精神分析客体关系革命的折衷进路:英国独立学派评述

自精神分析学诞生以来,其发展进路经历了自我革命、客体关系革命、自体革命、关系革命和神经科学革命。英国独立学派是客体关系革命的主要发起者和中间力量,它诞生于20世纪40年代英国精神分析学会内部的“论战”,并在规模以及精神分析理论和技术方面都取得重大发展。独立学派的精神分析师以开放和折衷的态度批判性地汲取各种现存的精神分析观点,形成不同于克莱因学派的客体关系思想,并表现出独立性、开放性、关系性和真实性的内涵与特征。温尼科特、费尔贝恩和巴林特是独立学派的主要代表人物,他们各自建构出独特的客体关系理论,促使精神分析范式从一元驱力模式转向二元客体关系模式,推动了客体关系理论的深入发展,奠定了后续精神分析发展的基石。     

医患关系与依恋模式

目前,关于如何建立有效的医患关系凸显重要,从参与合作式的医患模式着手,分析这一模式的双面性.运用依恋理论的观点,分别探讨了患者的四种依恋模式和就诊心理,以及不同依恋模式的医生和患者在就诊过程中形成互动医患关系,为进一步促使医患关系的和谐发展提供了理论基础和现实依据.     

五“观”客体关系理论

客体关系理论是当代精神分析的一个重要流派,涵盖很多富于独创性的思想。他首先实现了由弗洛伊德驱力模式向关系模式的转变,认为人行为的基本动机不在于驱力的满足而在于寻求与客体的关系。他也改变了传统精神分析的心理结构观,认为早期与客体的关系模式决定了个体的心理结构和精神表象。客体关系理论以分裂为基础,考察了客体与自体关系的改变过程,这一发展过程先后经历了母性分裂、想象分裂、自体分裂和认同分裂四个阶段。任何一个阶段形成的不良客体—自体关系,均会影响现实生活的人际关系。     

弗洛伊德心理学的神经生理学模式

将研究人类大脑的神经科学与研究人类心智的精神分析相结合的设想,源于精神分析心理学的创始人弗洛伊德,精神分析理论中一直隐含和贯穿着一种神经学或神经生理学的模式.弗洛伊德提出的这个神经学模式包括神经元和能量或数量两个元素,其工作原理是神经元的惯性原理.     

母婴关系:女性主义精神分析学和伦理学探讨

母婴关系是精神分析学与女性主义交叉的一个关键课题.对于这一问题的探讨不仅有助于说明个体人格、身份和道德意识的形成,也可以展示当代女性主义精神分析学的研究成果,因为在女性主义学者看来,母婴关系不仅是人性的最原初形式,也是任何社会、宗教和文化形成的关键.     

广义自身心理学人格发展理论述评

自身是人格的核心,其发展取决于个体遗传特征与自身对象环境的相互作用.如果自身对象人格健全,就能满足个体的自身对象需要,自身对象在满足个体自身对象需要方面不可避免的疏忽只会使个体遭受适度挫折,适度挫折促使个体通过变形性内化获得原来由自身对象为其行使的心理功能,从而形成自身结构.使自身--自身对象关系从原始走向成熟.广义自身心理学的人格发展理论超越了古典精神分析、自我心理学和对象关系理论的人格发展观,但过分强调早期自身对象关系对人格发展的决定作用,忽视个体遗传特征和社会文化因素对人格发展的影响.     

弗洛伊德的得意门生——亚伯拉罕和费伦茨对精神分析发展的贡献

亚伯拉罕和费伦茨都是弗洛伊德的早期弟子,他们在精神分析早期理论以及治疗技术的创新和发展中都有着重要的贡献。亚伯拉罕重新划分了弗洛伊德的心理性欲发展阶段并探讨了前俄狄浦斯期的母子关系,这都深深影响了后来的客体关系学派;费伦茨发展了弗洛伊德的性诱惑理论并在治疗技术上做出了许多革新,这为精神分析后来的发展开辟出了更广阔的道路。     

浅析主位推进模式在大学英语中的作用

主位结构的划分及主位推进模式分析是研究文章连贯性以及对文章进行结构分析的重要手段，因为主位结构是一篇文章的中心内容，主住的推进模式是一篇文章的观点论证发展的过程。本文选取的课文来自大学英语课本《大学体验英语》第一册，以其中第七单元的课文NotJustaJob，an Adventure：Undergraduate Research为分析对象，对文章中的主位结构及其推进模式进行分析。     

“淑女之争”与“君子协议”:回眸英国精神分析学会的“论战”

20世纪40年代,英国精神分析学会内部爆发一场影响全世界精神分析学发展的"战争"。以Anna Freud和Melanie Klein各自为首的精神分析师团体围绕潜意识幻想、本能与力比多以及精神分析培训与教学等一系列主题展开激烈争论,即历史上著名的"Freud-Klein论战"。这场"论战"就精神分析培训问题达成协议,并直接导致克莱因学派、维也纳学派和独立学派三"组"鼎立的英国精神分析时局。"论战"促使了客体关系精神分析与自我心理学的分离,推动了精神分析研究从驱力模式向关系模式的范式转变,奠定了后续精神分析运动发展的格局。     

精神分析理论的某些最新发展

精神分析理论发展到今天出现了明显的多元化倾向,本文简要介绍了目前这一领域中的几种主要理论观点和研究方向。自我心理学及自我/适应模型强调自我的适应机能,把病理性信念做为心理异常的关键;对象联系理论和人际关系模型强调个体与他人建立密切联系的需要及其动机特点;而经典精神分析的驱力/结构模型则注重欲望和恐惧对心理异常的作用。文中还对这种多元化倾向及其争论做了简短评述。     

Jamaican Family Structure: The Paradox of Normalcy

The relationship between basic research, theory, and clinical work with families is conceptualized during a discussion of Jamaican family structure and the application of change theory to a clinical case of depression in a Jamaican woman. It was found that three types of family structure are prevalent in Jamaica. The European ideal of a patriarchal-patrifocal structure creates problems for working-class Jamaicans. General system theory provides support for a different model. Change theory is applied to resolve the paradox created by the European model.     

An operations model of psychosocial structure and function and of psychotherapy

Currently, personality theory and clinical psychology have a fairly substantial tradition of promoting a strongly scientific basis for clinical work and theorizing. However, an appropriate foundation model has been difficult to identify and establish. A theory of human operations, here proposed, may provide such an elementary model. The theory is rooted in the organizational and industrial field known as operations, which is a highly systematic, precise, flexible, scientific approach to the understanding and management of human goal-seeking action in the broadest sense. The proposed model includes the classical humanistic, clinical, and decision theoretic notions of values, cognition, emotions, ego, behavior, objectives, outcomes, feedback, and defenses. These notions are placed within an overall operations frame of reference and developed in such a manner that they can be used to assess human clinical problems and to design therapeutic interventions. The strengths and limitations of the model are discussed.     

The suicidal mode: a cognitive-behavioral model of suicidality

This article discusses the theoretical foundation and potential clinical application of the suicidal mode, a cognitive behavioral theory of suicidality. The model presented represents a specific elaboration of Beck's modal theory of psychopathology. In addition to discussing the fundamental requirements of a theory of suicidality, the theoretical assumptions of the suicidal mode are identified, its component parts defined, its inherent strengths emphasized, and its application in clinical settings detailed. Definition of a modal theory of suicidality represents the growing influence of cognitive-behavioral theory in efforts at psychotherapeutic integration in clinical suicidology.     

Self-efficacy and reasoned action: Predicting oral health status and behaviour at one,three, and six month intervals

Abstract

This study tested the usefulness of the theory of reasoned action and the addition of self-efficacy to this model for the prediction of oral health behaviour as part of a larger intervention at the State University of New York at Buffalo School of Dental Medicine. Self-efficacy is a belief in one's ability to perform a particular behavior. The theory of reasoned action is an attitudinal model focused on predicting behavior. One hundred and sixty-six patients volunteered for an intervention and assessment program at the Oral Health Enhancement Clinic. Participants visited the clinic 7 times over a 14 month period. Relationships among social cognitive model variables and clinical and self-report outcome measures were examined at three different time points over increasingly longer time spans. Results indicated that the theory of reasoned action model was useful in predicting oral health behavior, and adding self-efficacy to the model significantly increased the reliability of predictions of outcome measures. Relationships for social cognitive variables were stronger for self-report than for clinical indices. Reasons for these differences are suggested.     

Discussion: Putting our Heads Together; Mentalizing Systems

This discussion reviews the psychoanalytic and developmental psychological theories that utilize nonlinear dynamic systems theory to situate Sperry's paper in its theoretical and historical context. The power of such nonlinear models for clinical work and theories of mind is argued. The essay then argues that the shift in theory entails a shift in ways of clinical writing and that the clinical discussion in the paper does not always feel consonant with the theory. Moving to a model of nonlinearity, intersubjectivity, and uncertainty is likely to entail shifts in conceptualizing and conveying clinical material.     

Multiple Personality Disorder and One Analyst's Paradigm Shift

Joseph Sandler elegantly integrated clinical experience and psychoanalytic theory in his three-box model. He unites topographical, structural, and object relations theory with the patient's experience of the lack of safety from humiliation and shame in the psychoanalytic relationship. In the three-box model, the danger of humiliation and shame is reduced by an affect of safety that is promoted by the analyst. By adding recent ideas about a developing self, I demonstrate the clinical usefulness of the three-box model.     

A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy.

Nonadherence in the management of chronic illness is a pervasive clinical challenge. Although researchers have identified multiple correlates of adherence, the field remains relatively atheoretical. The authors propose a cognitive-affective model of medication adherence based on social support theory and research. Structural equation modeling of longitudinal survey data from 136 mainly African American and Puerto Rican men and women with HIV/AIDS provided preliminary support for a modified model. Specifically, baseline data indicated social support was associated with less negative affect and greater spirituality, which, in turn, were associated with self-efficacy to adhere. Self-efficacy to adhere at baseline predicted self-reported adherence at 3 months, which predicted chart-extracted viral load at 6 months. The findings have relevance for theory building, intervention development, and clinical practice.     

Integrating Basic and Advanced Fieldwork With Academic Coursework

This paper presents a model for integrating academic and clinical learning in allied health. In this model (which is based on the TAR - teaching, application, reinforcement - approach) two levels of fieldwork are used: an introductory level which begins prior to and continues throughout a theory course, and an advanced level which follows successful completion of that course. Both levels are linked to the theory course through a series of workbooks, clinical exercises, and seminars. The introductory level fieldwork begins as a one-week full-time clinical placement, with structured activities focusing on the observation of five basic concepts. These concepts are then explored theoretically in the first part of the theory course, applied during the weekly continuation of the introductory fieldwork, and reinforced in a weekly seminar. Mastery of the five basic concepts provides a foundation for related advanced concepts presented in the latter part of the theory course, applied through specific assignments at the advanced level of fieldwork, and reinforced in a biweekly college seminar concurrent with the three-month fieldwork.     

A Brief History of Metacognitive Therapy: From Cognitive Science to Clinical Practice

Metacognitive therapy (MCT) is proving to be an effective treatment for anxiety and depression with effects that may exceed CBT. It has been described as a paradigm shift in psychotherapy in its theory-driven cognitive science approach and systematic development and evaluation. MCT was developed by Adrian Wells based on an information processing theory, the Self-Regulatory Executive Function model by Wells and Matthews. MCT theory formulates psychological disorders as sharing common causal factors under the influence of metacognition, representing a particular top-down model of biases in cognitive regulation. A key clinical implication was that a core set of interventions could be developed to impact a wide range of symptoms and disorders. In this paper, we trace the historical development of MCT and the major studies that informed theory and practice with the aim of introducing clinicians and researchers to this area and to understand why the metacognitive approach has developed into a treatment that is proving to be potentially more effective than current gold-standard treatments. In doing so, we will draw out the distinctive features of the approach and explore how this might offer a blueprint for scientific advancement in clinical psychology and psychotherapy.