Tuning into the psychotic wavelength: Psychoanalytic supervision for mental health professionals

In this paper, material is presented from supervision groups run for mental health professionals in different mental health settings. I will argue that a psychoanalytic framework, which puts the transference and countertransference at the centre of clinical practice, offers an important model for thinking about psychosis and psychotic means of communication. When staff are able to ‘tune in’ to their patients' communications it can help to change a patient's monologue about his/her delusional world into a meaningful dialogue about their emotional world.     

Making the case for dedicated infant mental health services

SUMMARY

This paper seeks to demonstrate the case for establishing dedicated Infant Mental Health Services. It is argued that the 0–3 age-group is not well served by the current arrangement for the provision of mental health services along child/adult lines, and falls between these two stools. It is further argued that priority should be given to services for this group because of the immense potential of early intervention programmes. The nature and ethos of such services are discussed, and it is suggested that the time is now ripe for Infant Mental Health to be given institutional recognition as a distinct specialism in its own right.     

The psychotic personality: A psychoanalytic theory and its application in clinical practice

This paper presents and discusses aspects of Bion's theory of the psychotic personality. In particular, it focuses on the psychotic personality's attacks on the dependent and needy self. The paper considers how Bion's theory can be applied to understanding the schizophrenic patient. Examples are given to show its importance not only in analytic practice, but also within general psychiatry.     

The role of psychoanalytic assessment in the management and care of a psychotic patient

The pressure on mental health services to move patients on quickly, and the emphasis on the recovery model, can encourage a superficial assessment of the patient's difficulties. The author argues that a narrow definition of the medical model based on the presence or absence of symptoms ignores the deeper psychic structures that govern thinking and behaviour over time. A psychoanalytic assessment can offer a dynamic picture of deeper psychic structures in the patient's internal world. This is particularly important with psychotic patients who may successfully use denial and rationalization to cover up their underlying psychopathology. The developmental perspective inherent in the psychoanalytic view can also give a picture of the patient's propensity to repeat certain aspects of his/her psychopathology. In addition, a psychoanalytic approach may shine some light on the relationship between relapse and risk behaviour.     

Beyond emotional bonding: The role of preverbal communication in mental growth and health

Next to nutritive and hygienic needs, emotional needs have been most commonly considered in theories on early human development and in therapy of early disorders in social interactions. Needs concerning cognitive and communicative development have gained far less attention although they belong to species-specific means of human adaptation, depend on intrinsic motivators, and are very often involved in the symptomatology of disorders in social behavior. Most mechanisms of dialogic interchanges are based on nonconscious processes and escape parents' rational control. They may be disturbed or inhibited due to pathological deviations and/or unfavorable sociocultural circumstances, both on the parental and infant sides. Preverbal communication plays a key role in the environmental support to infant cognition, communication, and social integration. The elucidation of its forms and therapeutic application has proved helpful not only for infants but also for children whose communicative age is lower than their chronological age.     

Making the case for psychoanalytic therapies in the current psychiatric environment

A variety of political, economic, and scientific forces have caused psychoanalytic therapies to become marginalized in psychiatry. These therapies are given short shrift in recently developed treatment guidelines, which are based largely on notions of empirical validation narrowly construed. Questions about the efficacy of psychoanalytic therapy can be meaningfully addressed by systematic assessment of available knowledge and potential data bases and by explicit efforts to locate the role of psychoanalytic therapies alongside other modalities. Several steps that might lend the psychoanalytic therapies greater credibility are proposed: (1) define the distinguishing features; (2) identify clear indications and contraindications; (3) systematically collect case histories of successfully treated mentally ill (diagnosable) patients; (4) increase vigilance (together with the patient) toward assessing progress in treatment.     

Migrant mental health: a model for indicators of mental health and health care consumption.

OBJECTIVE: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. DESIGN: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. MAIN OUTCOME MEASURES: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" RESULTS: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. CONCLUSIONS: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups.     

Coparental communication,relational satisfaction,and mental health in stepfamilies

This study tested a series of actor–partner interdependence models of coparental communication, relational satisfaction, and mental health in stepfamilies. Participants included 127 couples (N = 254). Results revealed 2 actor‐oriented models whereby parents' and stepparents' coparental communication quality positively predicted their own (but not their partners') satisfaction and mental health. A final model revealed that parents' relational satisfaction mediated the effect of coparental communication on their own mental health. A similar pattern emerged for stepparents, although coparental communication continued to have a direct, positive effect on stepparents' mental health. Importantly, parents' coparental communication produced an inverse partner effect on stepparents' mental health, highlighting the potential stress stepparents may experience as they are called upon to help raise their spouse's offspring.     

The production and understanding of utterances in dyadic communication

Verbal communication in four dyads was analyzed with respect to syntactic form and cognitive and affective functions. Quantitative and qualitative methods were proposed to study these aspects of language behaviour. Utterances which conveyed a negative affective evaluation tended to be syntactically and cognitively complex. The cognitive and affective functions of a speaker's utterance tended to influence the syntactic quality of the listener's following utterance more than what the listener said in his own previous utterance. An investigation of the relationships between the personality characteristics flexibility, intelligence and verbal competence, and language variables suggested that flexible subjects often used utterances which expressed a positive evaluation. Furthermore, flexible subjects tended to influence the listener more by what they said than intelligent and verbally competent subjects did. It was concluded that this kind of functional analysis of language should be more adequate for psychological inquiry than in particular that of the transformational generative theory of language.