Working with psychosis: Part 2 – encounters with an omnipotent super-ego

This is the second in a series of four papers presenting work with a man suffering from a bipolar disorder. The present paper describes the second year of the work and my encounters with an omnipotent super-ego which made ferocious attacks on the work, especially when there were any developments. The attacks were particularly disabling because my own implacable super-ego was mobilized in the counter-transference. Consequently developments seemed to melt away as my patient and I were often reduced to mindless states. I came to understand that these omnipotent attacks were stirred by feelings of infantile helplessness and dependency, and were a means of trying to manage a dread of falling to pieces and unintegration.     

Working with psychosis: Part 3 – ‘Struggling to contain madness – losing and recovering a capacity to think’

This is the penultimate paper in a series about working with a patient suffering from a psychotic disorder. The paper describes the third year of the work in which ‘John’ had four breakdowns in a period of six months. Much of the time I was unable to think. I was sitting on the edge of my chair either worrying that John was breaking down again or trying to help him recover from a breakdown. My small office became a cramped prison cell in which I felt myself a witness to a disturbing dance into and out of madness. A turning point seemed to happen as I developed a way of thinking about John's breakdowns. I seemed then to become a less persecutory figure in John's mind and more someone to whom John could turn for help. We found a way of thinking and talking about an infant in John. John responded by finding a way of being in my office as though he was reclining in a hammock. His breakdowns ceased. He was able to share in common humanity's concerns following September 11. Finally, I discuss thoughts about containment particularly about the paternal role in containment, drawing on Robert Caper's elaboration of Bion's ideas about containing psychotic aspects of experience.     

Cognitive Therapy: Nature and Relation to Behavior Therapy – Republished Article

Recent innovations in behavior modification have, for the most part, detoured around the role of cognitive processes in the production and alleviation of symptomatology. Although self-reports of private experiences are not verifiable by other observers, these introspective data provide a wealth of testable hypotheses. Repeated correlations of measures of inferred constructs with observable behaviors have yielded consistent findings in the predicted direction.Systematic study of self-reports suggests that an individual’s belief systems, expectancies, and assumptions exert a strong influence on his state of well-being, as well as on his directly observable behavior. Applying a cognitive model, the clinician may usefully construe neurotic behavior in terms of the patient’s idiosyncratic concepts of himself and of his animate and inanimate environment. The individual’s belief systems may be grossly contradictory; i.e., he may simultaneously attach credence to both realistic and unrealistic conceptualizations of the same event or object. This inconsistency in beliefs may explain, for example, why an individual may react with fear to an innocuous situation even though he may concomitantly acknowledge that this fear is unrealistic.Cognitive therapy, based on cognitive theory, is designed to modify the individual’s idiosyncratic, maladaptive ideation. The basic cognitive technique consists of delineating the individual’s specific misconceptions, distortions, and maladaptive assumptions, and of testing their validity and reasonableness. By loosening the grip of his perseverative, distorted ideation, the patient is enabled to formulate his experiences more realistically. Clinical experience, as well as some experimental studies, indicate that such cognitive restructuring leads to symptom relief.     

Working with Italian patients in Munich – The case of Penelope1

Abstract

With their book Psychoanalytic perspectives on migration and exile (1989), L. Grinberg and R. Grinberg (1984) opened up a new clinical field, which had been neglected for a long time in the psychoanalytic community, although Freud’s multilinguistic competence had greatly contributed to the creation of psychoanalysis. With their book The Babel of the unconscious, Jacqueline Amati Mehler, Simona Argentieri, and Jorge Canestri were able to confirm the hypothesis that it is possible to help multilingual patients to integrate the different aspects of their self which are bound to their mother tongue and to their foreign tongue(s), and thus to allow them to develop a new identity. The author, who has been a psychoanalyst in Munich since 1999, works every day with his Italian patients in this new clinical field, that is in their common mother tongue and at the two levels of their old Italian and their new German identity. Through the detailed presentation of a clinical case, he furthermore shows how, on the one hand, the migration creates a new space in which therapy actually becomes possible, and on the other hand, not only therapy, but also the kind of relationship developed by the patients to their “new country” plays a decisive role in the whole process. Such a frame proved to be particularly good for the emergence, revisitation, and reelaboration of the transgenerational trauma around which the case of Penelope is centered. The author further assumes that the theme of “migration and identity” is becoming more and more important in our globalized world, with clinical consequences whose elaboration requires a specific cultural and technical preparation.     

‘She's not going to leave me' – counsellors' feelings on ending therapy with children

This study sought to explore the impact of ending therapy on counsellors working with children in schools. Five counsellors were interviewed and their responses were analysed using interpretative phenomenological analysis. Four master themes emerged, one of which, empathic identification, is the focus of this paper. The findings of this study suggest that the counsellor's experience of ending therapy can evoke long-term powerful emotions.     

“Working with Couples: Satir and the Tao,”

SUMMARY

One of Virginia Satir's greatest gifts to the world was the use of herself as an instrument of healing. By daring to use all of her-self-body, mind and spirit-the connections Virginia made with others were warm and real. Besides being authentically caring, Satir worked out of a pluralistic and comprehensive theoretical base to individualize each intervention. By co-creating strong, trusting relationships she inspirited others with her own life-force energy, and enabled them to become more fully human. Able to put her own ego needs aside, Virginia modeled how to join common sense with a sense of high purpose.     

Twenty-Five Years of Change in Working with Partner Abusers—Part I: Observations from the Trenches About Community and System-Level Changes

The past 2 ½ decades have witnessed explosive growth in research and practice in the area of intimate partner violence, especially regarding perpetrators. The author reflects on his observations of key community and systemic developments in the field of research and treatment with batterers. The author examines systemic changes that have facilitated growth in the field and examines related issues and controversies. The author calls for continued development of an empirical base to guide both theory development and practice standards. The author also calls for openness to change within the field so that new developments will lead to appropriate dialogue and debate, increased dissemination and translation of new research findings into formats that are useful to clinicians, and accountability and change in abusers.     

Working with “Difficult” Patients: An Interview with Jorge García Badaracco

Jorge García Badaracco's pioneering work is well-known in his native Argentina, but not so much elsewhere. Since he was appointed as Director of a service in the Borda Buenos Aires Neuro-Psychiatric Hospital in 1959, García Badaracco started to make use of all available resources to overcome the many problems that the analysis of "difficult patients" (often psychotic) entails. In later years, he developed his ground-breaking "multifamily groups", that is, therapeutic groups that included patients, their relatives, nurses, members of the staff, and that offered the possibility to work simultaneously, in one single therapeutic intervention, on the individual, familiar, and social dimension of the mind. In this interview with García Badaracco, Francesca Viola Borgogno introduces the reader to this distinguished figure, as well as to some of his most original theoretical and clinical concepts, such as "the maddening object", "the pathological and pathogenic interdependence", "the healthy virtuality", and so on.     

Introduction: Engaging with Nanotechnologies – Engaging Differently?

The idea of conducting upstream public engagement over emerging technologies has been gaining popularity in Europe and North America, with nanotechnologies seen as a test case for this. For many of its advocates, upstream engagement is about a re-conceptualisation of the science–society relationship in which a variety of ‘publics’ are brought together with stakeholders and scientists early in the Research and Development process to co-develop technological trajectories. However, the concept, aims and processes of upstream engagement remain ill-defined, are often misunderstood, and have undergone little critical analysis. This special issue of NanoEthics, entitled ‘Engaging with Nanotechnologies–Engaging Differently?’ takes a multi-nation, multi-case approach to explore this idea, drawing on work represented by four articles from the US and Europe, from ethnographic work in the nanotechnology lab through to analysis of a Citizens’ Jury and other attempts to move public debate ‘upstream’. An overall message from the papers is that without adequate critique ‘upstream engagement’ might end up re-producing out-dated forms of science communication or being rejected as a failed concept before it has even matured.     

School Counselor Consultation: Teachers’ Experiences with Rational Emotive Behavior Therapy

Professional development in schools is often conducted to assist teachers in curriculum, instruction, and general pedagogy. Little emphasis is placed on social-emotional issues experienced by teachers, although high levels of stress and burnout are common. School counselors are in an ideal position to support teachers by providing consultation focused on social-emotional health. This qualitative investigation explored teachers’ experiences with Rational Emotive Behavior Therapy. Teachers participated in Rational Emotive Behavior-Group Consultation conducted by a school counselor for six sessions across 7 weeks. Data were collected with questionnaires administered at the conclusion of the group consultation. Consensual Qualitative Research was utilized to analyze the data and identify categories, domains, and core ideas. Emergent themes included increased well-being and improved relationships. Implications for teachers, students, and school counselors along with recommendations for future research are discussed.     

Cognitive Behaviour Therapy: How is it Different with Older People?

This paper discusses the treatment of depression in older adults (over age 65) using cognitive therapy techniques first developed by Beck and colleagues. The focus of this paper concerns whether modifications of CBT are required in order to ensure maximal efficacy and discusses what modifications may be suitable by advocating conceptual and theoretical reasons for their adoption. Some important contextual factors may need to be taken account of when working with older people such as dealing with expectancies about lifespan, the likelihood of chronic physical illness and longevity and chronicity of the personal history of problems. It is our contention that much more has been written about outcome in CBT with older people than has been written about psychotherapy process issues. This paper aims to address this perceived gap in the literature.     

Encounters with Boundary Challenges: A Preliminary Model of Experienced Psychotherapists’ Working Strategies

Five experienced clinical psychologists were interviewed about their strategies for maintaining boundaries in psychotherapy. The interviews were subjected to qualitative analysis using grounded theory techniques to develop a preliminary model of boundary maintenance. The central principle exhibited by the interviewees was maintaining a therapeutic relationship to facilitate client self care. Overall, the central principle was comprised of three main working strategies: (1) maintaining client boundaries to ensure a clear focus on client needs; (2) maintaining psychotherapist boundaries to protect effective practice; and (3) maintaining psychotherapy boundaries to facilitate client reflection, awareness, and assumption of responsibility. Each strategy included two or three distinct meaning categories, explicated in the paper. Implications for clinical work and future research are discussed.     

No Man's Land?: The Role of Men Working with Sexually Abused Children

Most sexual abusers of children are men. It is argued that sexually abused children may be anxious about contacts with men, especially when these include discussions of sexuality or of their abusive experiences. The implications of this for the role of men working with sexually abused children are explored. It is suggested that disclosure interviews should not usually be carried out by men, but that men do have a role to play in the post-disclosure therapeutic process.     

“When Righteousness and Bliss Can Kiss”: Working with Our Inner Opposites

The problem of conflicting energies and desires is basic to human beings. Starting with earliest childhood, whenever some instinctual impulses and feelings are forbidden or unacceptable, they become unconscious. Thus, a part of the personality is lost to us, expressed only in projection onto others. Gaining psychological wholeness then requires the hard work of becoming conscious of these unconscious parts of oneself, and of accepting them.     

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.     

Working with Research Integrity—Guidance for Research Performing Organisations: The Bonn PRINTEGER Statement

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity—Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on the following key issues:

1. § 1.
   Providing information about research integrity
    
2. § 2.
   Providing education, training and mentoring
    
3. § 3.
   Strengthening a research integrity culture
    
4. § 4.
   Facilitating open dialogue
    
5. § 5.
   Wise incentive management
    
6. § 6.
   Implementing quality assurance procedures
    
7. § 7.
   Improving the work environment and work satisfaction
    
8. § 8.
   Increasing transparency of misconduct cases
    
9. § 9.
   Opening up research
    
10. § 10.
    Implementing safe and effective whistle-blowing channels
     
11. § 11.
    Protecting the alleged perpetrators
     
12. § 12.
    Establishing a research integrity committee and appointing an ombudsperson
     
13. § 13.
    Making explicit the applicable standards for research integrity
     

     

Working memory deficit in children with mathematical difficulties: a general or specific deficit?

This study examined whether children with mathematical difficulties (MDs) or comorbid mathematical and reading difficulties have a working memory deficit and whether the hypothesized working memory deficit includes the whole working memory system or only specific components. In the study, 31 10-year-olds with MDs and 37 10-year-olds with both mathematical and reading difficulties were compared with 47 age-matched and 50 younger controls (9-year-olds) on a number of working memory tasks. Compared with the age-matched controls, both groups of children with MDs performed worse on tasks tapping the central executive (e.g., visual matrix span) and the phonological loop (e.g., word span). More important, the MD group performed worse than the younger controls on the counting span task, whereas the group with comorbid mathematical and reading difficulties performed worse on the counting span task and the visual matrix span task. These findings provide support for the assumption that children with MDs have a working memory deficit. More specifically, children with MDs have a central executive deficit connected to concurrent processing and storage of numerical and visual information.