Agoraphobic and claustrophobic anxieties two problems in leaving university for some final-year students

Abstract

This article considers the way final-year students present with agoraphobic and claustrophobic symptoms which have caused them to break down academically before the end of their courses. It presents a brief theoretical discussion of these anxieties in students, and offers a way of thinking about them in terms of a particular understanding of projective identification. Fragments of casework with three students are used to show that the anxieties are brought about when the desire for invisibility for part of the self, the motive for projective identification in these cases, is more exposed by the arrival of the final months leading up to the end of the students' courses.     

Editorial

Abstract

This paper is an attempt to address the issue of trust in the therapeutic relationship from the counsellor's perspective, with a particular reference to working with drug addicts. It is a personal reflection on previous work with drug addicts in which a cognitive-behavioural approach was used. The comparison will be made, in a post hoc, reflective manner, on the issue of trust from a very different perspective; namely psychodynamic. It is suggested that the counsellor's trust in their own ability to contain the patient's often projected anxiety, is a central element or variable that can be seriously disrupted by the process of projective identification. And, moreover, it may have some explanatory power for the choice of method of working with this particular client population, that the issue of trust and its containment says as much, if not more, about us as counsellors, as it does about the client. It is argued that our anxieties may lead us to adopt a certain course of action in the therapy, rather than to address the possible meaning of these anxieties in terms of the relationship regarding the clients' needs.     

Prediction of end-of-life fears in COPD – hoping for the best but preparing for the worst

Objective: The diagnosis of a life-threatening illness can trigger end-of-life fears. Early studies show that end-of-life fears play an important role in chronic obstructive pulmonary disease (COPD). However, predictors of these fears have not yet been identified. This study investigated the relevance of socio-demographic variables, illness severity, psychological distress and disease-specific anxieties as predictors of end-of-life fears in COPD.

Design: A total of 131 COPD patients participated at two time points. Regression and mediation analyses, as well as cross-lagged panel analyses were conducted.

Main outcome measures: The participants completed questionnaires assessing end-of-life fears (Multidimensional Orientation toward Dying and Death Inventory), psychological distress (Hospital Anxiety and Depression Scale), and disease-specific anxieties (COPD Anxiety Questionnaire). Pulmonary function and a 6-min walk test served as measures of illness severity.

Results: Illness severity was not predictive of end-of-life fears. However, gender and psychological distress explained incremental variance. When disease-specific anxieties were included as additional predictors, psychological distress was no longer significant. Cross-lagged panel analyses mostly supported these results. Moreover, disease-specific anxieties mediated the association between psychological distress and end-of-life fears.

Conclusion: Administration and intensity of end-of-life care (especially concerning end-of-life fears) in COPD patients should be based not only on illness severity, but rather on psychological distress and disease-specific anxieties.     

Individual and institutional defences against primitive anxieties: Counselling in prison

Abstract

This paper describes a counsellor's attempts to understand the unconscious dynamics affecting the process of counselling women in prison. The social system of the prison serves to defend both prisoners and officers against powerful anxieties about the potential for sadistic attack originating from primitive states of mind, that is persecution, helplessness and destructiveness. The implications of the rigid means of defence are considered, and die role of unconscious guilt motivating the need for external punishment is briefly explored. Emphasis is placed on the role of splitting and projection in the management of potentially overwhelming feelings of guilt, and fear of punishment. The author develops the premise that there is in effect an institutional requirement that prisoners remain in the paranoid-schizoid position because of the feared consequences were they to experience depressive anxieties.     

Very brief psychodynamic counselling with young people

Abstract

This paper attempts to re-create the flavour and the atmosphere that is evoked when counsellor and client meet with prior agreement to engage in a piece of very brief counselling work. The context is an informal self-referral service operating on the boundary of a large psychiatric clinic which specializes in psychoanalytic and systemic work.

The situation provides a transitional space for both counsellor and client to observe and to learn from their own responses to each other and in so doing to concentrate their minds on the essential core anxieties that the client is currently experiencing. In this way the area of difficulty can be named and become available for thought.     

Psychoanalytic observation in community and primary health care education

Summary

This paper describes a psychoanalytic observation seminar that was set up as part of an MA in Community and Primary Health Care programme. The seminar was intended for senior professionals outside psychotherapy trainings, drawn from the health and social-care fields. The author outlines the way in which a conventional infant-observation model was adapted for this group, enabling the students to observe both individual subjects and also diverse primary-health and community-care settings. The advantages of such a learning experience are discussed; and also the inevitable anxieties stirred by it. Several examples of observations are provided, showing how students were helped to negotiate and explore challenging primary-health and community-care settings.     

Learning Contracts and the Use of Goal Attainment Scaling (GAS) for Occupational Therapy Students on Mental Health Fieldwork

SUMMARY

To counteract stereotyped views of the mentally ill and to empower occupational therapy students on their mental health clerkship, students developed individualized learning contracts. The contract required formulating their educational goals as a series of graded steps structured through the use of a sequential numerical scale, Goal Attainment Scaling (GAS) (Kiresuk & Sherman, 1968). Goals were related to the students' social-emotional concerns and anxieties encountered in this practice area through an affective GAS also known as a comfort scale. Task skills were addressed via a psychomotor/cognitive GAS. Students took an active role in monitoring their progress on their GAS while exploring emotional reactions. Through the use of an interactive log format, students received ongoing feedback and support from the academic instructor while honing their performance and clinical reasoning skills. Students often articulated a positive transformation of their views of the mentally ill and their sense of efficacy and comfort in working with this population fostered by success with their personal goal achievement on their GAS.     

The Failure to Contain: How Persecutory Anxieties Contribute to Noncompliance in Adult Patients with Congenital Chronic Pain Conditions

ABSTRACT

Patients with sickle-cell disease suffer from lifelong pain. Many prefer to receive emergent rather than managed health care, which results in these people being termed “noncompliant.” This paper explores the contributing factors of such noncompliance in the adult patient with painful chronic illness. In the earliest stages of development, internal pain is attributed to external origins, and the effects of this on the psyche are analogous to those of physical abuse. When the infant's pain cannot be contained, projective identification and persecutory anxieties become deeply ingrained. Interventions that focus on healing from trauma and building trust are preferable to those which most value immediate compliance, as the patterns of behavior are so firmly entrenched.     

Who's Afraid of Gay Theology? Men's Studies,Gay Scholars,and Heterosexual Silence

Abstract

Despite the growing body of gay scholarship in religious studies, there is a dearth of responses by heterosexual scholars in the field of men's studies in religion. Gay theology can still count more predictably on the ire of a conservative public than on a nuanced, non-homophobic critique by their heterosexual colleagues. What contributes to disregarding gay scholarly voices? Paradoxically, their voices are marginalized to the point of invisibility and yet are also in the center of public discourse. This article sifts through some reasons of why heterosexual men shy away from a public debate of the merits of gay scholarship. Besides methodological reservations, heterosexual male anxieties cause such weariness. Autobiographical insertions by gay scholars combined with discipline-transgressions may lead to ‘homosexual panic’ even among non-homophobic scholars. The article argues that heterosexual men's studies in religion need to overcome their silence and engage the scholarship of gay theology.     

Simultaneous Semipermeable Groups for Mothers and Their Early Latency-Age Boys

Abstract

Bonding is an ongoing aspect of intersubjective experience, a type of mental relationship to oneself and others. As a behavioral mode, bonding utilizes verbal and nonverbal communication primarily to establish a basic feeling of connection between individuals. Bonding is the floor, a cognitive-affective state that precedes and prepares the way for the complex processes underlying identification. The concept relates to Bion’s early theory of basic assumptions, and takes on new and different meanings according to his later ideas regarding social communication. Bonding is also a therapeutic posture or technique, an element in the establishment of group cohesion, the positive transference, and therapeutic and group alliance. Case examples illustrate how the therapist and other group members bring a complex of bonding needs and anxieties that must be negotiated to establish and maintain bonding, which is a necessary condition for successful therapeutic work.     

“Castration Anxiety” Revisited: Especially “Female Castration Anxiety”

ABSTRACT

I find the term castration anxiety a still relevant and important key body fearful fantasy in males, especially expressing fear of the father; as is female castration anxiety an equivalent key fear of the ablation of the sexual and reproductive organs of females, especially by the avenging mother. Freud’s and his followers’ version of the female anxiety, however, has repetitively been shown to be askew since the 1930s, yet it keeps appearing again, as if still worthy of serious argument. To demonstrate its utter blindness to an emotional or imaginative appreciation of female body reproductive functioning, a detailed critique is offered of the once classic paper, “The Body as Phallus” by Bertram Lewin (1933). I recommend that a straightforward sense of female castration is helpful in exploring female body anxieties as a more defined bodily referent than can be encompassed by separation anxieties that are currently more popular.     

Three Phases of Treatment with Borderline and Psychotic Patients

Three distinct, yet overlapping, phases of treatment emerge when working with some borderline and psychotic patients. This are patients who test the ordinary limits of psychoanalysis, but can profit from its deep exploration. The first phase is colored by acting out, interpersonally and intrapsychically. An analytic envelope of containment is necessary to sustain the treatment. Interpretive holding and containing help the patient find a psychic receptacle capable of detoxifying violent projections. Many of these patients terminate prematurely. The second phase is centered around the patient's defensive use of the death instinct to extinguish or destroy certain parts of their mental functioning. This difficult standoff between parts of the patient's mind becomes replicated in the transference. The third phase reveals the more fundamental problem of paranoid～schizoid anxieties of loss and primitive experiences of guilt. These include fears of persecution and annihilation. Some patients abort treatment in the first or second phase and never work through the phantasies and feelings of loss. Nevertheless, much intrapsychic and interpersonal progress is possible. Given the instability and chaotic nature of these patient's object relations, the analyst must be cautiously optimistic in their work and realize the potential to help the patient even when presented with less than optimal working conditions.     

Tanya and the Adaptive Dialectic of Romantic Passion and Secure Attachment

My analytic work with Tanya illustrated one unique, heightened, individual version of a pervasive human conflict: the way in which erotic passion can be experienced as inherently conflicting with other relational bonds and broader values. In virtually every culture throughout human history, we find expressions of this tension between passionate Eros and other forms of love.

My clinical approach entails an openness to multiple analytic perspectives, including Mitchell's posthumous views in Can Love Last. In addition, I make use of a sensibility informed by evolutionary biology as a vantage point for understanding the individual struggle of patients like Tanya, as well as illuminating some of the larger issues about Eros and attachment. I suggest that romantic aspects of Eros may have evolved as part of a complex psychological system designed to deal with specifically human existential vulnerabilities and anxieties, as well as a way of challenging the inherent human tendency to over-accommodate to the subjective world of the other.     

Vocation for travel. Catholic priestly training in Sri Lanka

ABSTRACT

Catholic priests and advanced seminarians in Sri Lanka often describe their entrance to the seminary as the response to a strong spiritual calling that they could not ignore. Young seminarians offer more ambiguous narratives, where a combination of material anxieties, local cultural traditions and individual aspirations, encourage them to consider joining the clergy. This article examines how seminaries highlight aspects of religious formation where vocational discernment and the authenticity of one's calling are left for later stages of formation. Emphasizing aspects of career mobility, graduate studies overseas and missionary work, seminaries provide an attractive alternative for prospective priests in Sri Lanka. I argue that there is no contradiction between the spiritual dimensions of religious vocation and the material aspirations of seminarians. Although ethical dispositions emerge and replace the mundane impulses that initially attract young men to the seminary, material incentives are never completely eliminated from the vocational map of seminarians.     

Avoidance temperament and social-evaluative threat in college students' math performance: a mediation model of math and test anxiety

Background and Objectives: Standardized testing has become a common form of student evaluation with high stakes, and limited research exists on understanding the roles of students' personality traits and social-evaluative threat on their academic performance. This study examined the roles of avoidance temperament (i.e., fear and behavioral inhibition) and evaluative threat (i.e., fear of failure and being viewed as unintelligent) in standardized math test and course grades in college students. Design and Methods: Undergraduate students (N = 184) from a large public university were assessed on temperamental fear and behavioral inhibition. They were then given 15 minutes to complete a standardized math test. After the test, students provided data on evaluative threat and their math performance (scores on standardized college entrance exam and average grades in college math courses). Results: Results indicate that avoidance temperament was linked to social-evaluative threat and low standardized math test scores. Furthermore, evaluative threat mediated the influence of avoidance temperament on both types of math performance. Conclusions: Results have educational and clinical implications, particularly for students at risk for test anxiety and underperformance. Interventions targeting emotion regulation and stress management skills may help individuals reduce their math and test anxieties.     

The early appearance and intergenerational transmission of maternal traumatic experiences in the context of mother-infant interaction

The paper describes the case of a girl of 8 weeks, referred by her mother because of 'intolerable hysterical attacks' triggering maternal impulses of abuse. Maternal perception of her infant was distorted to the extent that the mother was re-experiencing encounters with her own intrusive and traumatizing mother in the face of her screaming child. She also perceived the infant's motor impulses as physical attacks on herself and expressed intense anxieties about her daughter's future aggressive potential. The infant was viewed by her mother as extraordinarily and dangerously greedy. Even neutral infantile vocalizations were perceived as manipulating and sadistic. She tried to ward off these anxieties by employing a rigid scheme of rules and obsessively controlling the father's and grandmother's interaction with the child. The mother feared being overwhelmed by the infant's needs if she were to yield to them in a flexible way. The mother's background of early neglect and trauma is described, in the light of recent literature about the early intergenerational transmission of traumatic experiences, in order to demonstrate possible treatment modalities and the need to consider both protective and risk factors.     

Private selves and shared meanings: Or forgive us our projections as we forgive those who project into us

Abstract

This paper explores the difficulty university counselling services experience in finding common purpose with their institutions at the present time. It draws on a review of the relevant literature and personal experience to argue that it is extremely difficult to sustain depressive-position functioning in the current organizational culture, which, the author suggests, is dominated by fears about survival. The paper examines some defensive strategies counsellors may use to protect themselves against prevailing anxieties and argues for the importance of recognizing and working with these.     

Shaping Piety Through Catechetical Structures: The Importance of Order

Abstract

This paper explores how the order in which the Creed, Lord's Prayer and Decalogue are placed in a catechism shapes the way the authors intend to inculcate piety. First, the reason for the order of three chief parts in the catechisms by Augustine of Hippo is studied. Then, three catechisms from the fifteenth and sixteenth centuries, which place these chief parts of the catechism in different orders, are compared, namely Dietrich Kolde's A Fruitful Mirror, Luther's Small Catechism and in Henrician England, The King's Book. It is shown that each of the composers of these catechisms was deliberate in the order they set out the material before them, with a view to shaping the piety of the people in a particular way.     

The parables of a green-eyed monster: Two tales about envy

Abstract

This paper describes how the dynamics of envy infiltrate interactions if envy is not contained. An interactive model of a 'giver' and 'recipient' is presented as a way of looking at envy and is applied to a clinical and organizational example. An analysis is made in terms of utilizing symbiosis defensively in order to avoid coming to grips with envy.