How to grow up or (nearly) die trying: developing trust in one’s own capacity for growth

This paper is a single case study describing intensive psychoanalytic psychotherapy with an adolescent girl, an apparently bright and capable girl who was struck down at 15 by a double blow of trauma and loss. She cracked along her fault lines which, it is argued, were created during the ordeal of her psychic birth in the first year of life. It is proposed that ordinary Oedipal humiliations precipitated anxiety about dependency. While any adolescent is likely to have to grapple with these difficulties, the terrible life events that befell this girl compounded her dependency just when she might have been moving towards independence. In addition, the ordinary task of mourning childhood and familiar family relationships was obscured by the new and devastating losses that needed to be mourned. Unable to face this task, she spurned the support of her loving family and any potential good object and instead became dependent on manic over-achievement and grievance. The paper traces how the intricacies of the patient’s internal world slowly unfurled through the transference and countertransference and through her story as she told it to her therapist. The therapist describes the slow and difficult process of making links between that story and their experiences together in the consulting room. The theoretical concepts that enabled these links to be made are outlined and the ways in which they guided the therapist’s technique are discussed.     

Parenting,Protecting, Preserving:Mission of the Adolescent Female Runaway

This paper presents a systemic framework for therapy with families of adolescent female runaways. The runaway adolescent is viewed as serving three functions within her family. First, she often parents her parents and siblings. Second, she protects her parents' marriage and regulates marital distance. Third, she preserves her family unit at the preadolescent developmental stage. Interventions are described that remove the adolescent from those roles by empowering the parents to take charge of the adolescent, by changing the communication process such that the couple deal with their marital issues without the help of the teenager, and by facilitating the family's movement toward a new stage of separation and individuation.     

Bereavement and triangular relationships in a case of a child suffering from anorexia

This paper describes the mother–child assessment of a five-year-old girl suffering from anorexia since weaning, which was carried out in an Italian NHS neuropsychiatric child and adolescent unit. The author aims to show how she was able to link the little girl’s refusal of food to a death in the maternal family, which occurred soon after her birth. As well as this post-traumatic formulation, the author links the child’s anorexia to two related aspects of the family dynamics: avoidance of the awareness of death and the inability to manage triangular relationships, due to important intrusion and exclusion anxieties. Using extracts from the sessions, the author shows how the little girl was able to begin to work through the death phantasy which was previously inaccessible to her and her family. The concept of the death phantasy is defined and explored and possible analogies between this case and what is observed in some anorexic adolescent girls and their families are described.     

Family Etiology and Remission in a Case of Psychogenic Fugue

A psychogenic fugue lasting six days occurred in a 15-year-old girl living with her mother, sister, and stepfather. The fugue was of the most complete type — the patient assumed a new identity; spoke a foreign language she had studied in school; “regressed” to an earlier period in history; radically altered her dress and grooming; and showed skills, interests, and personality features she had not shown before. Although accounts of fugues are rare and often sketchy, the present case is unique in the amount of detail that was available. The argument between situational and psychodynamic interpretations of fugue is reviewed briefly, and a family systems interpretation of the present case is offered.     

Caste,class and culture: A case study

This case study is concerned with the deteriorating relationship between an Indian doctor who comes from a wealthy, high-caste Brahmin family from Calcutta, and an English girl from a middle-upper-middle class family from Dorset. She is a graduate in English and is a “budding” novelist. They have known each other for several years and have often lived together. Despite the fact that they have decided to become engaged, and are planning to get married shortly, their relationship has turned sour, and she has walked out on him. The study examines the nature of their relationship, the irreconcilable cultural differences that separate them. The case is viewed almost entirely from the doctor's perspective because of her unwillingness to meet with him.     

Korean adolescents' "examination hell" and their use of free time

A 15-year-old girl's daily life is a vivid testimony to the hardships the Korean high school student is faced with. She leaves home for school at 7 A. M., taking two lunch bags, one for supper, with her. After regular classes end at 5 P.M., she attends the "autonomous study classes" studying by herself until 10 P.M. The exhausted young girl returns home at about 10:30 P.M. and gets to bed around midnight at the earliest. Under the current system, this will be her life for three years. Of course, there is no guarantee she will be able to enter the university she wants. She has no family life, except for Sundays, and they hardly ever see each other, let alone get together at the dining table for dinner. People call this "ipsi chiok," entrance examination hell. ["High School Students Deprived of Spring," 1996, p. 13].     

Dichotic listening during forced-attention in a patient with left hemispherectomy

A young left-handed girl with an extensive posttraumatic lesion in the left hemisphere was tested with dichotic listening (DL) under three different attentional instructions. The major aim of the study was to evaluate a structural vs attentional explanation for dichotic listening. As both her expressive and receptive language functions were intact after the lesion, it was assumed that the right hemisphere was the language-dominant one. In the free-report condition, she was free to divert attention to and to report from both ear inputs. In the forced-right condition, she was instructed to attend to and report only from the right ear input. In the forced-left condition, she was instructed to attend to and to report only from the left-ear input. Her performance was compared with data from a previously collected sample of normal left-handed females. Analysis showed that the patient, in contrast to the normal sample, revealed a complete right-ear extinction phenomenon, irrespective of attentional instruction. Furthermore, she showed superior correct reports from the left ear, compared with those of the normal sample, also irrespective of attentional instruction. It is concluded that these results support a structural, rather than attentional explanation for the right-ear advantage (REA) typically observed in dichotic listening. The utility of validating the dichotic listening technique on patients with brain lesions is discussed.     

Cross-cultural issues in the treatment of intractable anorexia nervosa

This paper presents a case of intractable anorexia nervosa in a child burdened beyond her capabilities by unresolved conflicts in a parent. The dynamics will be assessed in the context of open systems theory of family function to suggest that the mother's conflicts, fixated at the time she left her native country, and her attempts to adapt to a new one, combined with other family members' failure to understand or appreciate the mother's cultural roots, interrupted the patient's normal maturation/development. The paper also presents a successful course of treatment of the binational anorexic girl, using a comprehensive inpatient program, emphasizing intensive family therapy with an open systems theory framework.The earlier version of this paper was presented at the Sixth World Congress of the International College of Psychosomatic Medicine, Montreal, Canada, September, 1981. Helpful comments by Regina Casper, M.D., helpful discussion by Kenneth Calestro, M.A., and support and encouragement by Katharine N. Dixon, M.D. are greatly appreciated.     

Carmen Amaya: Gypsy Princess, Flamenco Dancer, and the Role of the Family

Carmen Amaya was a great Spanish Flamenco dancer raised in the Gypsy tradition, which strictly prescribes, among other things, gender obligations. The proper behavior of women is to bear children and maintain the home. Carmen, from an early age, showed extraordinary skill in the dance form that the Gypsies brought to Spain. Her grasp of the intense, sensual dance was quickly recognized and she became famous throughout the world. But she was trapped in a universal problem: How much loyalty does a great artist owe to family? She died of kidney failure at age 50 in 1963. Hers is an extreme case that focuses attention on a universal problem. She did not draw a dividing line between herself and family tradition.     

“Is Our Daughter Crazy or Bad?”: A Case Study of Therapeutic Assessment with Children

In this paper we present a new model of intervention with documented efficacy that combines psychological tests and assessment methods with therapeutic techniques to promote change in clients. We will discuss Therapeutic Assessment of Children and their families (TA-C) through the case of a 4-year-old girl, Clara, and her family. Clara’s parents were distressed by her uncontrollable rage outbursts and feared she might be “crazy”. The treatment helped to shift the narrative the parents had about Clara and give new meanings to her behaviors. We describe in detail the steps of the assessment and provide a theoretical discussion of the therapeutic processes involved.     

An investigation of the use of nocturnal dream reports as diagnostic indices in the assessment of family problem solving

This study investigated the use of series of nocturnal dream reports to diagnose patterns of family functioning. Five families (twenty one subjects) collected a total of 126 dreams. A Treatment Group consisted of two families undergoing family therapy whilst a Non-Treatment Group, comprising three families, was drawn from a population ranging from severely disturbed to superior family functioning. The manifest content of the dreams was analysed, qualitatively and quantitatively. The presenting problem, case history, therapeutic processes and outcome were unknown to the dream researcher. The family therapist was blind to the dream content and dream analysis. Each family was independently rated by the therapist and the dream researcher. The agreement between the two assessments was highly significant. In addition, the problem areas, family transactions and treatment outcome were correctly identified by the dream researcher. It was concluded that analyses of dream series reflect the problem areas encountered by a family system. Implications for therapeutic strategies are discussed.     

心理咨询中当事人的改变过程：同化模型的视角

摘 要 目的：选用心理咨询中获得成功改变的中国当事人,验证美国学者William B. Stiles等提出的同化模型。方法：采用同化分析这一用来追踪心理治疗中当事人问题经验发展进程的研究方法,对案例的会谈逐字稿资料进行分析。结果：三位研究者追踪到了两个主题（两对声音）,摘录了68个段落。其对两个主题摘录段落的同化评分与三位独立评定者的评分具有较高的相关（0.90和0.85）,同化的评分随着会谈的进程而提高（相关分别为0.89和0.91）。当事人在心理咨询中的改变过程遵循同化模型有关治疗改变的发展序列。结论：中国当事人的心理咨询改变过程支持同化模型的理论构想。     

Too Sexualized to be Taken Seriously? Perceptions of a Girl in Childlike vs. Sexualizing Clothing

Girls in the United States are increasingly confronted with a sexualized culture, including sexualized clothing made especially for pre-teen girls. Previous research has shown that when adult women are portrayed as sexualized they are seen as less competent. In the present study we depicted a pre-teen girl in sexualized clothing to determine if similar effects would occur as have been found with depictions of adult women. One hundred sixty two male and female students from a small liberal arts college in the Midwestern U.S. looked at one of three images of a fifth-grade girl (obtained from an internet advertisement and manipulated through computer software) who was presented in either childlike clothing, somewhat sexualized clothing, or definitely sexualized clothing. Level of accomplishment was also manipulated so that the girl was described as either average or above average in accomplishment. Participants then rated the girl on ten different traits. The clothing and accomplishment manipulations significantly affected ratings of the girl’s masculine-stereotyped traits such that the girl who was portrayed as more sexualized and less accomplished was seen as the least intelligent, competent, determined, and capable. In addition, the sexualized girl was seen as perhaps “responsible” for her sexualized clothing in that she was rated relatively low in self-respect and morality. Possible implications of the sexualization of girls are discussed.     

Liquid fading to establish milk consumption by a child with autism

Liquid avoidance by children with developmental disabilities is a common problem but has not been researched extensively. In this study, a 4‐year‐old girl who had autism and food selectivity was taught to drink milk through a liquid fading procedure. The feeding protocol consisted of gradually increasing the concentration of milk in a beverage she consumed 100% of the time. Intervention was implemented by educational staff in a school setting. Milk consumption was achieved rapidly without interruption to the fading sequence. Clinical and research issues related to liquid avoidance and fading treatments are discussed. Copyright © 2005 John Wiley & Sons, Ltd.     

Case marking in the Parsing of Complement Sentences: Evidence from Eye Movements

An eye-tracking experiment investigated the role of case-marking in parsing. We manipulated the case of pronouns in reduced complement sentences like I recognized you and your family would be unhappy here and I recognized she and her family would be unhappy here , in which the nominative pronoun she immediately disambiguates the sentences, in contrast to the ambiguous you . The nominative pronoun she disambiguates the sentence because I recognised she is ungrammatical, and thus she and her family must be the subject of an embedded sentence and not the NP-object of the preceding verb. Subjects took longer to read she and her family than you and your family during initial processing. The pattern reversed at the disambiguating phrase would be . Unambiguous control sentences containing the complementizer that did not produce case-marking effects. These results demonstrate very rapid effects of case-marking on parsing. Either case information is used immediately, or it is employed after an extremely short delay. We discuss implications for current theories of parsing.     

‘Only connect’ – a sexually abused girl's rediscovery of memory and meaning as she works towards the transition from a therapeutic community to a foster-family

This paper looks at the role of individual psychotherapy with a severely sexually abused girl in a therapeutic community, and the place of this work as she makes the transition into foster-care. It emphasizes the importance, not only of the individual work, but also of the drawing together of the work around the child, particularly at such a critical time. There is discussion of the ideas of ‘deadness’ versus ‘aliveness’ in the therapy, and detailed case material is used.     

Individual, Peer, and Family Factors Influencing Urban African American Adolescents’ Responses to Problem Dating Situations

A clear understanding of factors influencing adolescents’ responses to problem dating situations is needed to guide efforts to promote healthy dating relationships and address issues such as emotional distress, conflict, and violence in dating contexts. This study used qualitative methods guided by a socio-ecological model to identify factors at the individual-level and those within adolescents’ peer and family relationships that influenced their use of specific strategies (active, avoidant, support-seeking, or aggressive) in response to problem dating situations. Interviews were conducted with 38 African American middle and high school students in an urban public school system. Participants identified nine themes that would make it easier for them to engage in their best response strategies to deal with problem dating situations. These included four individual-level factors (e.g., individual characteristics and adolescents’ confidence in their ability to address dating problems), three peer factors (e.g., supportive advice from peers), and two family factors (e.g., support, advice, and messages about dating relationships from family members). Nine themes were identified that would make it harder for adolescents to engage in these responses including three individual-level factors (e.g., difficulty in regulating anger, anxiety, and sadness in dealing with dating problems), four peer factors (e.g., peer instigated conflict among dating partners), and two family factors (e.g., family involvement in adolescents’ dating relationships). The results inform prevention efforts that focus on promoting healthy dating relationships during adolescence.     

Living in with Normal Families

Connie Hansen participated in my project, “Methodology for Studying Family Interaction,” in the mid 1960s. One of the purposes of that project was to compare several groups of families, including “normals.” Connie suggested that it might provide a rich source of data if she were to “live in” with a few of the “normal” families and observe them day to day on their own territory. (A year or so before, Dr. Jules Henry had given a talk to the MRI staff about living-in with “schizogenic” families, and I believe that Connie had discussed her idea with him.) Connie was an experienced family therapist — she was one of Virginia Satir's first students — and a most perceptive observer. She lived with three “normal” families for a week each during 1966–67; she was excited by the wealth of material and exhausted by the experience. She tried to develop a group of central themes from her data and gave me a preliminary draft of a paper in 1969. It clearly contained a number of important observations about the complexities and subtleties of family systems and some beginning attempts at conceptualization. She struggled for years to clarify and elaborate on her material. Several times she sent me portions and fragments of new drafts, each with additional insights, but she was never satisfied with her efforts. It seems a fitting tribute to Connie — she died early in 1979 — to attempt to put together her various drafts. We wanted to publish this very important material in a readable form and yet still preserve the immediateness, enthusiasm, and vividness of her observations. I hope, that if she were to read it, she would not be overly critical of this final draft. JULES RISKIN, M.D. It is a special privilege for me to participate in this posthumous publication of Connie Hansen's unique contribution to the further knowledge of family interaction. She died before the material could be published. I feel particular gratitude to the young woman who entered my first training program in 1961 at the Mental Research Institute. This was a time when such training seemed “far out” and was regarded as “probably only a fad.” She was willing to face the risks inherent to her professional standing by choosing to do this training. It was this same courage together with her imagination and curiosity and her willingness to document her experience without judging it that resulted in the article now being published. Farewell, Connie, and thank you for your presence in my life. VIRGINIA M.SATIR     

The danger in deception: oedipal betrayal and the assault on truth

Certain potential precursors to heterosexual women's experience of partner infidelity are explored as these dynamics unfold within the oedipal crisis-the "betrayal" by the oedipal objects. As each child moves into the oedipal phase, he or she comes to recognize not only desire for the mother, but the mother's desire for the father. A doubling of this experience of "deception," encountered first in relation to the mother, and then repeated with the father, may be especially pronounced for a girl, as she is likely to inhabit more fully her bisexual potential in negotiating the expected shift of object choice from mother to father. "Deceived" by her primary maternal oedipal object, a girl sets forth toward her paternal oedipal object with "fidelity" already an issue, and with faith in her mind's ability to determine reality already shaken. Undermined trust in self and other is the context in which she begins the oedipal relation to her heterosexual object. This path is quite distinct from that traveled by the heterosexual boy. Clinical material illustrates the assault on one's mind, on one's confidence to determine what is true, that is a central aspect of both oedipal and adult betrayal.