Do drop-outs differ from successfully treated obsessive-compulsives?

The most common reasons given by patients for dropping out of treatment are: environmental constraints, dissatisfaction with services and that they no longer need help. In this study two groups of patients suffering from obsessive-compulsive disorders are compared. The drop-outs' reasons for terminating treatment are compared with the comments of patients who completed the therapy successfully. Drop-outs differ from successfully treated OCD's in five respects: they appear to be less obsessive-compulsive; they have more discongruent treatment expectations; they are more critical of the therapist; they experience less anxiety in carrying out homework assignments; they less frequently come under pressure from people close to them.     

Distinguishing obsessive features and worries: the role of thought-action fusion

Obsessions are a key feature of obsessive-compulsive disorder (OCD), and chronic worry is the cardinal feature of generalized anxiety disorder (GAD). However, these two cognitive processes are conceptually very similar, and there is a need to determine how they differ. Recent studies have attempted to identify cognitive processes that may be differentially related to obsessive features and worry. In the current study we proposed that (1) obsessive features and worry could be differentiated and that (2) a measure of the cognitive process thought-action fusion would distinguish between obsessive features and worry, being strongly related to obsessive features after controlling for the effects of worry. These hypotheses were supported in a sample of 173 undergraduate students. Thought-action fusion may be a valuable construct in differentiating between obsessive features and worry.     

You’ve Got to Believe: Core Beliefs that Underlie Effective Psychotherapy

A mixture of core beliefs may lay the foundation for effective psychotherapy. Sincere trust in these beliefs may help to promote therapeutic change. The therapist must have faith in the power of words to promote change. Clients usually change in a gradual manner, and the initial plan for therapy can be simplified by focusing on strategies for changing actions and attitudes. Also, therapy can help to improve various aspects of clients’ intimate relationships. However, before attempting to promote therapeutic change, it is important for the therapist to begin by understanding the client’s life situation, current distress, and natural tendencies. Clients benefit from emotional tolerance of stressors by recognizing that many negative life events turn out better than initially expected. A tendency to dwell on past events can perpetuate problems, while it can be more helpful to accept and grow from negative events. Therapists are encouraged to view a client’s emotions as natural reactions, not deviant dysfunctions that need to be blocked or suppressed through medications. In a similar manner, most labels, including many psychiatric diagnoses, pose a danger through societal discrimination and self-stigma. When therapists adopt these core beliefs, they can more effectively help clients move forward, making adaptive psychological changes.     

The narcissistic therapist meets a narcissistic patient

The presence of narcissism in both therapist and patient results in a collusion that preserves the narcissistic integrity of the therapist and validates the narcissistic injury of the patient. Not only is the narcissistic behavior of the patient condoned, but narcissistic excesses in the therapist are tolerated. The unconscious identification on the part of the therapist with the patient produces anxiety in the therapist which results in treatment that intensifies the pathology of the patient.     

Gender differences in the frequency of personality disorders in depressed outpatients

We examined gender differences in the frequency of DSM-III-R personality disorder diagnoses and symptomatology in a sample of 225 depressed outpatients. This research partially replicates and extends one of the first studies in this area by Golomb et al. (1995). Males were significantly more likely than females to meet diagnoses for schizotypal, paranoid, narcissistic, antisocial, obsessive compulsive, and borderline personality disorder. Compared to females, males were also significantly more likely to have schizoid, schizotypal, narcissistic, antisocial, and obsessive-compulsive personality disorder symptomatology. Females did not predominate in any personality disorder symptomatology or diagnoses. A possible explanation for these findings is discussed. The results of this study challenge traditional assumptions about gender differences in the frequency of personality disorders, and confirm the need for future studies to investigate the relation between gender and personality disorders in specific Axis I samples.     

Strategic Issues in the Psychotherapy of Patients with Narcissistic Pathology

Narcissistic personality disorder is a relatively uncommon diagnosis in clinical settings; however, these patients are frequently in need of and referred for long-term psychotherapy. Such patients may not seek therapy willingly but do so at a time when they experience sufficient vulnerability to accept therapy. Given these and other characteristics, the narcissistic patient can be challenging for therapists. This paper suggests some strategic approaches that may be employed with patients with narcissistic pathology. Partly, these approaches incorporate more contemporary understandings of narcissistic pathology such as appreciating that these patients can present both the grandiose and vulnerable elements of narcissistic pathology and that a gender focus using theories of masculinity may enlighten our approach to these patients. Specifically the strategies reviewed are: starting therapy by assessing for the patient’s vulnerable characteristics and offering some gratification for their need for acknowledgement; monitoring and managing the risk of suicide and comorbid disorder in patients with narcissistic pathology and in the working through phase of therapy, recognizing the need for patients to developed increased self-cohesion and the importance of supervision/consultation in the working through process of therapy.     

Pastoral Care for Shame-Based Perfectionism

While perfectionism has been associated with guilt dynamics, the form of perfectionism that is most frequently discussed by psychologists is connected to self-condemnation for perceived failures to reach the high standard set for personal achievement. There is therefore a strong link between perfectionism and inferiority shame. Psychotherapists have given quite a bit of attention to shame-based perfectionism; it has been largely neglected by pastoral psychologists. Three approaches to the pastoral care of shame-based perfectionism are developed. The first approach is based in cognitive therapy. It is argued that perfectionism is grounded in a faulty core belief about the self—namely, “I am what I achieve.” The second method makes use of strategies developed by John Bradshaw for accepting and affirming all one’s sub-selves. Bradshaw’s approach is critiqued, however, for the way in which shame-based and guilt-based perfectionism are confused. The third method is a modification and adaptation of Heinz Kohut’s strategy of “mirroring” (empathy, admiration, and approval) that he developed for use in work with clients with narcissistic personality disorder.     

Putnam’s account of apriority and scientific change: its historical and contemporary interest

In the 1960s and 1970s, Hilary Putnam articulated a notion of relativized apriority that was motivated to address the problem of scientific change. This paper examines Putnam’s account in its historical context and in relation to contemporary views. I begin by locating Putnam’s analysis in the historical context of Quine’s rejection of apriority, presenting Putnam as a sympathetic commentator on Quine. Subsequently, I explicate Putnam’s positive account of apriority, focusing on his analysis of the history of physics and geometry. In the remainder of the paper, I explore connections between Putnam’s account of relativized a priori principles and contemporary views. In particular, I situate Putnam’s account in relation to analyses advanced by Michael Friedman, David Stump, and William Wimsatt. From this comparison, I address issues concerning whether a priori scientific principles are appropriately characterized as “constitutive” or “entrenched”. I argue that these two features need to be clearly distinguished, and that only the constitutive function is essential to apriority. By way of conclusion, I explore the relationship between the constitutive function a priori principles and entrenchment.     

Narcissistic Personality Disorder as an Intrapsychic Trajectory to Real Self-Love: A Case Report

The intrapsychic mechanism of remission in a forensic psychiatric patient with narcissistic personality disorder and comorbid antisocial features is examined. The positive impact of a therapeutic and academic program on the patient’s development and recovery and correlated increase of true self-love is analyzed and discussed. Real self-love appeared to be associated with stable selfesteem and enhancement of self-insight, authenticity, and reality testing capacities.     

Psychologists' and social workers' self-descriptions using DSM-IV psychopathology

There is limited information on mental health of psychologists and social workers despite their rendering mental health services, so their subjective perception of mental disorder was explored via a self-evaluation survey in which they self-diagnosed the presence of DSM-IV disorders within themselves. The sample of 128 professionals included 63 psychologists and 65 social workers. The presence of Axis I traits was reported by 81.2%, the three most frequent traits being mood, obsessive-compulsive disorder, and eating disorder. Axis II traits were reported by 73.4% of subjects, the three most frequent conditions being narcissistic, avoidant, and obsessive-compulsive personality traits. While a high percentage of subjects reported the presence of either an Axis I or Axis II disorder, the average severity reported was low. More psychologists reported on mood, social phobia, and eating problems than social workers, while the latter reported more on psychotic problems. Psychologists reported more Axis II traits, especially paranoid, narcissistic, and avoidant subtypes. More women than men reported eating problems, while more men reported schizoid and avoidant personality traits. In conclusion, manifestations of subthreshold psychiatric conditions were prominently reported. These findings suggest encouraging mental health care professionals to explore treatment for problems if present.     

Reading <Emphasis Type="Italic">Principia Iuris</Emphasis>

This paper illustrates the main features of Luigi Ferrajoli’s theoretical approach to law, as they are developed in his Principia Juris. These include his opposition to the traditional perspective of natural law; his anti-cognitivist orientation; and, finally, his fundamentally normative approach. Among the numerous problems discussed in Ferrajoli’s compendious book, the paper focuses on his definition of constitutional democracy. In particular, the paper discusses the way in which Ferrajoli defines the complementarity between democracy and rights; Ferrajoli’s own criticism of T. H. Marshall’s idea of citizenship; and the importance that the distinction between ‘decidable’ and ‘non-decidable’ rights have in Ferrajoli’s own system. Other issues of interests that are briefly discussed include the constitutionalisation of private law, and the defence of different kinds of liberty-rights.     

Providing Information to Parents of Children with Mental Health Problems: A Discrete Choice Conjoint Analysis of Professional Preferences

We used discrete choice conjoint analysis to model the ways 645 children’s mental health (CMH) professionals preferred to provide information to parents seeking CMH services. Participants completed 20 choice tasks presenting experimentally varied combinations of the study’s 14 4-level CMH information transfer attributes. Latent class analysis revealed three segments. Open Access professionals (32.2%) preferred that intake workers automatically provide all parents with CMH information. They preferred information prepared by professional organizations and located at accessible settings such as public schools. They responded favorably to the internet as a source of information for parents. Controlled Access professionals (22.2%) preferred information that was approved and recommended by a child’s therapist, prepared by an experienced clinician, and located at hospitals and CMH clinics. Process Sensitive professionals (45.6%) showed a stronger preference for active learning materials with parenting groups and therapist “coaching” calls supporting the knowledge transfer process. Simulations suggested that realizing the benefits of CMH information requires the development of knowledge transfer strategies that align the preferences of professionals with those of the families they serve.     

Internalism and Hyperexternalism About Reasons

Alan Goldman’s Reasons from Within is one of the most thorough recent defenses of what might be called ‘orthodox internalism’ about practical reasons. Goldman’s main target is an opposing view that includes a commitment to the following two theses: (O) that there are such things as objective values, and (E) that these values give rise to external reasons. One version of this view, which we can call ‘orthodox externalism’, also includes a commitment to the thesis (I) that rational people will be motivated by any reason they have of which they are aware. Goldman himself embraces (I), and deploys it frequently in his criticisms of orthodox externalism. But there is logical space for an externalist view that includes a commitment to (O) and (E), but that denies (I). The resulting “hyperexternalist” view holds that some reasons need not motivate us, even if we are rational. In this paper I argue that Goldman’s criticisms of orthodox externalism leave hyperexternalism untouched, and that his specific criticisms of my own version of hyperexternalism do not work. In light of Goldman’s criticisms of orthodox externalism and my own criticisms of Goldman’s view, hyperexternalism emerges as the favored option.     

Therapist memory and reverie: implications for the clinical setting

In this work, the author considers reveries to be ‘dream-like-memories’. In the course of a session they appear as proto-memory – the therapist’s early traumatic object relations that are recorded in the unconscious at an almost bodily level (a type of unthought known) and which are resurrected between therapist and patient when a similar traumatic subject arises between them. The therapist’s reveries are recollections in the form of dream-like allusions to his past experience. A clinical vignette from the psychotherapy of a child whose father suffered from PTSD (following a wartime experience in Afghanistan and Iraq) is discussed. Dissociative dynamics were repeated in the therapeutic relationship, in the form of an obsessive game intending to preserve the state in which there was no need to remember what had been unconsciously transmitted to the child: his father’s wartime experience. The projection of the primary elements which had been silenced evoked in the therapist allusions to his unconscious identification with his ancestor’s post-traumatic experiences. These allusions helped in overcoming the dissociated state. The role of memory in child psychotherapists’ receptivity of trauma is revisited.     

East of Ego: The Intersection of Narcissistic Personality and Buddhist Practice

This article explores the intersection of clinical narcissism and Buddhist meditation practice. Through the lens of Otto Kernberg and Heinz Kohut’s theories of narcissism, the article investigates the many facets of Eastern spiritual practice when undertaken by a narcissistic practitioner. In particular, questions are raised regarding the potential psychological dangers of pursuing meditation practice when suffering from clinical narcissism. Potential applications for a cross-pollination of psychoanalytic support and Buddhist practice are also considered for the narcissistic patient and/or spiritual practitioner.     

Essence and Properties

The distinction between the essence of an object and its properties has been obscured in contemporary discussion of essentialism. Locke held that the properties of an object are exclusively those features that ‘flow’ from its essence. Here he follows the Aristotelian theory, leaving aside Locke’s own scepticism about the knowability of essence. I defend the need to distinguish sharply between essence and properties, arguing that essence must be given by form and that properties flow from form. I give a precise definition of what the term of art ‘flow’ amounts to, and apply the distinction to various kinds of taxonomic issues.     

An Island Entire of Itself: Narcissism in Anorexia Nervosa

ABSTRACT

This article explores the idea of anorexia nervosa as a narcissistic disorder, in which the denial of the need for food symbolically represents a denial of the need for relatedness and dependence. Narcissism is a state in which self and object are undifferentiated and all objects are felt to be within the individual’s omnipotent control. Primary narcissism occurs when the capacity for object relations has never developed and secondary narcissism develops as a defense against dependence which is associated with overwhelming anxiety, envy, or fear of disappointment. Both processes can occur in anorexia nervosa, which provides a cognitive and behavioral framework for the expression and maintenance of the narcissistic position. Narcissistic anorexia is a state of omnipotent isolation in which the patient denies one of her most basic needs and rejects a powerful source of connection with the outside world. An important aim of therapy is to help the patient to develop a capacity for object relations and to be able to acknowledge dependence. This is achieved through coming to experience the therapist as separate and real and requires the therapist to resist being taken over by the patient’s projections.     

Phenomenology of Early Childhood Onset Obsessive Compulsive Disorder

This paper describes the phenomenological features of early childhood onset obsessive compulsive disorder (OCD; defined as children meeting DSM-IV criteria for OCD with age of onset <8 years). Fifty-eight children (ages 4–8) were included in the sample. OCD and comorbid diagnoses were determined by structured interview, and OCD severity was measured using the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Mean age of OCD onset was almost five, and mean age of presentation was between 6 and 7. Mean symptom severity was in the moderately severe range. Comorbidity and family history of OCD were common. Contamination and aggressive/catastrophic obsessions and washing and checking compulsions were endorsed most frequently. Results indicate that early childhood onset OCD may have a lower boy to girl ratio and lower rates of depressive disorders, but may be similar to later childhood onset OCD in terms of OCD symptom presentation and severity.     

Five Issues in Training Edited by Irving R. Weschler and Edgar H. Schein

This case study illustrates how combined therapy (individual, group, and marital) by the same therapist was used to resolve a woman's narcissistic transference. The author's position is that combined therapy creates a psychologically stimulating environment, which uniquely elicits a depth and range of transference feelings, thereby generating multiple therapeutic opportunities to experience and work through transference resistance in the here-and-now. Highlights of the treatment demonstrate how the synergy of three modalities is used to elicit, modulate, and resolve positive and negative aspects of the narcissistic transference. Four guidelines are suggested for treatment of patients in combined therapy.