Changes In Life Circumstances Research Articles

Cooperativism as pedagogy: Conversation with Gustavo Machado a lecturer and researcher from Facultad de Ciencias Sociales de la Universidad de la República

This conversation with Gustavo Machado discusses the role of cooperativism as a pedagogical process in Uruguay. Machado emphasizes how cooperatives serve as models for housing production and transformative social learning processes, embedding collective action and mutual aid into daily life. He distinguishes between housing, habitat, and inhabitation, advocating for a broader understanding of living that transcends physical structures and integrates social, cultural, and communal dimensions. Our conversation delves into the political significance of cooperatives in the face of neoliberalism, positioning them as alternatives to market-based housing models. Machado discusses the challenges cooperatives face, such as state regulation and the need for flexibility in adapting to changing life circumstances. He also reflects on his personal experiences growing up in a cooperative during Uruguay's dictatorship, which shaped his political and professional views. The article highlights the intersection of cooperativism with broader social movements, such as gender equality and mental health, and the importance of international dialogue in expanding cooperative housing models across Latin America.

'There are things I have learned the hard way' Patient experiences on lasting challenges 4 months after Transient Ischemic Attack: A qualitative study.

Fatigue, depression, anxiety and cognitive difficulties are reported by 1/3 of patients following transient ischemic attack (TIA). To explore the timeline and how the diagnosis impacts individuals experiencing lasting challenges after TIA. Furthermore, to identify what they believed facilitated return to everyday life. Qualitative exploratory study with a phenomenological-hermeneutic approach. Individual semi-structured interviews and thematic analysis. Fifteen patients were included. Four themes were identified; (1) 'They say it is transient - no, not for me' where all participants described lasting challenges emphasizing invalidating fatigue and impaired social participation, (2) 'I am a changed person; how does this impact my future?' which reflects altered identity and elevated alertness to symptoms, (3) 'Time has been my ally and new perspectives have evolved' where most participants described improvement over time and a few considered the diagnosis a wake-up call to change lifestyle. Lastly (4) 'What would have helped me recover?' which unfolds that close, trustful relations influence positively. In addition, the system often failed to support. Participants described pressure to return to work and lack of trust and negative experiences when involving their general practitioner. During the 4 months since diagnosis, participants experienced limitations impacting physical, psychological and social domains. They felt uninformed that lasting challenges could affect them. Different coping strategies were activated, and participants with close, supportive relations managed better. A pressure to return to work and a lack of trust in the general practitioner affected their recovery negatively. Overall, return to everyday life after TIA was considered stressful and appropriate support lacking. To be able to support patients with challenges following TIA, we as healthcare professionals need to understand the identified impact and life changing circumstances. Currently the system seemingly is not able to provide timely, sufficient and competent support. WHAT PROBLEM DID THE STUDY ADDRESS?: We know from the literature that up to 1/3 of patients following transient ischemic attack experience lasting challenges measured on a variety of questionnaires. This is paradoxical to a diagnosis defined by focal neurological symptoms that resolve within 24 h. It is unknown how patients with lasting challenges experience the timeline from diagnosis and until 4 months after, how the diagnosis impacts the lives of these individuals, and what they believe as beneficial in returning to their everyday life. WHAT WERE THE MAIN FINDINGS?: These participants with self-reported lasting challenges experienced substantial impacts on physical, psychological and social domains. Further, they felt alone with their struggles and when in need of support from the healthcare system, it failed to provide this. A pressure to return to work and a lack of trust in the general practitioner affected return to everyday life negatively, whereas close and supportive relations facilitated positively. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This study will have an impact on the healthcare professionals that provide support and the (limited) follow-up services to patients after TIA. These healthcare professionals are often specialized nurses who need to know what these patients experience and need in order to act upon their struggles and provide timely support. The Standards of Reporting Qualitative Research (SRQR). Patients with TIA was involved in planning this study. They participated in a panel to plan a prospective observational cohort study and emphasized the importance of exploring the subjective perspectives of impact and prognosis for those patients struggling in a longer term (through qualitative interviews).

Young people returning to alcohol and other drug services as incremental treatment

Young people who attend intensive alcohol and other drug (AoD) treatment commonly do so more than once. This paper aims to understand precipitators, enablers and barriers to young people's re-engagement in programs. Data come from a longitudinal qualitative study involving three waves of interviews with Australian young people recruited while attending intensive AoD programs (n = 38 at wave 1).We found that young people's ambitions for what they might achieve with a new stay and capacity to benefit from programs, evolved. Skills learnt in earlier stays or changed life circumstances often helped them achieve better outcomes subsequently. Ongoing contact with an AoD worker was the most important enabler to service re-engagement.Across the span of a year, we saw most young people in our study sample develop a stronger sense of wellbeing and control over substance use. While researchers tend to focus on evaluating outcomes associated with single stays at specific programs, young people think about their trajectories towards managing substance use and their lives as occurring more holistically, supported by engagements with a range of services. We argue that the notion of incremental treatment is useful in depicting the synergistic effects of service engagement over time.

How the size and structure of egocentric networks change during a life transition

While social networks are typically relatively stable in size over time, major changes in life circumstances can result in opportunities to acquire new friends. How young adults manage their relationships with their wider network of friends and family during such transitions is, however, not well understood. Using a prospective longitudinal design, we investigate changes in the size and composition of complete egocentric networks of two cohorts of young adults moving away from home to college. We show that, although networks grow rapidly due to an influx of new friends made at college, the social overload that would result is partially mitigated through the progressive loss of pre-transition friendships (but not family relationships). In addition, most of the new relationships are placed in the outermost, emotionally less close network layers that are less costly to maintain. In contrast, the more intimate inner layers of the network remain stable in size, with efforts being made to conserve these relationships. The overriding importance of face-to-face interaction in creating and maintaining ties (compared to digital media) results in the emotional quality of a tie being traded off against the constraints imposed by physical distance. The most reliable predictor of the proportion of original members with whom relationships were maintained post-transition was pre-transition network size, with weaker effects due to geographical proximity and personal popularity in the new social context. These findings have implications for managing transitions to a new environment at any life stage.

The role of the community in providing psychological and social support after catastrophic events

IntroductionNatural disasters are a risk for significantly disrupting the quality of life as a result of changes in life circumstances they bring, such as endangering health, property, existential issues, and can lead to social exclusion. They can also affect mental health and increase the risk of developing psychiatric disorders.ObjectivesTo show the impact of natural disasters on the psychosocial functioning of people in the affected area and the importance of adequate preparedness of the social community, including mobile teams, with an emphasis on providing somatic, psychological, and social support.MethodsData were collected from research on the consequences of major natural disasters and providing psychological, psychiatric and social support to the affected population.ResultsAfter natural disasters, there are significant changes in social functioning with the possible development of mental health problems. It is especially evident in sudden and intense catastrophic events.ConclusionsIn addition to the immediate provision of psychiatric and psychological assistance to victims, people who have experienced a catastrophic event need to be provided with immediate and continuous assistance and socioeconomic support, due to the need for better social inclusion and return to their role in the community.Disclosure of InterestNone Declared

Exploring sedentary behavior during neo- or adjuvant treatment in patients with cancer: A phenomenological study

PurposeIncreased sedentary behavior during cancer treatment is common, which may have negative long-term health effects. Understanding patients' experience of sedentary behavior during neo- or adjuvant cancer treatment may be crucial in developing effective support for patients to reduce sedentary behavior. Therefore, the present study aimed to explore sedentary behavior in patients undergoing neo- or adjuvant cancer treatment. MethodsEleven interviews were conducted with patients undergoing treatment for breast, prostate, and colorectal cancer. Participants were recruited from a university hospital in Sweden. Interviews were analyzed phenomenologically, and the results were presented as descriptions of the phenomenon sedentary behavior. ResultsThe overarching theme of sedentary behavior during cancer treatment was that sedentary behavior is experienced through being physically active or not. Furthermore, experiences of sedentary behavior increased with side effects and varied depending on the type and phase of cancer treatment, meaning that sedentary behavior is an adjustment to side effects. Additionally, sedentary behavior was influenced by life circumstances and social interaction, such as work status and having social support. Finally, sedentary behavior is influenced by strategies and motivations, such as the perceived benefits of physical activity and self-image. ConclusionsSedentary behavior is difficult for patients to discern, which is why health care personnel may need to help patients by increasing awareness of the negative impact of sedentary behavior in a way that does not stigmatize patients. Furthermore, developing support that targets periods with more side effects and helping patients reduce sedentary behavior throughout changing life circumstances may be helpful.

Using risk of crime detection to study change in mechanisms of decision making.

Perceptions of crime detection risk (e.g., risk of arrest) play an integral role in the criminal decision-making process. Yet, the sources of variation in those perceptions are not well understood. Do individuals respond to changes in legal policy or is perception of detection risk shaped like other perceptions-by experience, heuristics, and with biases? We applied a developmental perspective to study self-reported perception of detection risk. We test four hypotheses against data from the Dunedin Longitudinal Study (analytic sample of N = 985 New Zealanders), a study that spans 20 years of development (Ages 18-38, years 1990-2011). We reach four conclusions: (1) people form their perception of detection risk early in the life course; (2) perception of detection risk may be general rather than unique to each crime type; (3) population-level perceptions are stable between adolescence and adulthood; but (4) people update their perceptions when their life circumstances change. The importance of these findings for future theoretical and policy work is considered. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

MASS MILITARY PSYCHOSIS IN CONTEMPORARY RUSSIA: THE PERFORMATIVE DIMENSION OF COUNTERMEASURES

The article examines how to counteract the mass militaristic psychosis (MMP) in modern Russia that is unfolded in discourses and narratives of the hostile media and is consistent with societal psyche intentions. The study’s purpose is to substantiate the methods (collective and individual) counteracting causes, manifestations and consequences of MMP in the aggressor country in the context of the performative approach in psychotherapy. Research methods: analysis of everyday discourse and media content to identify leading intentions of ideological influence, including observation and comparative analysis of the effectiveness of various psychotherapeutic methods, and axiopsychological reinterpretation of some psychotherapeutic practices. The results. The study revealed limited possibilities for implementing psychological education and encouraging critical thinking of the militaristic propaganda recipients. Instead, in the era of dominance of performance, when contemplation has been replaced with actions, the techniques of “emotional judo” become useful that introducing careful counterarguments to remove leaders – demagogues and dictators – from power and to apply real changes in life circumstances (primarily, to achieve Ukraine’s victory in the war). The forms of individual resistance to MMP, the imperial “rashism” ideology are derived from M. Seligman's PERMA formula. This is an axio-psychological interpretation of its emotional, intellectual, communicative and physical (acts) components. The article considers types of shaming used by political bloggers due to the total influence of Internet communications and widely spread invective practices in media content. The features of limited shaming in counter-propaganda are described. Conclusions. The antidote to MMP in the latest era of Meta-modernism means the performative exposition of its causes, manifestations and consequences to achieve real value transformation in the population affected by the imperial ideology. Axiopsychological reinterpretation of the positive psychological formula PERMA consists of the following steps: emotional rejection, reflexive criticism, value-orientation unity, reliance on a sense of dignity, defense of universal values and the will to defeat an existential enemy.

Collaborative autoethnography in applied linguistics: reflecting on research practice

Abstract This reflective paper explores collaborative autoethnography (CAE) as a research method by analyzing 15 of our CAE English language teaching and applied linguistics studies published from 2015 to the present. Focus is given to tying CAE to its ethnographic roots, including autoethnography and duoethnography. The implications of CAE representing a methodological expansion of ethnographic methods from researching and reporting on the other to researching and representing one’s own authentic experiences are explored. We discuss the “counter-narratives” that CAE spaces facilitate, where minoritized opinions and experiences can be safely shared and (re)affirmed, including how to facilitate transformative experiences in practice. Two implications for CAE practice are shared. The first concerns the need for CAE participants to be conscious of different levels of participation, particularly as life circumstances change, and to flexibly accommodate these. The second concerns how CAEs should represent a process that facilitates growth and transformation rather than a final, published product. We conclude by noting that while CAE may have shortcomings, it represents a promising avenue of exploration for practitioners interested in developing professional practices through reflection and discussion with research collaborators.

Who remained happy despite the pandemic?: the impact of changed life situations and mobility and perceptions and attitudes toward the altered lifestyle during COVID-19

ABSTRACT This study explored the determinants of happiness during the COVID-19 pandemic by emphasizing a broad range of factors, including individual (i.e. socio-demographic status, life situations, attitudinal and perceptual characteristics) and policy restrictions. In particular, the study delved into the impact of changes in life situations and mobility, as well as perceptions and attitudes toward the altered lifestyle during COVID-19, on happiness. By analyzing data with 75 items from a U.S. nationwide survey in 2020, this study found that socio-demographic factors played a significant role in increasing happiness specifically when income increased and individuals transitioned from unemployment to employment or sustained employment during the pandemic. Happiness was also significantly reduced by COVID-19 altered attitudinal and perceptual changes such as restricted social interactions and activities, perception of infection risk, avoidance of online alternatives, perceived infection risk from close relationships, and a preference for compactness. Individuals who were users of public transportation before COVID-19 reported lower levels of happiness during the pandemic. This comprehensive exploration underscores the multifaceted nature of happiness during the COVID-19 pandemic, highlighting the intertwined roles of socio-demographic factors, changes in life circumstances, and attitudes and perceptions to new life style.

The Twin Dangers of Order and Disorder: Rethinking the Relationship Between Movement and Change in Drug Treatment

In this article, we propose that the perpetual difficulties in drug treatment can be understood as a consequence of how a binary opposition of order and disorder continues to structure drug discourses and treatment practices. When drug use is seen as a disorder of addiction, recovery becomes reduced to movements between fixed points benchmarked against preexisting standards. This obscures how recovery could be understood as a process of self-differentiation where subjects develop new norms to adapt to changing life circumstances. In the article we draw on empirical material from a Copenhagen drug-treatment facility for young drug users, to analyze how change and development can be facilitated through a fundamental institutional “movability.” Drawing on the philosophy of change of Henri Bergson, the assemblage approach of Deleuze and Guattari, and the aesthetic theory of Jacques Rancière, we analyze how a particular assemblage of discourses, the organization of treatment and aesthetic spaces disrupt existing orders and open for different possibilities for participation and development for young drug users. In particular, we turn the attention to how aesthetic spaces and sensuous processes can counter stigmatization by overcoming the frame of “treatment” and the affective experiences associated with the categorization as a “drug-user” and facilitating the development of care as new ways of becoming and being-together.

Zootherapy in social rehabilitation of children with special needs

Children with special needs experience significant difficulties in organizing their educational and communicative activities and behavior due to their developmental characteristics, as well as somatic diseases. Such children have problems in socialization and psycho-emotional sphere (they are anxious, vulnerable, painfully react to changes in life circumstances, and prone to frequent mood changes). They also have limited ideas about the world around and underdeveloped higher mental functions. The purpose of social rehabilitation is to restore skills, lost or not acquired during socialization, and abilities to perform social functions, relationships, and roles. One of the means of social rehabilitation is zootherapy, which is based on the interaction of a person with an animal. Zootherapy includes various areas: hippotherapy, canis therapy, dolphin therapy, feline therapy, etc. Therapy with animals has a positive effect on children with special needs: it stabilizes the emotional state, reduces the level of anxiety and stress, and promotes the development of communication skills, as well as the development of moral qualities.

"Taking from Peter to pay Paul": The experience of people in receipt of fuel and food vouchers from a UK foodbank.

For people on very low incomes, household fuel and food environments are increasingly uncertain. Many live in precarious situations with little control over their lives. In addition to food parcels, many foodbanks also supply emergency fuel payments. There has been a surge in demand due to the cost of living crisis in the United Kingdom. This qualitative study, using semi-structured interviews, explored the lived experience of people who received a fuel voucher via a foodbank to gain insights into food preparation, eating practices and heating and appliance use in their homes. All participants (n = 6) described a change in life circumstances leaving them at crisis point with overwhelming uncertainty. Using Thematic Analysis, we identified four themes: (1) Bewilderment in using foodbank services; (2) The need to make trade-offs between food and fuel; (3) Feeling shame at using the services and (4) Missing out on pleasurable eating practices. Three case studies give fuller insights and context. All interviewees had acute and complex needs and described being 'at rock bottom', with fuel vouchers viewed as a 'lifeline' to address essential cooking, heating and electrical appliance needs. We, therefore, suggest the need for extra support and follow-up for first-time users who are in a state of denial and shock when seeking help. Further research is needed on how to best help organisations develop strategies to address and ameliorate a sense of powerlessness and shame felt by their clients which likely limits them from seeking help, despite being in acute, complex and dire need.

Mediating Effects of the COVID-19 Pandemic on the Associations between Physical Activity and Physical Fitness; Cross-Sectional Study among High School Adolescents.

The COVID-19 pandemic and the imposed social distancing measures caused negative changes in physical activity levels (PALs) and physical fitness (PF) among adolescents, but the potential mediating effect of the pandemic on the association between PAL and PF is unknown. This study aimed to evaluate gender-specific associations between objectively measured PAL and indices of PF among high school adolescents during the period of the COVID-19 pandemic. The participants were 150 adolescents (101 females) aged 14-18 years; their anthropometrics were evaluated, and they were tested on PF (cardiorespiratory fitness (CRF; beep test), power (broad jump), flexibility (sit-and-reach test), and abdominal strength (sit-ups)) and PAL (using a pedometer for 7 days) during the pandemic period. A T-test was calculated to determine differences between genders. Associations between variables were evaluated using Pearson correlations. Additionally, multivariate taxonomic classification was used to sort participants into homogenous groups (clusters) according to their PF, and then analysis of variance (ANOVA) was performed to differentiate them according to PAL. For the total sample, PAL was correlated with CRF only (R = 0.25, p < 0.05), while gender-stratified correlations showed that PAL was significantly associated with CRF among girls only (R = 0.29, p < 0.05), which was additionally confirmed with multivariate cluster analysis and subsequent ANOVA. No association between PAL and PF was found for boys. The relatively low association between PAL and PF is most likely related to the mediating effect of the change in life circumstances during the COVID-19 pandemic, and limited applicability of pedometers in evaluating high-intensity PAL. Further studies in other age groups and environments are warranted.

Community Stakeholders’ Perceptions of the Impact of the Coronavirus Pandemic on Homelessness in Canada

Homelessness was already a well-known risk factor contributing to premature death, morbidity, mental illness, and substance use disorder. The coronavirus disease for 2019 (COVID-19) pandemic has amplified disparities in Canada’s public health system, disproportionately impacting people experiencing homelessness. The present study aimed to investigate the impact of the COVID-19 pandemic on the homelessness situation in Canada from community stakeholders’ perceptions. The study used qualitative research approaches underlain by focused ethnography tenets. The sample includes 200 service providers from 28 communities across Canada (at least one site in each province and territory) to participate in virtual focus groups. Data analysis followed a four-step ethnographic approach for thematic analysis in qualitative research. Six main themes emerged: (a) system changes precipitated by the COVID-19 pandemic; (b) personal changes in life circumstances; (c) previous strategies no longer working; (e) opportunities; (d) some things getting better; (f) an overall increase in first time and recurrent homelessness in Canada. The study findings underscored mechanisms required to help ‘tip the scale’ in affording people experiencing homelessness the opportunity to avoid or exit homelessness.

Long-Term Treatment of Narcolepsy and Idiopathic Hypersomnia with Low-Sodium Oxybate.

Narcolepsy and idiopathic hypersomnia are chronic conditions that negatively affect alertness, mental and physical energy, functioning, and quality of life (QoL). Calcium, magnesium, potassium, and sodium oxybates (low-sodium oxybate; LXB) is an oxybate formulation with 92% less sodium than sodium oxybate (SXB; a treatment for narcolepsy) and the same active moiety. LXB is approved in the US for treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age or older with narcolepsy, and idiopathic hypersomnia in adults. In Phase 3 clinical trials, LXB exhibited a safety profile consistent with that of SXB in narcolepsy. Besides continued efficacy in treating symptoms, potential benefits of long-term LXB treatment include flexible optimization of dosing and regimen, improvement of QoL and functioning, weight loss, and (relative to SXB in narcolepsy) health benefits of reduced sodium content. Dosing of LXB is twice nightly (for narcolepsy) or once or twice nightly (for idiopathic hypersomnia) based on patient characteristics and response, and individualized titration can be leveraged over the long term as a patient's life circumstances change. Patients with narcolepsy transitioning from SXB initiate LXB at the same dose, and most patients require no further changes to achieve similar efficacy and tolerability. Improvements in functioning and QoL with LXB treatment could have cascading positive effects in multiple domains, particularly in younger patients. In clinical trials, LXB was associated with weight loss in both narcolepsy (in which obesity is a well-established comorbidity) and idiopathic hypersomnia, only occasionally leading participants to be underweight. As both narcolepsy and idiopathic hypersomnia are associated with increased risk of cardiometabolic and cardiovascular comorbidities, limiting medication-related sodium intake with LXB may have significant health benefits, although this has not yet been verified prospectively due to the prolonged follow-up required. LXB is a promising long-term treatment for narcolepsy and idiopathic hypersomnia.

How well can U.S. military veterans' suicidal ideation be predicted from static and change-based indicators of their psychosocial well-being as they adapt to civilian life?

Identifying predictors of suicidal ideation (SI) is important to inform suicide prevention efforts, particularly among high-risk populations like military veterans. Although many studies have examined the contribution of psychopathology to veterans' SI, fewer studies have examined whether experiencing good psychosocial well-being with regard to multiple aspects of life can protect veterans from SI or evaluated whether SI risk prediction can be enhanced by considering change in life circumstances along with static factors. The study drew from a longitudinal population-based sample of 7141 U.S. veterans assessed throughout the first three years after leaving military service. Machine learning methods (cross-validated random forests) were applied to examine the predictive utility of static and change-based well-being indicators to veterans' SI, as compared to psychopathology predictors. Although psychopathology models performed better, the full set of well-being predictors demonstrated acceptable discrimination in predicting new-onset SI and accounted for approximately two-thirds of cases of SI in the top strata (quintile) of predicted risk. Greater engagement in health promoting behavior and social well-being were most important in predicting reduced SI risk, with several change-based predictors of SI identified but stronger associations observed for static as compared to change-based indicator sets as a whole. Findings support the value of considering veterans' broader well-being in identifying individuals at risk for suicidal ideation and suggest the possibility that well-being promotion efforts may be useful in reducing suicide risk. Findings also highlight the need for additional attention to change-based predictors to better understand their potential value in identifying individuals at risk for SI.

The Impact of Nutrition on Muscle Health in Older Individuals

The Impact of Nutrition on Muscle Health in Older Individuals Abstract: The age-related change in the importance of nutrition for muscle health starts at the age of 50. Considering its effects on the mobility and physical independence of older people, the aging of the musculoskeletal system represents one of the greatest public health challenges and tasks for a demographically aging Switzerland. In particular sarcopenia, a pathological decrease in muscle strength, muscle mass and muscle function beyond the physiological age-related changes, correlates with a significantly increased risk of falls as well as increasing morbidity and mortality. Common chronic diseases related to old age not only promote additional muscle loss but also frailty, leading to an additional decline of the quality of life. General practitioners play a crucial role in the initial assessment of changing life circumstances and activity profiles of older people. Thanks to their medical care over many years they are able to identify functional impairments of their aging patients at an early stage and address them in time. This is important because the combination of a high-protein diet and exercise may be extremely effective for improving muscle health and function. Eating more proteins (taking into account the newly revised and increased daily protein requirement for healthy seniors of 1,0-1,2g/kg body weight (bw)) can significantly slow down age-related muscle loss. Depending on age and comorbidities, the daily protein requirement might be even higher (1,5 to 2,0g/kg bw). According to current studies, a minimal protein amount of 25-35g per main dish is recommended for optimal muscle growth stimulation among older individiuals. Thanks to their highly potent boosting power on myofibrillar protein synthesis rates the amino acid L-leucine and L-leucine-rich foods play an important role in elderly people's diet.

Female Economic Agency in Kinship, Gender &amp; Sexuality Studies

This article intends to show how sociocultural anthropologists have increasingly acknowledged the economic agency of women in their works on the subjects of kinship, gender and sexuality and will focus on two examples that connect these three subjects- Gloria Wekker's study of Afro-Surinamese women involved in the relational practice known as mati and Louise White's study of the female prostitutes of colonial Nairobi. The article first analyzes how Wekker gives Afro-Surinamese women a sense of economic agency by describing the systems of exchange these women establish with their male partners, their extended families, fictive kin and even the supernatural beings of their religion. The article then goes on to analyze how White gives the female prostitutes of Nairobi's colonial period a sense of agency by describing how prostitutes in the city obtained a level of autonomy that would have been beyond the reach of most prostitutes living during the late 19th and early-to-mid 20th centuries, and how these prostitutes used the changing circumstances of life in Nairobi to their advantage.

Blended online and face-to-face art therapy

This article focuses on a blended art-based practice that uses a combination of face-to-face, online, mobile and e-mail text-based methods. Blended art therapy alternates between digital and face-to-face formats complementing each other allowing clients to become autonomous and adapt to changing life circumstances. The approach encourages clients to take an active role in the distant treatment while undertaking continuous home art engagement tasks in between sessions. Switching between different digital, virtual and terrestrial formats will be described in this article. The outcomes discussed indicate certain client groups may benefit from a blended method approach. Attention will be given to the experiences of sensory perception, intimacy and relational proximity, during the virtual phases of the work. This article will also highlight observations in relation to the ways in which attachment dynamics have been identified and worked with in the face-to-face phase of therapy.