The anatomy of a symptom: concept development and symptom formation in a four-year-old boy

The case of a four-year-old boy with a postural symptom that resolved rapidly in the course of play therapy is presented. Various unconscious fantasies appeared to underlie the symptom. In particular, this case illustrates a young child's sophisticated capacity to abstract a complex relational feature from a set of unconscious fantasies that then became the basis of his symptom. The structure of the boy's symptom is relevant to (1) the question of what constitutes a symptom, (2) the relationship between concept development and symptom formation, and (3) the status of certain primary process mechanisms as they relate to concept development. Proposals are presented to help situate the contributions of psychoanalytic theory with respect to the domain of cognitive psychology, and to illustrate the unique contributions of each domain toward their mutual enrichment.     

A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 1. Quantitative outcome and process studies

Scope of review: The paper reports a meta‐review of 15 previous systematic reviews and meta‐analyses of the literature concerning the outcome of counselling and psychotherapy with people at risk of suicide; a meta‐analysis of 67 outcome studies in this area; and a narrative review of 17 studies of the therapeutic process. Publication time span: The literature reviewed was published between 1981 and 2008. Publication origin: The majority of the literature reviewed was by authors from the USA or the UK, but there were also authors from other European countries, Australia, Canada, India, and Sri Lanka. Findings: There is evidence of the effectiveness of dialectical behaviour therapy, cognitive‐behavioural therapy, and problem solving therapy, but also for other forms of therapy. Therapist and client variables, as well as the therapeutic relationship, appear to be related to treatment outcome. Conclusions: People at risk of suicide should have access to psychological interventions, including, but not necessarily limited to, those within the cognitive‐behavioural spectrum. Therapies for which there have been promising findings, but which are under‐researched, should be a research priority.     

A meta-analysis of school-based studies of psychotherapy

The purpose of this study was to apply the meta-analysis technique to school-based studies of psychotherapy. Thirty-three controlled studies were identified that met the criteria for meta-analysis. Although research efforts in this area offer a relatively small number of well-designed studies, the results of the meta-analysis indicate that psychotherapy in the schools can be viewed as at least moderately effective. Evidence was also found of the greater efficacy of group and behavioral theory interventions and interventions that target observed behaviors and problem-solving abilities.     

Epidemiological studies for the need of psychotherapy

Preliminary results obtained in epidemiological studies are reported. The data obtained shows extensive need for psychotherapy, with marked differences between urban and rural communities. Considerations on the present situation in psychotherapy are given and suggestions made for changes in the present system of treatment.     

Studying psychotherapy change in narrative terms: The innovative moments method

This paper aims to describe the Innovative Moments (IM) Coding System (IMCS), an idiographic and transtheoretical methodology that allows the identification of IMs—markers of changes in the client's initial maladaptive framework of meaning—throughout psychotherapy. The present study introduces the theoretical background underlying this methodology, along with the main empirical findings resulting from former studies that have applied this tool to clinical data. The IMCS application is also detailed: the coding phases, the training steps and inter‐rater agreement measures. In order to illustrate the application of IM coding, a case study is presented. Although a partial coding was used, the results are in line with previous research. Discussion is centred on the usefulness of the IMCS for the advance of process research in psychotherapy, and the potential use of this methodology in group format.     

The talking cure: Wittgenstein's therapeutic method for psychotherapy,by John M. Heaton

This paper offers an outline of the challenges particular to intersubjective approaches to psychoanalytic psychotherapy in South Africa. Past experiences of deeply entrenched and racialized divisions between communities continue to shape the negotiation of power in therapeutic spaces, and affect participants’ capacity to engage freely with the exploration of unconscious communication. Examples are given of the ways in which race, class and gender difference may complicate, hinder or enrich intersubjective psychoanalytic psychotherapy. Some suggestions are made about the kinds of reflective work that need to be undertaken by psychotherapists in order to assume fully the burdens of history and to appreciate fully the opportunities offered by a society in transformation.     

The scenic function of the ego and its role in symptom and character formation1

The author argues that the scenic function of the ego permits the situationally appropriate representation of an unconscious, infantile configuration – that is, of a relatively stable, personality‐based drive scene having the same status as latent dream thoughts. The products of conflict elaboration (symptoms, etc.) are manifested in different ways in accordance with the conditions of the relevant situation. The contents of the drive scene are created by the psychical apparatus on the basis of infantile perceptions and are revealed in screen memories. The capacity for situationally appropriate representation is apparently bound up with the mobile drive, including its narcissistic transformations. Desexualization (in the sense of neutralization) renders scenic elaboration impossible. The drive derivatives withdrawn from the scenic configuration contribute to ego organization and the formation of character traits, which no longer vary according to the situation, but can only be modified by a change in personality structure itself. It is as yet unclear whether a process of resexualization can make them amenable once more to analytic work. The form of narcissistic libido that can assume a scenic configuration is closely related to primary narcissism. Its manifestations, which may likewise emerge in situation‐dependent symptom formations, appear accessible to analysis.     

Quantitative approaches in environmental studies

Psychological scaling methods can be applied and can bring substantial knowledge to bear upon problems within the realm of environmental hygiene. Methodological issues related to the possibility of obtaining calibrated scales of perceptual variables such as discomfort, annoyance, and unpleasant odors are critical when the scale values are to be entered into a physical pollution index or a perceived environmental quality index, both being applied in the form of norms or recommendations. The level of measurement (ordinal, interval, or ratio scale) is related to the question of calibration of scales. From a practical point of view, the effects of observer-environment dependence are important to disguise in the scale values. Problems having to do with calibration of scales and with application of knowledge about perceptual processes to the scales are being explored in ongoing research projects. These include the measurement of temperature discomfort in different climates and the measurement of annoyance in areas with different noise exposures. Attempts have been made to solve an odorous air pollution problem with psychological measurements.