Relational treatment of a borderline analysand

Abstract

This paper, in case material, examines the role of the analyst is co-creating the sado-masochistic enactments so common in the transference/countertransference with borderline analysands. Emphasis is placed on how to resolve the enactments so that a new paradigm is created based on trust and cooperation.     

Depressive symptoms and cognitive control in a mixed antisaccade task: Specific effects of depressive rumination

Growing empirical evidence suggests that cognitive and affective problems in depression may be a reflection of cognitive control impairments. However, to date, the nature of such impairments is still poorly understood and further investigation of this topic is required to advance current knowledge on the underlying vulnerability factors for depression. Using a mixed antisaccade paradigm, the present study examined if depressive symptoms in general, and more specifically rumination, are related to impairments in cognitive control functions such as inhibition and switching. The results on antisaccade latency and error rates indicated that depressive symptoms in general were not related to impairments in inhibition and switching. However, rumination was associated with impaired inhibition such that high, compared to low, ruminators had slower antisaccade latencies. No group differences were observed on antisaccade error rates. Implications for understanding the underlying vulnerability factors for the development of depressive symptoms are discussed.     

Depressive symptoms and cognitive control in a mixed antisaccade task: specific effects of depressive rumination

Growing empirical evidence suggests that cognitive and affective problems in depression may be a reflection of cognitive control impairments. However, to date, the nature of such impairments is still poorly understood and further investigation of this topic is required to advance current knowledge on the underlying vulnerability factors for depression. Using a mixed antisaccade paradigm, the present study examined if depressive symptoms in general, and more specifically rumination, are related to impairments in cognitive control functions such as inhibition and switching. The results on antisaccade latency and error rates indicated that depressive symptoms in general were not related to impairments in inhibition and switching. However, rumination was associated with impaired inhibition such that high, compared to low, ruminators had slower antisaccade latencies. No group differences were observed on antisaccade error rates. Implications for understanding the underlying vulnerability factors for the development of depressive symptoms are discussed.     

Post-event rumination and negative self-appraisal in social phobia before and after treatment

This study investigated the relationship between self-appraisals of performance, symptom severity and post-event rumination in social phobia, and evaluated the effect of treatment on these variables. A socially phobic group and a nonanxious control group performed an impromptu speech and were told that their performance would be evaluated. Participants appraised their performance immediately after the speech and 1 week later, and the frequency of post-event rumination during the week following the speech was assessed. The socially phobic group maintained the negative appraisals of their speech over the week, whereas the nonclinical group showed increased positivity about their performance The socially phobic group also engaged in more negative rumination than controls. Treatment improved perceptions of performance and reduced negative rumination. These results are discussed in the light of cognitive models of social phobia.     

Depressive rumination and the C957T polymorphism of the DRD2 gene

Depressed individuals who ruminate have difficulties learning from punishment and suppressing task-irrelevant information. The C957T polymorphism of the DRD2 gene, which affects functioning of D2 dopamine receptors (DRD2) that are expressed predominantly in the indirect pathway of the basal ganglia, has been found to influence suppression and punishment learning. Given these associations, we examined in the present study whether depressive rumination is related to the C957T polymorphism in 317 clinically depressed individuals and 317 never-depressed control individuals. A 2 × 2 (diagnostic group ×C957T polymorphism) analysis of variance conducted on depressive rumination scores yielded a significant interaction of group and C957T: Individuals with two 957C alleles reported higher levels of depressive rumination than did individuals with one or two 957T alleles if they were depressed, but not if they were healthy. The present findings suggest that the dopaminergic system and DRD2 are related to the frequency of maladaptive rumination in depressed individuals. Thus, DRD2 may be an important target for the pharmacological treatment of depressive rumination.     

Assessment and treatment of rumination in a young man with autism

After a pretreatment screening analysis suggested that rumination by a 19‐year‐old man with autism was maintained by automatic reinforcement, we evaluated his preference for three snack foods and the frequency of his rumination after consuming each. Rumination was more common after eating high‐preference foods. We then examined noncontingent access to a type of lollipop (i.e., a Ring Pop?) to decrease rumination. The Ring Pop? reduced rumination to moderately low levels. Next, to further decrease rumination, we added a reprimand, which reduced rumination to near zero levels. Finally, we evaluated the reprimand by itself, which resulted in a reduction in rumination roughly equivalent to that produced by the Ring Pop?. Results are discussed in terms of the source of reinforcement for rumination and the behavioral mechanisms responsible for intervention effects.     

The death of an analysand: transference, countertransference and desire

This paper is offered as an exploration of transference and countertransference issues when, in the process of analysis, the analysand becomes terminally ill. Written from the point of view of the analyst, eros and boundary issues are discussed. It is proposed that those who are about to die may form particularly intense erotic attachments and that this is characteristic of a speeded up individuation process. The paper is based on the case of a suicidally depressed man who formed an immediate, dependent and erotic transference. After three months, he was diagnosed as having an inoperable lung cancer. From then on the analytic frame was challenged by pressures to act out in a number of different ways. It is argued that gender difference and the heterosexual pairing facilitated the differentiation of adult, sexual and Oedipal feelings from infantile, pre-Oedipal ones. Maintenance of the analytic frame enabled the individuation process to continue to the end.     

Depressive rumination and the emotional control circuit: An EEG localization and effective connectivity study

Ruminations are repetitive thoughts associated with symptoms, causes, and consequences of one’s negative feelings. The objective of this study was to explore the neuronal basis of depressive rumination in a non-clinical population within the context of emotional control. Participants scoring high or low on the tendency to ruminate scale took part in the EEG experiment. Their EEG data were collected during a state of induced depressive ruminations and compared with positive and neutral conditions. We hypothesized that both groups would differ according to the level of activation and effective connectivity among the structures involved in the emotional control circuit. Clustering of independent components, together with effective connectivity (Directed Transfer Function), was performed using the EEG signal. The main findings involved decreased activation of the left dorsolateral prefrontal cortex (DLPFC) and increased activation of the left temporal lobe structures in the highly ruminating group. The latter result was most pronounced during the ruminative condition. Decreased information from the left DLPFC to the left temporal lobe structures was also found, leading to the conclusion that hypoactivation of the left DLPFC and its inability to modulate the activation of the left temporal lobe structures is crucial for the ruminative tendencies.     

Liquid rescheduling for the treatment of rumination

A pre‐intervention assessment was conducted to determine the conditions under which rumination by a 19‐year‐old man with autism was most and least likely to occur. The results of the assessment suggested that rumination was least likely when the participant did not consume liquids with meals and when he consumed peanut butter during meals. Based upon the results of the assessment, an intervention consisting of rescheduling access to liquids (i.e., no liquids during meals) was evaluated across both breakfast and lunch at the participant's school placement. Results suggest that the intervention was effective in reducing rumination. Copyright © 2003 John Wiley & Sons, Ltd.     

Catalyzing the dialogue between the body and the mind in a psychotic analysand

The author presents the analysis of a 23-year-old, obese, psychotic man who was dominated by sensations and unable to work through the different levels of psychic elaboration. He could not discriminate between words and concrete objects or between the perceptual functions of sense organs and the oral-cannibalistic level of instinct. Following the working through of these inabilities, it became possible to understand the patient's use of sensation and to make him aware of his emotions and conflicts. The author's discussion of this material emphasizes the role of the body-mind conflict and how this can be confronted in the analytic relationship. Possible links with neuroscience are also indicated.     

The analyst and analysand as citizens in the world

Beginning with Jung's reflections on individuation as a starting point, this article examines the analytic relationship in the context of our current reality. The latter exerts pressures of all sorts that do not favour individuation. Indeed, geopolitical commentators see present‐day society as marked globally by excessive self‐love that seeks to dominate, at the expense of the other. Given that such forms of dominance are now also very prevalent in the workplace, this article examines how to help the increasing number of individuals with highly successful professional careers who suffer from this pressure and who then seek analysis. ‘Progressive movement’, an indicator of and incentive to change, is examined by studying the narrative processes emerging from dream activity ‐ including dreaming with the hands in the sand tray ‐ in the co‐transference. The article highlights how ‘progressive movement’, founded on narrative Competence and on the reflective function, may generate experiences of ‘realistic hope’. The latter signals the start of an individuation process in the analytic couple and, simultaneously, the transformation of both the analyst and the analysand into good enough ‘citizens in the world’.     

Diurnal variation in rumination

The present study investigated the daily fluctuation of ruminative thinking and its individual differences by using the experience sampling method. Participants recorded their thought contents and negative affect eight times a day for a week at semirandom intervals. High-trait ruminators showed high levels of self-focus, unpleasantness, and uncontrollability in their thoughts over the sampling course. These variables were interacted to predict the levels of concurrent negative affect: Self-focus was strongly associated with increased levels of negative affect when the thought was highly unpleasant and uncontrollable. A composite measure of rumination, including self-focus, unpleasantness, and uncontrollability, exhibited diurnal variation, which was assimilated by a quadratic function of time of day. However, there were differences in the estimated parameters of diurnal trajectories between high and low levels of depression, which indicated that individuals with higher levels of depression are more likely to engage in rumination in the evening, not in the morning, than those with lower levels of depression. These findings suggest that rumination in the evening would play an important role in the exacerbation and maintenance of depression.     

The goals of psychoanalytic treatment: Conceptual considerations and follow‐up interview evaluation with a former analysand1

There has been a long, ongoing discussion of goals in psychoanalytic treatment. Some analysts are even of the opinion that psychoanalysis ought to be goalless (‘just analysing’). The growing number of outcome studies, however, is in need of a generally accepted set of criteria by which treatment results can be judged. The author proposes a definition of the goals of psychoanalysis that covers four areas: the alleviation of symptoms and complaints, changes in life adjustment, changes in personality structure, and procedural goals such as the resolution of the transference neurosis. She illustrates the relevance of this conceptualization by an empirical study that considers the assessments of 19 psychoanalysts discussing statements made by a former patient about her analytic treatment. On the basis of this case, which comes from the follow‐up study of the DPV (German Psychoanalytical Society), reported by Leuzinger‐Bohleber et al. in 2002, the author demonstrates that psychoanalysts use the criteria defined above implicitly in forming their opinions. Moreover, they arrived at similar judgements regarding the treatment's outcome.     

Shame as a predictor of post-event rumination in social anxiety

Evidence shows that people with high social anxiety levels ruminate about distressing social events, which contributes to the maintenance of social anxiety symptoms. The present study aimed to explore the role of shame in maintaining post-event rumination (PER) following a negative social event (an impromptu speech with negative feedback) in a student sample (N?=?104). Participants reported negative rumination related to the event one day and one week after the speech. PER measured one day after the speech was not associated with social anxiety symptoms and state anxiety. One week later, participants with clinically relevant social anxiety symptoms experienced greater PER. State shame was the only significant predictor of PER in a regression equation that also included social anxiety symptoms, state anxiety and self-evaluation of performance. Possible explanations and implications are discussed in light of cognitive models of social anxiety.     

Decreasing rumination using a starchy food satiation procedure

A starchy food satiation procedure was evaluated in an ABAB withdrawal design on the post‐meal rumination of a nine‐year‐old girl with autism. During treatment unlimited quantities of starchy foods were provided following each meal. High rates of rumination occurred during baseline conditions, followed by an immediate decrease in rumination during treatment. Rumination decreased to 82 and 97% of baseline during the first and second treatment conditions, respectively. In addition, follow‐up probes were conducted at irregular intervals for 4 years following treatment, during which zero or near‐zero rates of rumination were sustained. This study extends the literature on the functional relation between increased starchy food quantity and rumination in adults to rumination with a young child, and demonstrates maintenance of the treatment effect for 4 years. Copyright © 2002 John Wiley & Sons, Ltd.     

Pain perception as a function of self-focused rumination

Pain sensitivity and tolerance were studied using the cold-pressor technique. A 3 independent groups design was employed using rumination as the independent variable. Group 1 was given a situation in which anger-related self-rumination was introduced. Group 2 was given a self-related rumination task in which anger was not induced. Group 3 received a rumination task not related to the self. In addition, the State-Trait Anger Expression Inventory was given prior to the experiment to test the hypothesis that ratings on the Anger-In subtest would correlate with pain sensitivity. In each group were 6 men and 6 women. Each participant took the anger and another inventory not relevant to the present study before the experiment. An anger measure was taken before and after the experiment for each group to see if the anger induction in Group 1 actually increased anger. There were no differences among the 3 groups on the second anger measure, so differences between Groups 1 and 2 could not be attributed to anger. A 1-way analysis of variance for 3 groups showed a strong main effect on pain tolerance but not pain sensitivity. Groups 1 and 2 were significantly more tolerant of pain than Group 3. The correlation of ratings on the Anger-In (internalized anger) subtest fell short of statistical significance with pain sensitivity and also was not significant for pain tolerance. Results were discussed in terms of the possibility that self-rumination may increase pain tolerance by requiring a greater cognitive load than nonself rumination.     

Brooding rumination and attentional biases in currently non-depressed individuals: an eye-tracking study

Both rumination and attentional biases have been proposed as key components of the RDoC Negative Valence Systems construct of Loss. Although theorists have proposed that rumination, particularly brooding rumination, should be associated with increased sustained attention to depression-relevant information, it is not clear whether this link would be observed in a non-depressed sample or whether it is specific to brooding versus reflective rumination. To address these questions, the current study examined the link between brooding rumination and attentional biases in a sample of non-depressed individuals (n?=?105). Attentional biases were assessed using eye tracking during a passive viewing task in which participants were presented with 2?×?2 arrays of angry, happy, sad, and neutral faces. In line with predictions, higher levels of brooding rumination were associated with greater sustained attention to sad faces and less sustained attention to happy faces. These results remained significant after controlling for participants’ prior history of major depression and current nonclinical level of depressive symptoms, suggesting that the link between brooding rumination and attentional biases is at least partially independent of current or past depression.