Spiritual Experiences in Counselling

Three questions are addressed. First, what are spiritual experiences? The one-two-three-infinity theory of spirituality is questioned, and it is suggested that there are at least nine distinguishable spiritual experiences. Second, how do we use such experiences in counselling? Examples are given of how this approach is useful in counselling. and particularly in dream work. The importance of intuition is stressed, and group work is discussed. Third, what are the implications for the training of counsellors? The issues of ego inflation and psychosis are raised, and it is suggested that the training of future counsellors needs to include the coverage of such issues, as well as the more general material dealt with in this paper.     

Promoting Advanced Ego Development Among Adults

An intervention study was conducted to investigate whether advanced ego development could be promoted if account was taken of the factors likely to be involved in the ego stage transition process in adulthood. A conceptual framework that identified such factors was described, in which it was hypothesised that stage transition occurs in response to life experiences that are structurally disequilibrating, personally salient, emotionally engaging, and interpersonal. The intervention was designed in accordance with these proposed types of life experiences, and was targeted toward adults at the modal stage of ego development. Using an experimental design, a significant increase in ego level was found in 2 equivalent intervention groups, with no increase found in a matched control group. The findings demonstrate the possibility of continued ego development in adulthood, including development to the advanced ego stages, and provide clarification regarding some of the processes involved in such development.     

The relationship between different types of dissociation and psychosis-like experiences in a non-clinical sample

This study investigated whether detachment-type dissociation, compartmentalisation-type dissociation or absorption was most strongly associated with psychosis-like experiences in the general population. Healthy participants (N = 215) were tested with the Dissociative Experiences Scale (DES, for detachment-related dissociative experiences); the Harvard Group Scale of Hypnotic Susceptibility (HGSHS: A, for dissociative compartmentalisation); the Tellegen Absorption Scale (TAS, for non-clinical ‘functional’ dissociative experience); and two measures of psychotic-like experiences, the 21-item Peters et al. Delusions Inventory (PDI-21) and the Cardiff Anomalous Perceptions Scale (CAPS). In multiple regression analyses, DES and TAS but not HGSHS: A scores were found to be significantly associated with PDI-21 and CAPS overall scores. A post hoc hierarchical cluster analysis checking for cluster overlap between DES and CAPS items, and the TAS and CAPS items showed no overlap between items on the DES and CAPS and minimal overlap between TAS and CAPS items, suggesting the scales measure statistically distinct phenomena. These results show that detachment-type dissociation and absorption, but not compartmentalisation-type dissociation are significantly associated with psychosis-like experiences in a non-clinical population.     

Evaluation of ego strength based on certain Rorschach variables.

Despite the importance of the assessment of ego strength for appropriate assignment of clients for psychotherapy and/or rehabilitation, existing techniques have not fulfilled expectations. A method for assessing ego strength through the Rorschach Test independent of clinical criterion is proposed. In addition to certain variables of Klopfer's RPRS (M+, FM+, FC+ plus CF+), sharply preceived space responses are included. They constitute a highly intercorrelated global measure of ego strength and are also highly correlated to a relatively independent Rorschach variable of global ego efficiency, i.e. integrated whole responses. In accordance with prediction, non-controlled color responses as well as accuracy of form perception did not correlate in a non-clinical sample with either measure of ego strength.     

Assessing Male Batterers With the Personality Assessment Inventory

Despite the importance of the assessment of ego strength for appropriate assignment of clients for psychotherapy and/or rehabilitation, existing techniques have not fulfilled expectations. A method for assessing ego strength through the Rorschach Test independent of clinical criterion is proposed. In addition to certain variables of Klopfer's RPRS (M+, FM+, FC+ plus CF+), sharply preceived space responses are included. They constitute a highly intercorrelated global measure of ego strength and are also highly correlated to a relatively independent Rorschach variable of global ego efficiency, i.e. integrated whole responses. In accordance with prediction, non-controlled color responses as well as accuracy of form perception did not correlate in a non-clinical sample with either measure of ego strength.     

Therapeutic techniques for the treatment of certain infantile personality disorders in ego disturbed children

This paper has discussed certain ego disturbed children of preschool and school age with infantile personality disorders. Although these children do not form a sharp diagnostic category, it is of clinical importance to differentiate them both from the neuroses and from other more serious ego disorders. These predominantly infantile children suffer chronic ego arrest and deviations as well as some degree of internal conflicts. Reality adaptation is characteristically distorted, ego defenses imbalanced, and social relations aberrant. Unlike some other borderline types, however, these children have no significant potential for psychosis. They are not prone to panicky anxiety attacks, or to psychoticlike ego regressions or withdrawal. Ego disturbed children with infantile personality disorders pose certain typical problems of therapeutic technique. They do not possess the ego strength for classical analysis, nor are they suitable candidates for a purely supportive or nurturing treatment. I have argued that the particular psychopathology of these children requires a form of corrective developmental treatment in which the therapist plays a flexible role and uses a combination of techniques corresponding to the child's progressive ego development. Early in treatment primarily supportive and nurturing techniques are used to promote a corrective identification and strengthen the defenses. As treatment proceeds, however, selected interpretations are introduced to modify the internal conflicts that block personality integration and development. Especially important are the mobilization and interpretation of hostile aggression. In the later treatment phases the therapist becomes increasingly more frustrating to the child's infantile wishes, encouraging reality adaptation and social maturation. The various shifts in therapeutic technique create resistances whose interpretation and working through are integral to the treatment process and cure.     

Environmental control and psychosis-relevant traits modulate the prospective sense of agency in non-clinical individuals

The sense of agency concerns the experience of being the source of one’s own actions and their consequences. An altered sense of agency can occur due to task automation and in psychosis. We tested in a non-clinical sample the hypothesis that reducing voluntary task control diminishes intentional binding as an implicit indicator of the sense of agency, possibly interacting with psychosis-relevant personality traits. Agent-device interactions were manipulated obtaining positive-control (voluntary interaction), no-control (automation), and negative-control (device-commanded interaction) groups. The main results showed reduced prospective intentional binding (predictive coding of action consequences) in the no-control and negative-control groups, compared to the positive-control group. Psychosis-like experiences covaried positively with intentional binding in the no-control group, but negatively in the negative-control group. Moreover, positive-social traits were associated with increased intentional binding in the positive-control group. These findings demonstrate the interplay between environmental and individual differences variables in establishing the implicit sense of agency.     

A latent class analysis of positive psychosis symptoms based on the British Psychiatric Morbidity Survey

This study aimed to describe the distribution of positive psychosis symptoms in a large scale, population-based sample. Data from the British Psychiatric Morbidity Survey was used to examine homogeneous sub-types of participants based on their responses to the five probe items of the Psychosis Screening Questionnaire. Latent class analysis was used to identify the underlying class structure of psychosis. Four classes of psychosis were identified. Associations between the latent classes and the demographic risk factors, clinical variables and reports of traumatic experiences showed significantly higher risks for the psychosis class, the paranoid class, and the intermediate class compared to the normative class. Four classes that appeared to represent an underlying continuum could best explain psychosis symptom expression at the population level.     

Life hassles, experiential avoidance and distressing delusional experiences

Life hassles have been implicated in both the formation and maintenance of psychosis symptoms. However, little is understood about the mechanism through which these stressors impact on psychosis. The current study proposed experiential avoidance (EA), a psychological coping style that is a central focus for change in Acceptance and Commitment Therapy (ACT), as a potential mediator of the link between life hassles and both the emergence and maintenance of delusional ideation. Participants were recruited to a non-clinical sample (N = 133) and a clinical sample of psychosis patients (N = 100). All participants completed a self-report questionnaire including a measure of delusions and delusional distress (Peters Delusions Inventory), life hassles (Survey of Recent Life Experiences) and EA (Acceptance and Action Questionnaire-II). Mediation testing (bootstrapping) indicated a significant mediation effect of EA in the relationship between life hassles and both delusions and delusional distress, in both clinical and non-clinical samples. The findings suggest that individuals (irrespective of their diagnostic status) with a tendency to suppress or avoid unwanted thoughts are significantly more likely to experience distressing delusions in response to stressful life occurrences. The use of ACT and Cognitive Behavioural Therapy to reduce EA in those at risk of emerging delusions and in patients with an already established psychosis is discussed.     

Hair pulling (trichotillomania)

Based on the findings in this case and common elements reported in other articles on trichotillomania, there seems to be evidence that the "irresistible urge" to pull out the hair has its beginnings in the early years of a child's life. The nature of the parent-child relationships appears to be especially important in establishing psychological antecedents for the later development of trichotillomania. Specifically, the trichotillomanic's mother sets the stage for the emergence of this symptom by extending the child's dependence upon her as the primary need-gratifier beyond early childhood into latency, adolescence, and adulthood. As a result the child is not gradually propelled to participate in newer and more complex learning experiences that ultimately lead to a sense of mastery and independent functioning in the environment. Important developmental stimuli are not presented at the appropriate times and the child is not exposed to certain types of interactions at the optimal times so that some very important ego functions do not develop, or develop minimally, or in a distorted manner. Simply, the mother cannot "let go" of her child, apparently deriving gratification of her own needs through infantilization of the child; as a result the child develops a limited or illusory sense of self sufficiency. Continuation of such an unhealthy symbiotic relationship, however, is found in many forms of psychopathology and the fact that it also underlies trichotillomania may partially account for hair pulling as a symptom associated with such a wide range of nosological categories. It is the main contention of this study, however, that the quality of the parent-child relationships impairs the ego development and causes failure of the trichotillomanic patient to establish object constancy. Without the establishment of object constancy an individual requires visible evidence that the object/person capable of gratifying basic security needs is present or available. In trichotillomania the hair seems to symbolize the need-gratifying object/person who is lost when the hair is pulled out and, more importantly, regained when it is eaten or restored. It appears to be this latter component of trichotillomania, i.e., reincorporation of the need-gratifying object/person, which reassures the patient that infantile needs can be gratified and security can be reestablished. Unfortunately, the trichotillomanic is driven to repeatedly and compulsively remove hair so that it can be regained temporarily since object constancy is never really established.     

Mindless Bodies–Bodyless Minds

Possibilities opened up by scientific–technical developments of the last century have led to the breaking up of our basic concepts regarding elementary aspects of human life. Boundaries are more easily crossed (also among genders); the reality of functions and the functions of reality are becoming interchangeable. The audio-visual galaxy, which has evolved over the course of the 20th century, with its two dimensionality has resulted in generations growing up in the past decades who have learnt that the “other” can be a virtual body: the sensual is no longer an essential part of human relations. The somato-affective aspects of the experience get split off—relationships emerge between bodyless minds. This fragmentation also means that the body is seen increasingly as mindless: the linkages between body and mind are profoundly undermined. Reality and fantasy melt into one another. Reality control and thinking becomes insecure effected by a view of the world that has lost its keystones of orientation. When body boundaries get confused in such a manner how do ego boundaries develop? How will primary relationships alter among such conditions? What will the internal images of the objects be like? The deconstruction of our basic concepts about space, time, dimensions, body- and ego boundaries made differentiation and the processes of symbolization extremely difficult. Postmodern ideas, questioning the validity of facts have contributed greatly to transforming our image of reality also on a theoretical level. How do these massive changes effect our daily clinical work and our theory of the mind? My paper tries to explore some experiences and ideas related to these questions through clinical cases and narratives of our present times.     

Need for closure and anxiety in delusions: a longitudinal investigation in early psychosis

This study investigated the role of need for closure (NFC) and anxiety in delusions. The Need For Closure Scale (NFCS) and measures of trait and state anxiety were administered to an early psychosis group with current delusions, a clinical (generalised anxiety disorder--GAD) control group and a non-clinical control group. The battery of questionnaires was repeated at follow-up one year later. The NFCS did not meet criteria for a unidimensional scale and two sub-scales were removed from all further analyses. At baseline the deluded and GAD groups scored significantly higher on the reduced NFCS (NFCS-R) than the control group. Trait anxiety was related to NFCS-R in the GAD and non-clinical control groups, but not in the deluded group. At follow-up all groups scored significantly lower on the NFCS-R, perhaps suggesting a practice effect, although the two clinical groups continued to have higher scores than the non-clinical control group. The recovered and non-recovered deluded groups did not differ on the NFCS-R one year later, unlike in the GAD group where recovered participants had significantly lower scores than the non-recovered. Change scores on the NFCS-R and trait anxiety were correlated at trend level in the GAD and non-clinical control groups, but not in the deluded group. These findings suggest that whilst NFC and trait anxiety are related in non-psychotic groups, NFC may be implicated in the formation of delusions, independently of anxiety, in psychotic individuals.     

Eros and psychotic despair

The author suggests that Freud's theory of sexuality is not adequate to explain the issue of psychosis. The sexual drive presupposes construction of the unity of the subject, whereas psychosis takes root in a period of life when the ego is not yet integrated. In a neurotic subject, suffering is always an expression of sexuality. By contrast, in a psychotic person, even aspects explicitly connected with sexuality represent an attempt to escape from despair. In the former it is a question of pleasure, and in the latter of relief In light of these considerations, the author discusses the problem of erotomania.     

The role of anxiety sensitivity and lack of emotional approach coping in depressive symptom severity among a non-clinical sample of uncued panickers

Panic attacks and depression frequently co-occur, and the presence of this co-morbidity is often associated with worse outcomes compared with each disorder alone. Despite this, not everyone who experiences panic attacks also suffers from depression, suggesting that individual difference factors may play a role in this co-morbidity. The purpose of this study was to provide a preliminary investigation of two such individual difference factors, examining the role of anxiety sensitivity and lack of emotional approach coping in depressive symptom severity among a non-clinical sample of uncued panickers. A sample of 79 college students reporting the occurrence of uncued panic attacks within the past year completed a series of questionnaires assessing the lower-order factors of anxiety sensitivity, emotional approach coping, panic attack frequency, panic-related disability, panic symptom severity and depressive symptom severity. Participants with more severe depressive symptoms reported greater anxiety sensitivity, panic attack frequency, panic symptom severity, panic-related disability and lack of emotional approach coping. The particular anxiety sensitivity dimension of fear of cognitive dyscontrol and lack of emotional approach coping emerged as the best predictors of depressive symptom severity. Findings are discussed in terms of their implications for the improved understanding of this co-morbidity, as well as its treatment.     

Anxiety and depression and their links with delusions and hallucinations in people with a dual diagnosis of psychosis and substance misuse: a study using data from a randomised controlled trial

Rates of depression and anxiety have been linked to severity and distress associated with positive symptoms in psychosis. There is also tentative evidence to suggest that these concurrent symptoms might be related to delusional and hallucinatory content. Our aim was to assess the cross-sectional associations between anxiety and depression, and hallucination and delusion severity and distress in a sample of 327 people dually diagnosed with psychosis and substance misuse problems. In addition, the relationships between specific symptom content and levels of anxiety and depression were examined. Anxiety was associated with delusion distress and depression with hallucination distress, although neither was related to symptom severity. Auditory commands to harm or kill the self were associated with higher levels of depression. Delusions with themes pertaining to the paranormal, and those with references to celebrities were associated with lower levels of depression. No specific delusion or hallucination content was associated with level of anxiety, when other variables were controlled for. The results demonstrate that anxiety and depression are linked to distinct aspects of psychotic experience, highlighting the need to acknowledge the role of these concurrent symptoms in the context of psychosis. In addition, findings relating to specific types of delusions and hallucinations highlight avenues for further research.     

Self-Transformation at the Boundary of Religious Conversion and Psychosis

The relationship between religious conversion, as a form of spiritual emergency, and psychosis is one of the fundamental issues at the meeting point of theology and clinical psychology. In the present study, we assessed 53 individuals referred to a psychiatry center with the initial diagnosis of a psychotic episode by focusing on the clinical diagnosis (psychosis vs. spiritual emergency), subjective experiences (basic symptoms), and neuropsychological functions. Twenty-nine individuals meet the diagnosis of schizophrenia-spectrum disorders, but 24 persons experienced only religious and spiritual problems (religious conversion). Both groups reported similar levels of perplexity (e.g., ambivalence, inability to discriminate between own feelings, and hyperreflectivity) and self-disorder (e.g., depersonalization, impression of a change in one’s mirror image, and experience of discontinuity in own action). Diminished affectivity, disturbed contact, and perceptual/cognitive disorders were pronounced in psychosis, whereas anxiety and depressive symptoms were more severe in people with spiritual and religious problems. These results indicate that perplexity, self-disorder, and emotional turmoil are common features of turbulent religious conversion and psychosis, but a broader emergence of anomalous subjective experiences and cognitive deficits are detectable only in psychosis.

     

Regressive experiences in Vietnam veterans: Their relationship to war,post-traumatic symptoms and recovery

Regression has been commonly associated with war and postwar symptomatology. Posttraumatic symptoms have been considered regressive when manifested by chronic dependent behavior or outbursts of primitive, aggressive behavior. Recovery from regressive symptoms may in itself induce regressive experiences since recovery necessarily leads to another change in ego boundaries; rigid or fused boundaries becoming realigned, intact, and flexible. Recovery therefore requires a stable and trusting therapeutic relationship to gradually permit such changes. Psychological treatment of Vietnam veterans often has occurred in phases with immediate management of regressive symptoms occurring during early phases and induction of regressive states has often occurred during late phases to facilitate integration of split-off traumatic experiences and emotions.     

The Rorschach Ego Impairment Index in Heterogeneous Psychiatric Patients

There is a need for test measures of ego functioning that identify treatment needs and predict treatment response. Perry and Viglione's Rorschach Ego Impairment Index (EII; Perry & Viglione, 1991) is a composite measure assessing reality testing, thought process, defensive regulation, and object relations. It has been shown to correlate with Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) scales and subscales and other measures of psychosis in a schizophrenic sample and to predict antidepressant treatment outcome in a depressed sample. This investigation examined the EII as a measure of ego impairment in a sample of 85 heterogeneous psychiatric inpatients and outpatients. In this sample, the EII did discriminate between inpatients and outpatients; it did not discriminate between psychotic and nonpsychotic patients, though there was a trend in this direction and one of the EII's object relations variables (Good H) did so. The EII did not generally show significant relations with MMPI indices of ego impairment (Es or Scale 8), though there were some significant patterns of relation with Scale 8 subscales. The study provides some, though not unequivocal, support for the EII as measure of ego impairment and for its utility compared to other measures and adds credence to earlier suggestions of the importance of object relations measures to ego functioning assessment.     

Religious Service Attendance and Religious and Secular Organizational Engagement in the United Kingdom

The study uses nationally representative data to examine whether the moral freighting Putnam and Campbell (2010) propose, based on American experiences, may apply to overall British society. Specifically, it tests whether religious service attendance increases religious or secular organizational activities, possibly due to moral freighting that encourages religious congregants to practice their faith, transcending ego boundaries and self-interest. It is also necessary to determine if engagement in religious or secular organizational activities elevates the degree of religious service attendance, thus forming a bidirectional association. The study employs the maximum likelihood-structural equation modeling (ML-SEM) method to verify the proposed reciprocity. The empirical tests confirm that a synergistic reciprocal relationship is established between religious service attendance and religious organizational engagement, and that religious service attendance increases secular organizational engagement. However, secular organizational engagement does not make a bidirectional contribution to religious service attendance.     

Maternal Representations of Patients with Schizophrenia as Measured by the Parental Bonding Instrument

Maternal perceptions were assessed, using the Parental Bonding Instrument (PBI) in 19 subjects with schizophrenia, 14 subjects with borderline personality disorder and 15 non-clinical subjects. Subjects with schizophrenia and subjects with borderline personality disorder reported significantly less care and more overprotection than did non-clinical subjects. No significant differences were found in representations by subjects with schizophrenia and subjects with borderline personality disorders. To the extent that the reported negative maternal behaviour gives a true picture of childhood and adolescent experiences, it does not seem to be specific for schizophrenia, but may be one factor in the development of severe mental disorders.