Psychoanalytic psychotherapy in paediatric liaison: a diagnostic and therapeutic tool

Paediatric liaison work requires an appreciation of the interweaving of the different factors involved when a child has physical symptoms. Psychoanalytic psychotherapy is usually viewed simply as a potential treatment option. This paper argues that its use is both therapeutic and diagnostic and that it should be valued for this breadth of contribution. The therapeutic process is conducted in a way that can promote an understanding of the child and their context and thus enhance the ability 9 to meet the child's needs by all involved in their care. This can be achieved without sacrificing the degree of privacy that the psychotherapist/patient relationship requires. Material is presented from the psychotherapy of a child who had an hereditary condition which moved unexpectedly into a terminal 2 phase after psychotherapy was started. Examples are given to illustrate the importance of the understanding gained from therapy and how, through an integrative process, it was used to assist the overall 4 care. The material also describes the potential diagnostic use of information from psychotherapy when this is formulated by consideration of conscious and unconscious mechanisms alongside mental state phenomenology. This has implications for the relationships between disciplines and for their training requirements.     

Poetry as a therapeutic avenue

The significance of poetry in the context of pastoral psychology has not, as yet, received the attention it has in professional psychoanalytic literature. The authors of this series (eventually to be published at book-length) provide a terse but extensive review of such research, underscoring the therapeutic value of symbolic,intrapsychic artistry. Religious ideation, as well as other intrapsychic expressions, are incorporated by means of personal therapeutic situations focused on a patient's or client's poetry. With permission, these poems are quoted directly. From this data and their clinical experiences, the authors set forth two modes for considering unconsciously defensive or consciously self-disclosive uses of written poetry in and during psychoanalytic pastoral counseling or psychotherapy.Dr. Christensen is in the private practice of psychiatry, Northbrook, Illinois. He holds senior academic positions at the medical schools of Northwestern University and the University of Illinois, Chicago, as well as the post of Consulting Psychiatrist to The Community Pastoral Counseling and Consultation Center, Lutheran General Hospital, Park Ridge. Dr. Moss is the Executive Director of The Seabury Institute for Pastoral Psychotherapy, Atlanta. He is also the co-editor ofThe Organization and Administration of Pastoral Counseling Centers, Book Review Editor of theJournal of Religion and Health, and Editor of Artistic Photography forPilgrimage: The Journal of Existential Psychology. Reprint requests should be directed to: All Saints' Episcopal Church, 634 West Peachtree Street, N.W., Atlanta, GA 30308.     

Absorption as a therapeutic agent

The process of absorption is therapeutically adaptive for patients in a variety of contexts. Absorption is defined as the temporary loss of self through immersion in an object that eventuates in self-enhancement. Patients who become absorbed in animate and/or inanimate objects are better able to cope with a variety of problems and experience a heightened sense of well-being. Absorption is distinguished from symbiosis, mystic experiences and religion. The recognition, validation and employment of absorption in the analytic session is elucidated.     

Meditation as a therapeutic technique

Pastoral Psychology -     

Conservatism as a Determinant of Sexual Experiences

An examination of the relationship of conservatism to reports of sexual experiences and reasons for nonparticipation was conducted using 64 male and 50 female introductory psychology students. Conservatism was found to be inversely related to the frequency and variety of sexual behaviors. High conservative subjects gave the reason that it was morally wrong more often than any other reason for not engaging in coital activities and more intimate forms of petting. Results were in accord with previous research and were interpreted as supporting the notion that the fear of loss of control of one's impulses and hence the basis for conservative attitudes are determinants of sexual experiences.     

Neuroleptic malignant syndrome: diagnostic and therapeutic dilemmas

Neuroleptic malignant syndrome (NMS) is a life threatening medical state complicating the use of antipsychotic medications and other drugs that affect the dopaminergic system on administration or withdrawal. The condition was recognised nearly half a century ago, shortly after the discovery of antipsychotic medications. However, there are still no systematic studies about NMS. There are no definitive guidelines on its treatment. Although early recognition is emphasised and usually possible, delayed diagnosis is not rare. We here report on a case of NMS complicated by renal failure, and possibly respiratory failure. The report underscores the seriousness of delayed diagnosis and puts forward a comprehensive management recommendation based on our experience and the existing literature.     

Infants' vocalizations as a diagnostic tool

This article reviews the literature concerning infants' vocalizations and their relation to development of language and to diagnosis in studies of pathology. Some researchers believe that pre-speech vocalizations are reflexes, random activities that serve as practice for motor activities. Others believe they are directly related to the development of language. The literature reviewed dealing with the relationship between abnormal cries and pathology suggest a differential diagnosis of certain pathologies. Crying should be included in the collected symptoms to achieve a more accurate and comprehensive diagnosis.     

The therapeutic relationship as a paradoxical experience

The therapeutic relationship exists within multiple levels of reality—including that of ordinary life and that of the therapeutic frame. This interplay between these two levels of reality gives rise to paradoxical experiences for both participants. Certain “principles”; or “rules”; of technique can be understood as a means of enabling the therapist to cope with what is usually referred to as “boundary”; issues. It is essential that the analyst or therapist demonstrate capacity to shift playfully from one level of reality to another. The “rule”; of abstinence and the asymmetry of desire that exists between the two participants are discussed. Gratification within the therapeutic frame is paradoxical in that gratification at one level of reality leads to privation at another level of reality. These paradoxical experiences for both patient and analyst are examined in relation to projective identification and to the analyst's countertransference.     

The therapist's poetry as a therapeutic incident

Poetry can be understood as an intrapsychic record of introspection, and as a means for interpretation in the therapeutic situation. In this installment (the second of a series to be eventually published at book-length) the authors examine from their personal research the uses, as well as dangers, of utilizing poetry in therapy. Poetry should not be used as a gimmick to direct the process of therapy, but as a point of spontaneous interaction, insight, and empathy. Used appropriately, poetry may bring to the client and to the therapist insight and meaning. The therapist may also use his or her own poetry as a creative means for recognizing countertransference in the therapeutic setting.Dr. Moss is an Episcopal Priest and the Executive Director of The Seabury Institute for Pastoral Psychotherapy, Atlanta, Georgia. He is also the co-author ofThe Organization and Administration of Pastoral Counseling Centers and Book Review Editor ofThe Journal of Religion and Health. Dr. Christensen is Senior Consulting Psychiatrist to the Pastoral Psychotherapy Institute, Park Ridge Illinois. In 1981 he was the recipient of the American Association of Pastoral Counselors' Distinguished Contributions Award. This paper was initially presented at the Southeast Regional Conference of The American Association of Pastoral Counselors, Hendersonville, N.C., 1983. Reprint requests should be directed to: The Seabury Institute, 2997 Piedmont Road N.E., Atlanta, 30305.     

The developmental prestages of defenses: diagnostic and therapeutic implications

In the interest of clarifying the distinction between psychopathology based on structural conflict and psychopathology rooted in an arrest in ego development, the hypothesis is offered that there is a developmental line for each defensive process and that a defense mechanism represents the endpoint of a series of developmental achievements. Clinical material is presented to demonstrate the decisive diagnostic and therapeutic consequences of distinguishing between the defenses of projection, incorporation, and splitting, on the one hand, and their specific developmental prestages, on the other.