Cultural and integrative therapy issues in the treatment of a Jamaican woman with panic disorder.

This article examines the treatment of a Jamaican woman with panic disorder, with a specific focus on the role of culture and the use of multiple formulations of the clinical problem. The work suggests that complex decisions are sometimes called for in assessing whether treatment should advocate against a cultural norm of the clients. The work further suggests that conceptualization of the problem from the vantage point of multiple frameworks is warranted in some instances, but that it requires considerable thought in order to achieve an integrated, coherent treatment plan.     

A transitory homosexual passion in the course of an analytic treatment1

Do homosexualities express a sexual confl ict originating in bisexuality or must we look for their deep determinism in the narcissistic confl ict and its vicissitudes? Two clinical sequences from the treatment of a borderline patient, which occurred during years seven and eight of treatment, a period characterised by intense drive turbulence and the unexpected occurrence of a transitory homosexual passion, will enable the reader to follow the psychical movements and evolution of the work of representation. The fi rst sequence throws light on the links between her sudden involvement in this homosexual passion and the traumatic dangers of a breakdown of her ego's capacity for representation, linked to a reactivation in the transference of early and later traumatic traces whose reverberation in the transfero/countertransference dynamic was the source of a painful transference that was responsible for this lateral transference movement. The second sequence shows the links between the strengthening of her capacity for representation, thanks to the working through of the oedipal confl ict in its two aspects, and her renunciation of this passion. The roots of this transitory homosexual passion in the deep fl aws of her psychical functioning raise metapsychological questions concerning, in particular, the dynamic of the ‘double’(‘twin’) and narcissism.     

Impulsivity predicts treatment outcome in obese children

Treatment for obesity is still running short, particularly on the long term. However, some people do take advantage of treatments and are able to retain their weight loss. What makes the difference between those who can keep their weight loss and those who cannot? One possible predictor of relapse in obesity treatment is impulsivity. Overall, obese people are found to be more impulsive than lean people, especially obese binge eaters. Intuitively, it would make sense that the most impulsive people are less able to keep control over eating behaviour. Therefore, impulsivity could serve as an obstacle for treatment. In the present study impulsivity was measured with a behavioural task (the stop signal task) in 26 obese children. Overweight of the children was measured before and after treatment and at 6 and 12 months follow ups. The results show that impulsivity was related to overweight at all moments: The most impulsive children were the most overweight ones; even after 12 months. Moreover, impulsivity predicted therapy success: the most impulsive children lost less weight. Impulsivity appears to contribute to the difference between succeeding or failing in attempts to lose weight.     

Resistance,counterresistance, and balance: A framework for managing the experience of impasse in psychotherapy

Client resistance in psychotherapy although a healthy, expected and necessary phenomenon, may lead to an impasse when left unmanaged. Resistance takes numerous forms and occurs under many circumstances, but always for the purpose of client protection against the threat of change. Defensiveness and client rigidity lessen when the therapists provides a psychologically safe framework. The degree of client resistance varies in proportion to perceived danger and must be therapeutically confronted so as to enable the client to achieve flexible defensiveness and balance.     

Functional analytic psychotherapy and the treatment of obsessive compulsive disorder

This paper argues that Functional Analytic Psychotherapy (FAP) can contribute to the treatment of Obsessive Compulsive Disorder (OCD). FAP is a behavior analytically informed approach to talk-therapy, developed by Kohlenberg and Tsai. It uses natural occurrences of clinically relevant behavior in the client-therapist relationship to promote therapeutic change. A selection of vignettes of client-therapist dialogues involving two clients with OCD is discussed. The examples show how natural interactions between therapist and client can be used to bring therapeutic technique closer to the natural occurrences of obsessive-compulsive behavior. Furthermore, the fragments illustrate that FAP can encompass exposure and response prevention. Therefore, the in vivo learning during the session as promoted in FAP can be an asset in the treatment of clients with OCD, and it deserves attention in future treatment research.     

The analytic group: A multifaceted approach to the treatment of adolescents

During adolescence the peer group plays a major role in facilitating developmental processes, since it not only serves as a replacement for childhood love-objects and attachments, but offers the adolescent allies in the struggle to separate and become emancipated from parents. For those adolescents who, because of interpersonal and intrapsychic difficulties, have no peer group or have chosen an inappropriate peer group, providing a therapeutic group can make it possible for development to proceed. This paper presents not only a theoretical basis for the utilization of groups of peers in the treatment of adolescents, but also an elaboration on the dynamic processes which make possible improvement of ego-functioning and resolution of core conflicts related to the past, as well as to this particular developmental phase.     

Retrospective treatment of incest victims: suggested analytic attitudes.

This paper includes a brief consideration of literature relevant to childhood sexual abuse detection and prevalence. That literature indicates that such detection may be difficult and that the occurrence of childhood sexual abuse is widespread. These findings, as well as a consideration of literature relevant to trauma, stress, and the identification of survivors of sexual abuse, suggest an analytic attitude of receptivity to the hypothesis of the event of sexual abuse as well as the fantasy of sexual abuse. A second analytic attitude suggested concerns diagnosis. Childhood trauma is implicated in the development of BPD, as the majority of borderline patients have experienced the trauma of child abuse. Further, trauma can lead to dissociation as a defense against stress, and multiple personality disorder is an extreme example of dissociation. The analytic attitude suggested here is that the diagnosis of BPD or MPD may be a necessary but not a sufficient explanation when the symptomatology is a defensive reaction to the traumatic event of childhood sexual abuse. Lastly, it is suggested that the abuse may need to be central to the treatment in analytic work with sexually abused victims. This is suggested in light of the importance of recovery and integration of traumatic memories with their associated affects.     

Psychoanalytic treatment of a woman with anxiety attacks and conversion

This case study describes the psychoanalytic treatment of a young woman presenting with symptoms of overwhelming anxiety, panic, and conversion. The emphasis is on technique with detailed reporting on the psychoanalytic process. Attention is paid to transference-countertransference paradigms at critical junctures in the treatment. The role of clinical supervision in the unfolding of the process is described also. This patient developed an identifiable transference neurosis during the course of the treatment, which became the focus of the analysis. Follow-up observations on this patient are also presented, as she returned for a brief course of treatment 4 years following initial termination.     

Silent dialogues in the analytic relationship

Abstract

In borderline or even narcissistic patients, the relation to the objects is built on the basis of omnipotent control, so that those patients present difficulties related to mourning for the loss, as well as for the independence, of the objects. Their basic trait is a huge inability to recognize the separateness of others, together with an excessive use of primitive defense mechanisms, such as projective identification. Each experience that contains the danger of re-experiencing the primal separation poses an attack on the analytic setting, in order to avoid such a re-experiencing. Those attacks sometimes take the known form of acting out, whereas other times they are limited to a special use of speech, which lacks any communicational faculty and is used rather as a weapon. This special climate affects the analyst, causing specific countertransferential reactions. Nowadays, we tend to consider such a communication not mostly as an obstacle, but rather as an opportunity, allowing the analyst to comprehend the patient, through his countertransference, and create a meaning to replace the void those patients usually experience. The transference and countertransference enactments, their silent dialogues taking place in the analytic setting, are those which progressively give meaning in this primitive non verbal communication.