Combined therapy with borderline and narcissistic inpatients at the cassel hospital

An account is given here of a rather unorthodox approach to psychodynamic therapy with Borderline patients in part of the therapeutic community at the Cassel Hospital. ‘Combined therapy’ here refers to the setting in which one therapist sees patients in groups and individual sessions concurrently. The paper demonstrates the manner in which this approach brings to the fore the massive destructiveness and rage which so often lies at the core of these patients' difficulties. This is done by describing the development of the group over its first nine months. The therapist comes to be split in the patient's perception, the group sessions representing separation in all its most hated aspects rather than as a prerequisite for differentiation and growth. The resultant rage and destructiveness threaten to render the group unworkable and dangerous. The individual sessions, by contrast, represent a fantasy of being regressed and at one with the ideal mother. It is my belief that these difficulties can be contained only within a therapeutic community. The strength of this approach lies in the vivid reconstruction of a central conflict for these patients and corresponding potential for working through difficulties in the area of separation and individuation. It is also particularly effective in bringing the therapeutic community alive within the therapy. The discussion attempts to address some of the complex theoretical issues raised by the transformation of the transference in both settings which occurs when they are used together and with the same therapist.     

Convergent validity of the Agnew Relationship Measure and the Working Alliance Inventory

The convergent validity of the Agnew Relationship Measure (ARM) and the Working Alliance Inventory (WAI) was assessed in samples drawn from 2 comparative clinical trials of time-limited psychotherapies for depression. In 1 sample, clients (n = 18) and therapists (n = 4) completed self-report versions of both measures after every session (n = 198). In the other sample, clients (n = 39) and therapists (n = 6) completed the ARM, and observers subsequently rated selected audiotaped sessions (n = 78) using the WAI. In both samples, the ARM's core alliance scales (Bond, Partnership, and Confidence) were correlated with the WAI's scales (Bond, Tasks, and Goals) strongly when assessed within client and therapist perspectives and, with some qualifications, moderately when assessed between client, therapist, and observer perspectives, supporting the assumption that the ARM and the WAI measure some of the same core constructs.     

Assessing the impact of group treatment for aggressive inpatients

The purpose of this research was to determine if psychodynamic group psychotherapy decreases the occurrence of physical assault by male group members. The design of the study was a randomized clinical trial. Patients assigned to the control group received the customary clinical care. Patients assigned to the Group Therapy attended a psychodynamic psychotherapy group to help them cope with their aggressive impulses. Both quantitative and qualitative measures were used. Group members showed decreased expression of anger at followup, increased effort to control anger at followup, and decline in aggressive behavior. Control subjects demonstrated no change in level of angry feelings, increased expression of anger at follow-up, decrease in effort to control anger at follow-up, and no change in aggressive behavior. A model for conducting a psychodynamic psychotherapy group for assaultive men was developed which describes process and content aspects as well as leader interventions by group phase.     

A feminist therapy application of the boundary model with obese female binge eaters

Increasing empirical attention is being paid to understanding the etiology, course, and duration of binge eating disorder, and numerous types of treatment for this disorder are currently available. This article examines binge eating disorder and discusses problematic issues in its current treatments from a feminist therapy perspective. A model conceptualizing the regulation of food intake and binge eating is presented. Clinical applications of the model consistent with principles of feminist therapy are suggested.     

Assessing collective affect recognition via the Emotional Aperture Measure

Curiosity about collective affect is undergoing a revival in many fields. This literature, tracing back to Le Bon's seminal work on crowd psychology, has established the veracity of collective affect and demonstrated its influence on a wide range of group dynamics. More recently, an interest in the perception of collective affect has emerged, revealing a need for a methodological approach for assessing collective emotion recognition to complement measures of individual emotion recognition. This article addresses this need by introducing the Emotional Aperture Measure (EAM). Three studies provide evidence that collective affect recognition requires a processing style distinct from individual emotion recognition and establishes the validity and reliability of the EAM. A sample of working managers further shows how the EAM provides unique insights into how individuals interact with collectives. We discuss how the EAM can advance several lines of research on collective affect.     

The Impact of Breaks on Sustained Attention in a Simulated,Semi‐Automated Train Control Task

Summary: Sustained attention is a factor in many work environments where operators intervene on a regular basis to ensure the safety and security of a system. Different types of activity during break periods may facilitate different levels of performance following extended periods of attention in these environments. The impact of five different breaks from task activity was assessed against the performance of a no‐break control group during a simulated, high signal probability rail control task. A total of 87 university students were assigned to a no‐break control condition, or one of five break activity conditions that occurred between two, 20‐minute periods of simulated rail control. Post‐break, the analysis revealed that, in comparison to the control condition, performance was greater in all of the five break conditions. Any activity that drew operators' attention from the primary rail control task enabled improvements in performance beyond a no‐break control task.Copyright © 2017 John Wiley & Sons, Ltd.     

Thinking about psychoanalytic curricula: an epistemological perspective

The author discusses the role that curriculum development can play in preparing psychoanalytic candidates to understand the challenges created by theoretical pluralism in our field and by the growth of knowledge in neighboring disciplines. Curriculum design can be used to encourage the development of epistemological perspectives that can serve as organizing frameworks to help candidates think critically about psychoanalytic knowledge. It is possible to teach these complex matters in a way that students find accessible and useful. The author presents exemplars taken from the curriculum at the Columbia University Center for Psychoanalytic Training and Research in New York.     

Group versus individual cognitive-behavioural treatment for obsessive-compulsive disorder: a controlled trial

The efficacy of group cognitive behaviour therapy (CBT) for obsessive-compulsive disorder (OCD) has received relatively little research attention compared with the large number of studies that have investigated individual CBT. The current study is the first controlled study to compare an identical CBT protocol, containing both cognitive and behavioural elements, delivered either individually or in a group. Participants were randomly assigned to either 10 weeks of individual CBT, 10 weeks of group CBT or a 10 week wait-list. Participants with significant rates of secondary comorbidity were included in the study to enhance the generalisability of results. Intention-to-treat and completer analyses were carried out and indicated no differences between the group and individual treatments on outcome measures. Large effect sizes were found for both conditions. Analysis of clinically significant change indicated that the individual treatment was associated with a more rapid response but that both treatments had equivalent rates of recovered participants by brief follow-up. The importance of further investigations of the efficacy of group CBT for OCD is discussed.