Thoughts about the internalised speaking object: psychoanalytic psychotherapy with children of delayed verbal development

This paper discusses the meaningful effects of intensive psychoanalytic psychotherapy on language development in children with verbal delay or disorder. Three clinical cases of children aged five to seven are presented; two of these display significant verbal delay and one exhibits unusually high verbal abilities. Following Meltzer, the author explores the concept of the ‘internalised speaking object’ – a good object speaking to the child, which has been internalised. This internal model is essential for the child’s development of language and speech. At times, these children experience this internal object as a persecutory object which must be warded off and avoided. Even more so, when the external object addresses the children verbally, language itself becomes a persecutor and they experience a fear of disintegration. During such times, the therapist must find new and creative ways for communication. The author describes his therapeutic efforts in dealing with these difficulties which stem both from the lack of a reciprocal verbal communication and from the therapist becoming a persecutory object to the child, and demonstrates the manner in which he facilitated gradual shifts in the patient, from an anxious and defensive position into a more relaxed one. These efforts set in motion a process of internalisation of a speaking object by the child and the development of internal language, that is, thinking along with expressive verbal language. The article furnishes some evidence to support the idea that verbal development relies significantly on establishing good, strong and healthy early object relations.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

Treatment manuals and the advancement of psychoanalytic knowledge: The Treatment Manual of the Tavistock Adult Depression Study

This paper has two aims: first, it seeks to understand the absence of treatment manuals in psychoanalysis. Secondly, it summarizes the treatment manual of the Tavistock Adult Depression Study, which describes the form of psychoanalytic psychotherapy whose effectiveness has been evaluated both in the Tavistock Adult Depression Study (TADS); and in the German Die Langzeittherapie bei chronischen Depressionen (LAC) Studie. Throughout the history of psychoanalysis, opinions about treatment manuals, empirical research and their antecedents have been deeply divided. After tracing the often polarized unfolding of these matters, the paper proposes that emotional and cognitive difficulties as well as scientific ones underpin their persistence. It is suggested that greater familiarity with them may lead to better combinations of outcome research and psychoanalysis: for example, the Tavistock manual seeks to match one account of the objects, aims, values, spirit and methods of psychoanalysis (as well as of connected forms of psychoanalytic psychotherapy); and also to meet what is required of treatment manuals by random allocation controlled trials. It has been a crucial element in the above studies of the outcome of long‐term psychoanalytic psychotherapies with chronically depressed patients. After describing the Tavistock Manual, the paper concludes suggesting that, if appropriately constructed, treatment manuals can make a contribution to the advancement of specifically psychoanalytic knowledge.     

Personality disorders and psychosocial changes after intensive psychotherapy: A prospective follow-up study of an outpatient psychotherapy project, 5 years after end of treatment*

This report presents the results of a 7-year prospective outcome study designed to examine the psychosocial changes during and after therapy among 25 outpatients suffering from personality disorders and psychoses. The therapeutic approach was based mainly on object relations theory and psychodynamic self-psychology, and focused in particular on affect consciousness, parental images, self-image and interpersonal relations. Twenty patients completed the form which measured psychosocial changes during therapy, and 21 persons participated at follow-up. The data show statistically significant changes in the capacity to tolerate intimate relationships and actually establish such relationships, improved quality of contact in relationships with friends, a general raising of socioeconomic status and reduced use of ordinary health and social services. Both the global psychosocial outcome at follow-up as measured by HSRS and the general level of symptoms measured by SCL-90 suggest that 76% of the sample had reached a level of psychosocial functioning and adaptation that can be defined as “no-caseness”.     

The effect of contingent reinforcement on target variables in outpatient psychotherapy for depression: a successful and unsuccessful case using functional analytic psychotherapy

The current study investigated a behavior-analytic treatment, functional analytic psychotherapy (FAP), for outpatient depression utilizing two single-subject A/A+B designs. The baseline condition was cognitive behavioral therapy. Results demonstrated treatment success in 1 client after the addition of FAP and treatment failure in the 2nd. This study highlights the challenges in measuring treatment progress and outcome idiographically in this population.     

The challenge of understanding process in clinical behavior analysis: the case of functional analytic psychotherapy

Whether explicitly acknowledged or not, behavior-analytic principles are at the heart of most, if not all, empirically supported therapies. However, the change process in psychotherapy is only now being rigorously studied. Functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009) explicitly identifies behavioral-change principles used to bring about therapeutic improvements in adult outpatients whose clinical problems stem from ineffective interpersonal repertoires. These principles include contingent responding to behavioral excesses and deficits by a therapist who has established him- or herself as a salient source of social reinforcement. Empirical support for FAP is emerging, but a variety of pragmatic and theoretical questions warrant investigation. Among the issues described in this paper are the training and dissemination of procedures for how to conduct a functional analysis, how to train therapists to identify functional stimulus classes, how to best address decreasing problem behavior without creating an aversive environment, how to enhance generalization, and how to account for the principle of equifinality when trying to specify therapeutic procedures. These and other issues stem largely from trying to disseminate a behavioral principle-based intervention rather than a topographically specified intervention. These issues present challenges and research opportunities for applied clinical behavior analysts if they wish to extend their science to address clinical issues important to the treatment of adult outpatients with normal intellectual functioning.     

Soul murders,wolf mother: Re-reading the Mowgli stories of The Jungle Book in a contemporary psychoanalytic perspective

Kipling’s (1894) ‘Mowgli stories’ a trio of tales set in India and written by an Englishman during the colonial period, are a natural bedfellow with cultural psychoanalysis; an approach to the unconscious that takes into account regional geography. While psychoanalysis’ interest in The Jungle Book began early and affectionately with Freud, both he and his successors read Kipling from the viewpoint of a certain geography and history associated with early European psychoanalysis. As such, psychoanalytic and post-colonial literary ways of reading Kipling, have, like the East and West of the writer’s ballad, generally resisted meeting. In this paper, I re-read the Mowgli Stories of Kipling’s Jungle Book with an awareness of how geography might have affected the subjectivity of prior analytic readers, offering the Mowgli stories anew to modern – by which I mean post-colonial – readers.     

The effectiveness of psychoanalysis in a case study using multi‐perspective methodology: Conflict in choosing a partner due to transgenerational mandate

A case study is presented to evaluate the effectiveness of psychoanalysis and the persistence of its benefits 20 years later in a young woman with severe depression, professional inhibition, and difficulties in partner selection due to transgenerational mandate (TGM). The investigation was carried out with psychoanalytic interviews with the patient and analyst, which were evaluated by both psychoanalytic and non‐psychoanalytic judges following a methodology based on one tested in Germany by Leuzinger‐Bohleber et al. (2003). The psychoanalytic treatment began in the early 1980s in Monterrey, Mexico. The study concludes that the psychoanalysis was effective in assisting with the patient's character disorder and partner selection, mainly because of the therapeutic alliance, the analysis of transference and character, and the patient's increased capacity for mentalization as a result of the interpretation of the TGMs.     

Application of focusing‐oriented psychotherapy in dealing with issues of Asian immigrants: A single‐case study of a Korean immigrant in Japan

A single case study is presented of the successful application of focusing‐oriented therapy in the case of a Korean woman who migrated to Japan. The client had a host of problems related to the discrimination she faced from her own family and from Korean society for being female, as well as relationship and cultural difficulties in trying to adjust to married life in Japan. Through 10 sessions of focusing‐oriented therapy, the client was able to re‐examine her situation from a positive perspective and began to accept herself as a person, not necessarily as a woman or a Korean in Japan. Issues related to Korean women immigrants in Japan are explored and the related effectiveness of focusing‐oriented therapy for the particular population is discussed.     

How to study the ‘quality of psychoanalytic treatments’ and their long‐term effects on patients' well‐being: A representative,multi‐perspective follow‐up study3

How can we study the ‘quality of psychoanalytic treatments’? The authors attempt to answer this question by discussing a naturalistic, multi‐perspective and representative follow‐up study of psychoanalyses and long‐term psychoanalytic psychotherapies. We studied a representative sample (n = 401) of all the patients who had terminated their psychoanalytic treatments with members of the German Psychoanalytical Association (DPV) between 1990 and 1993. Between 70 and 80 per cent of the patients achieved (average 6.5 years after the end of treatment) good and stable psychic changes according to the evaluations of the patients themselves, their analysts, independent psychoanalytic and non‐psychoanalytic experts, and questionnaires commonly applied in psychotherapy research. The evaluation of mental health costs showed a cost reduction through fewer days of sick leave during the seven years following the end of long‐term psychoanalytic treatments. The results achieved using non‐psychoanalytical instruments are complemented by the richness of the idiosyncratic findings, gained by the psychoanalytic research instruments.     

The importance of identifying underlying process abnormalities in alexithymia: Implications of the three-process model and a single case study illustration

We present an in-depth case study of a rare individual (whom we will refer to as “Jane”) who reported an inability to experience emotion. Jane completed a range of assessments measuring alexithymia, emotional awareness, and emotion recognition ability. She, along with 22 control participants, also underwent skin conductance (SC) measurement and facial electromyography (EMG) during exposure to affective images, and self reported the valence/arousal of their responses to those images. Jane scored high on alexithymia and low on emotional awareness; yet she performed well on emotion recognition measures and showed a typical pattern of valence ratings. Her SC responses and subjective arousal ratings were atypically low, and some of her EMG responses were also atypical. Jane’s deficit profile highlights the dissociability of self-focused emotional awareness and other-focused emotion recognition ability, as well as the dissociability between the generation and representation of valence and arousal (with both subjective and objective measures).     

Evaluation of The Practitioner Online Referral and Treatment Service (PORTS): the first 18 months of a state-wide digital service for adults with anxiety,depression, or substance use problems

ABSTRACT

The Practitioner Online Referral and Treatment Service (PORTS) is a new digital mental health service (DMHS) providing assessment, treatment, and consultation across Western Australia, for adults with anxiety, depression, or substance use problems, and experiencing financial hardship or geographical disadvantage. From July 2017 to December 2018, a total of 2,527 individuals were referred to PORTS. Of these, 150 (6%) did not give consent for their results to be analysed. Of the remaining 2,377 patients, 615 (26%) could not be contacted to confirm the referral, 596 (25%) received assessment or information from PORTS, 427 (18%) were referred to another service, and 739 (31%) commenced treatment at PORTS. Almost half (47%) of patients were from areas with significant socio-economic disadvantage. Those referred by another mental health service were more likely to engage in treatment than those referred by a General Practitioner (GP). Overall outcomes were excellent, with large effect sizes (Cohen’s d: 1.1–1.4), from assessment to post-treatment and 3-month follow-up, reliable deterioration was low, and GP and patient satisfaction was high. These results indicate that the PORTS DMHS model is a promising method for engaging primary care patients with anxiety and depression, including those experiencing financial and geographical disadvantage.     

The effect of religiosity on quality of life in Muslim patients with heart failure: a study in Qom,the religious capital of Iran

Due to the low quality of life (QoL) in patients with heart failure, many researchers attempted to find new ways to improve the QoL in these patients. This study was conducted to determine the relationship between QoL and religious attitudes of patients with heart failure. In this cross-sectional study, 130 male and female patients with heart failure were selected based on the inclusion criteria. Data were collected using 36-item short form Quality of Life and structured Religious Attitude Questionnaires. The average age of subjects was 59.50?±?12.29; also, 52.3% of them were female. A significant relationship was observed between patients’ QoL and their religious attitudes in mental (p?=?.03) and general health (p?=?.04) dimensions, but religious attitude had no significant correlation with physical health dimension (p?=?.66) and the total score of QoL (p?=?.30). At the end, it was concluded that religious beliefs can improve patients’ quality of life.