike millions of miles, And
carry a ton on your back, And blister your heels and your shoulders,
too, Where the straps run down from the pack, In the rain or the
snow or the mud, perhaps, In the smothering heat or the cold? If
you have, why, then, you're a buddy of ours, And we welcome you
into our fold. [95]
 THE 321ST INFANTRY Did you ever eat with your plate in
your lap, With your cup on the ground at your side, While cooties
and bugs of species untold, Danced fox-trots over your hide? Did
you ever sleep in a tent so small That your head and your feet
played tag? Then shake, old man, you're a pal of ours, For you've
followed the same old flag. Did you ever stand in a front line trench,
With Fritzie a few feet away, With Jerries and Minnies a-whistling
around, And gas coming over all day? With No Man's Land a sea of
steel And a tempest of bursting shell? Then, come in, old man, and
toast your shins, For we're all just back from hell. —J. K. M., in
"Stars and Stripes.' Shooting Competition — Records — A. E. F.
Shoot at Le Mans. The experience we had had shooting at live
targets in battle greatly increased our interest in marksmanship. As a
result our interest in target practice on the rifle ranges after the war
was keener than ever before. Each man was anxious to establish a
new record for himself. The interest aroused in shooting soon led to
shooting contests between companies, regiments and brigades.
Later, out of these contests grew the big A. E. F. shoot at Le Mans, in
which thousands participated and many new records were made.
[96]
 AFTER THE ARMISTICE The 321st showed up well in all
these marksmanship tests. In both of the intra-brigade (81st
Division) shooting contests, the 321st won over the 322d. In the big
A. E. F. shooting competition at Le Mans, May 5-24, the 321st had
twenty entries in the rifle competition (one automatic rifle), and six
entries in the pistol competition. This was the largest number of
entries by any one regiment in the 81st Division. The 321st made
the second highest standing in the 81st Division, being beaten only
by her old rival, the 322d. Our standing with all regiments
participating was 28th out of 82, with a general average of 478. We
would have ranked about 18th, if two men had not been substituted
at the last moment who had never fired a Springfield rifle. Their
scores were 404 and 415. Four men from the 321st won medals :
Sergt. John T. Covington, Company A. Corp. A. W. Bates, Company
L. Corp. W. P. Chapman, Company K. Corp. F. L. Perry, Company F.
Entries from the 321st Infantry in the Rifle Competition, Le Mans,
France, were : First Lieut. Wisdom W. Rudolph, Company D. Capt.
John Emerson, Company I. Second Lieut. John F. Blackmon. Comnai?
v B. Sergt. John T. Covington, Company A. [97] 7-w
 THE 321ST INFANTRY Private J. L. DeBerry, Company B.
Corp. S. W. McWhorton, Company C. Sergt. W. L. Bodenhamer,
Company D. Private D. K. Chambers, Company E. Corp. F. L. Perry,
Company F. Corp. W. C. Hurst, Company G. Corp. P. E. Melton,
Company H. Mec. A. W. Muths, Company I. Private W. P. Chapman,
Company K. Corp. A. W. Bates, Company L. Sergt. Ed Jenkins,
Company M. Sergt. Billie H. Hall, Headquarters Company. Private
First Class Dennis T. McLawhorn, Machine Gun Company. Private D.
Bare, Supply Company. Private Edward V. Nolan, Company L.
PISTOL. First Lieut. Reynolds T. Allen, Company D. First Lieut.
George E. Doyle, Third Battalion. Clerk Perry E. Andrews, Company
D. First Sergt. Robert G. Edney, Company I. Sergt. Raymond Morse,
Headquarters Company, Sergt. M. L. Yeager, Company II.
AUTOMATIC RIFLE. Corp. George E. Sorensen, Company L. The 81st
Division won fifth place in A. E. F., winning over all other National
Army Divisions, and over two regular army divisions. It is also
worthy of note that the 81st Division was represented in the tactical
maneuvers at Le Mans by a platoon from the 321st Infantry. [98]
 after the armistice Health Record — Court-Martial Record.
The 321st has two other records to be proud of — health and court-
martial record. The health records of the 81st Division show that the
321st had fewer men sick, and a smaller number in hospitals than
any other regiment in the division. There was only one death from
disease in the Second Battalion during overseas service. (Company H
must have expected a death, for it is said they had a rehearsal of a
military funeral one Sunday morning.) The credit for this very
unusual health record is largely due to Lieutenant Colonel
Bloomhardt, who not only exercised great skill a? a physician, but
also great care in safeguarding the health of the regiment. In the
matter of courts-martial, the 321st again stands first in the division,
having to its credit fewer courts-martial than any other regiment.
Here again the honors go to the Second Battalion, which went for
eight months, May, 1918, to January, 1919, without a single
courtmartial. [99]
 the 321st infantry Last Days in France — Embarkation
Orders. Those were happy days the last of April, when we got orders
to prepare for embarkation. The 81st Division went into the S. 0. S.
May 2, and we knew that meant an early departure. Soon after this
date we got orders to be ready to move to the Le Mans area May 12.
It was not until we began getting ready to leave those little villages
in which we had spent the winter and spring that we realized how
many things there were in our camp life that we really could enjoy.
We had kept adding comforts and conveniences to our billets until
they were fairly comfortable. We spent many happy hours around
the big open fireplaces in those old billets. When we were not
cooking eggs, French fried potatoes and toasting bread, we would
be telling jokes and stories, or singing. But the two subjects that
usually monopolized the conversation for at least part of each
evening were, "Our experiences on the Front." and "When are we
going home?" Either of these subjects was sure to get the attention
of the whole crowd. The war songs, such as, "Over There," "Keep
the Home Fires Burning," "Hail ! Hail! The Gang's All Here," "Pack Up
Your Troubles," "There's a Long, Long Trail," "Goodbye, Broadway,"
were sung a great deal, but no more than the hymns. Almost every
night the [100]
 AFTER THE ARMISTICE boys in some billet were trying to
raise the roof with "When the Roll Is Called Up Yonder." This was
sung the most frequently and was the most popular of all the songs
ever sung in the 321st. Toward the last the entertainment, social and
religious programs in the "Y" huts, under the auspices of the
"Comrades in Service Movement," attracted an increasingly large
number. These "huts," with their canteens, libraries, reading and
writing rooms and games, and their entertainments, debates, mock
trials, and shows, were the social centers of each camp. But these
were some of the things we didn't learn to appreciate until we were
breaking camp. The French had heard of our embarkation orders
and would ask us every day, "Partee L'Amerique ?" They were almost
as much stirred up over our leaving as we were. They knew it was
best for us to clear out and give them a chance to look after their
own affairs; yet, they showed quite a bit of sentiment in their
attitude toward our departure. Many of them really hated to see us
leave. Some of them, when we told them good-bye, wept as if they
were bidding farewell to their own sons. In the Le Mans Area. The
321st cleared the Chatillon-Sur-Seine district May 14-16, going by
train (American box [101]
 THE 321ST INFANTRY cars) to the Le Mans area. We went
via Bourges, St. Aigman, Tours, Le Mans, to La Guerche, where
regimental headquarters were established. Headquarters Company,
SupplyCompany, Machine Gun Company, and the Sanitary
Detachment were located at La Guerche; the First Battalion at
Souligne, the Second Battalion at La Bazoge, and the Third Battalion
at Joul L'Abbe and Neuville. Here we stayed until June 4, getting new
equipment, fixing up records, making out passenger lists, and having
field inspections and reviews. The last of our many regimental
reviews came on May 31. We passed in review with full packs, and,
as usual, had to double time. There were rain and a talk from the
colonel to complete the program. This was Colonel Halstead's
farewell talk. He spoke feelingly of his pride and interest in the
regiment, and appealed to the men to go back home as strong and
clean as they left. On June 4 we were ordered to St. Nazairre, our
port of embarkation. Another box car "joy ride" awaited us. But we
knew this was our last ride in box cars, and for that reason it was a
joy ride even though we were packed in fifty-two to the car. It is a
good thing that singing doesn't require any extra space, for it was
the American soldiers' spirit of song and sense of good humor that
saved the day on many occasions in France. [102]
 AFTER THE ARMISTICE Port of Embarkation. We arrived in
St. Nazairre early on the morning of June 5. The four days spent
here were largely taken up with visits to the delousing plant,
bathing, and medical inspections. If medical inspections would keep
one well, we have had enough to keep us well till a ripe old age.
After being properly deloused, bathed, inspected, and fitted out with
new clothes, we were pronounced fit for a return trip to our native
soil. [103]
 THE 321ST INFANTRY CHAPTER V. HOMEWARD BOUND.
Aboard the U. S. S. Manchuria. Finally, that eventful and long looked-
f or dayarrived. On the morning of June 9, we heard that the U. S. S.
Manchuria was in the docks waiting for us to load on. We marched
out of camp and down to the docks at 10 :30 a. m., and were soon
walking up the gangplank of the Manchuria. As our boat pulled out
from the docks, a large crowd of the French and some American
soldiers belonging to other outfits, bade us farewell and shouted
"bon voyage." A French band played the "Marseillaise" and "The
Star-Spangled Banner." We had never dreamed there would be any
sadness of farewell for us when we left France, and we certainly did
not add any salt tears to the briny deep; yet, the memory of our
days in France, fraught as they were with so many thrilling
experiences, aroused a sentiment that was not void of emotion.
Distance will lend enchantment to many a view in La Belle France,
and time will help to soften the hardness of heart that we sometimes
had for French mud, town criers, and wood [104]
 HOMEWARD BOUND— The 321st Inf. embarking, St.
Nazairre, France, June 9, 1919. MID-OCEAN— LIFE ABOARD THE
MANCHURIA.
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