Case history of Farida: A year of psychotherapy with a girl who said she was sexually abused

This paper discusses how thinking about a playroom involves our thinking about the setting in psychoanalytical work with children in general - the physical as well as the human aspects - and how this encourages us to rethink some of the basic aims in psychoanalytic work. The paper describes the importance of the setting being such as to help the therapist to have the freedom to think and to feel what is going on in the child and himself. Links are then made with aspects of transference and counter-transference, and brief examples given.     

Working Through Physical Disability in Psychoanalytic Psychotherapy With an Adolescent Boy

The narcissistic injury that may be caused by physical disability in infancy and the possible familial traumatization may block the integration of the infant's body and self-image, and can consequently hinder the child's identity formation. This article presents how an adolescent boy with cerebral palsy in short-term psychoanalytic psychotherapy works through the mental impact of his physical disability using a story. Transference and countertransference reactions are discussed. The positive impact of short-term psychoanalytic psychotherapy highlights the importance of caring for the mental health of children with physical impairments.     

The psychotherapy of parenthood: towards a formulation and valuation of concurrent work with parents

This paper explores the process and value of concurrent work with parents when their child is being treated in individual psychotherapy. The position taken is that psychoanalytic understanding generally and the specific formulations presented in this paper have a broader applicability in other aspects and approaches in child and adolescent mental health practice. The central issues are the interweaving of knowledge of family processes, child development and psychopathology, and the uses that can be made of an understanding of transference and countertransference. A particular formulation is presented in relation to aspects of the work that constitute ‘child guidance’ and those that may be considered as ‘psychotherapeutic’ in relation to parental psychopathology. We have coined the term ‘the psychotherapy of parenthood’ to give this work the status it deserves and to define a boundary within which to explore the areas and levels of this complex work. Some practice and training implications are considered.     

费尔贝恩人格客体关系理论的心理治疗观

英国精神分析学家费尔贝恩在修正与发展弗洛伊德和克莱因思想的基础之上,提出了一种纯粹的人格客体关系理论,他发展了一套修正的心理病理学思想。他认为,精神分裂是所有心理病理现象的基础;心理治疗的目标是要让病人从无意识中释放坏的客体和减少自我的分裂、达到人格的整合,而分析师与病人的关系则是心理治疗的中心。     

From scapegoating to thinking and finding a home: delivering therapeutic work in schools

This paper discusses how the child psychotherapist's core skills can be usefully applied in a school setting. It outlines some of the important policy changes that have necessitated a move towards delivering therapeutic work in community settings such as schools. It is argued that the role of the child psychotherapist in schools has much in common with the role played by the psychotherapist in a therapeutic community. The paper suggests that therapy in schools is in many ways less simple than therapy in clinic settings, and in particular it is often unclear who exactly the client is and at what level to intervene when a referral is made. The referred patient is not necessarily the ‘problem’, so that the child psychotherapist must be prepared to tackle issues in the system to ensure that splitting and projection are reduced, and systems around children can become more containing. Clinical vignettes and one main clinical illustration are used to try to illustrate these points.     

Doing cognitive neuroscience: a third way

The “top-down” and “bottom-up” approaches have been thought to exhaust the possibilities for doing cognitive neuroscience. We argue that neither approach is likely to succeed in providing a theory that enables us to understand how cognition is achieved in biological creatures like ourselves. We consider a promising third way of doing cognitive neuroscience, what might be called the “neural dynamic systems” approach, that construes cognitive neuroscience as an autonomous explanatory endeavor, aiming to characterize in its own terms the states and processes responsible for brain-based cognition. We sketch the basic motivation for the approach, describe a particular version of the approach, so-called ‘Dynamic Causal Modeling’ (DCM), and consider a concrete example of DCM. This third way, we argue, has the potential to avoid the problems that afflict the other two approaches.     

心理疗法在针灸治疗中的应用

随着疾病谱和死亡谱的改变,生物医学模式逐渐地不能满足医学发展的需要,取而代之的是生物心理社会医学模式。现代医学模式全方位探求影响人类健康与疾病的因果关系,认为生物学、心理学及社会学因素是人类致病共同的重要因素。针灸是中国传统医学同时也是西方辅助与替代医学的重要内容。针灸医护人员应大力宣传针灸知识,应用生物心理社会医学模式去对待每一位患者。本文试述心理疗法如支持性心理治疗、认知行为疗法、放松疗法在针灸临床的应用,展现针灸心身同治的诊疗特点。     

Family matters The descendants of Freud and Jung

A brief history of what it has meant to be a Jungian analyst and/or analytical psychologist in the United States and England is portrayed. At first the differences between psychoanalysis and analytical psychology were very great, and there was great animosity between the two schools. The conflict was much stronger in the United States than in England where Jungians developed a much better rapport with psychoanalysis. Recent theoretical developments within psychoanalysis, such as the development of self theory and intersubjectivity, as well as speaking about religious issues in a new way, have brought psychoanalysis closer to analytical psychology. On the other hand, analytical psychology has been enriched by an increased awareness of the importance of developmental issues and transference and countertransference. The implications for both psychoanalysis and analytical psychology are explored.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

Thalamic fear

This paper suggests that some neuroscience concepts particularly concerned with brain pathways in trauma and fear, as well as the neurobiology of emotion, provide an additional vertex to the psychoanalytic understanding of patients' material. The role of the body has been neglected in psychoanalytic thought and formulations in favour of purely ‘mental’ experience. The paper attempts to show how neuro-psychoanalytic understanding, which is conveyed to patients through interpretation, can increase their depth of understanding. Different types of memory are delineated and the paper describes a simplified schema of emotional processing, drawing on Damasio's distinction between emotion as an instinctual body based experience and its mental representation as feeling. Clinical examples are used to illustrate the usefulness of the distinction. The concept of emotional regulation is discussed as well as showing how its failure is associated with the appearance of persecutory superego structures.     

Thoughts and feelings and things: A new psychiatric epistemology

Epistemology — the study of knowledge — is a philosophical discipline with close ties to psychiatry. When epistemologists address specific questions about how knowledge is actually realized by human beings, their philosophy must be informed by empirical studies of the sort psychiatrists now take up in a variety of forms. As this paper describes, psychiatrists can likewise improve their understanding of human psychology through a deeper appreciation of philosophical analysis in epistemology.The aim of this article is to introduce a unifying framework within which the experience from different approaches to psychiatry — (1) the conceptual schemas of cognitive psychiatry, (2) the mental structures of psychoanalytic psychiatry, (3) the categorical forms of existential psychiatry, and (4) the neural pathways of biological psychiatry — can all be applied productively to the central question of epistemology. By establishing a broad understanding of the problem of knowledge, this new view of epistemology is developed within the idiom of each psychiatric approach. In addressing themselves to a unitary problem, these diverse psychiatric approaches are themselves revealed, not as competing points of view, but as complementary views of a single subject. The result is a new epistemology that can not only bring the insights of psychiatry to philosophy, but can also contribute to the care of patients when psychiatrists bring this broader view to their clinical work.     

Destructive and reparative transference in multiple levels of group psychotherapy

Group members are challenged to form psychologically meaningful relationships with therapists, other members, and the group as a whole. The way in which individuals perceive this challenge is based on their past experiences. Early relationships establish a perceptual frame in which fears of being hurt and concern about hurting others coexist. Balance between these two ways of generating meaning enables individuals to form relatively healthy relationships. Imbalance in this perceptual frame results in distorted perceptions and maladaptive patterns emerging as transference manifestations. Working through involves repeatedly addressing distortions as members relate to therapists, others and the group as a whole.