Shared Traumatic Reality and Boundary Theory: How Mental Health Professionals Cope With the Home/Work Conflict During Continuous Security Threats

ABSTRACT

In a shared traumatic reality, mental health professionals and their clients are exposed to the same communal disaster. Both living and working in the same high-stress community can create a conflict between the professional's work and his or her private life. The author analyzed three focus groups consisting of 30 mental health professionals who worked with traumatized populations in a missile-stricken area in southern Israel. The professionals’ experience was explored through the lens of boundary theory by examining the ways in which they created and maintained boundaries between the different domains of their lives. Findings demonstrated that these professionals presented a continuum of segmentation and integration of the domains as suggested by boundary theory, when both living and working in a highly stressed environment. The discussion deals with possible costs and benefits of the boundary theory continuum.     

群体共享情绪的放大效应

相比独自经历情绪事件,在群体中与他人共享情绪事件会放大个体的情绪体验,该效应被称之为群体共享情绪的放大效应。以往研究为群体共享情绪放大效应提供了部分间接的实验证据,但以往的理论,如群体共同关注理论和情绪传染理论,并不能对该效应做出很好的解释。基于社会评估理论和共享现实理论提出的评估–证实–放大模型可较好地解释群体共享情绪的放大效应。未来研究可在真实互动的群体情境中检验群体共享情绪放大效应及评估–证实–放大模型。     

The analyst's implicit alpha-function, trauma and enactment in the analysis of borderline patients

The present paper discusses situations in which patient and analyst are involved in obstructive collusions, non-dreams-for-two, shaping enactments. Specifically, it describes explosions in the analytical field, acute enactments, which the analyst assigns, at first sight, to his faulty conduct. The subsequent amplification of the analytical dyad's capacity of symbolization makes the analyst investigate his presumed fault. The present work shows how acute enactments revive traumatic situations that were concealed by previous obstructive collusions, or chronic enactments. During chronic enactments unconscious exchanges occur between the dyad, in which the analyst provides implicit alpha-function to the patient, little by little recovering the traumatized parts. When there is enough recovery, the protective collusion is undone and the trauma is revived as acute enactment. This revival will not be traumatic because there are mental resources ready at hand to symbolize it. These situations are articulated with borderline patients. The patient clings to the analyst, using him as a protective shield against reality traumas. The implicit and explicit alpha-function exerted by the analyst contributes to the processing and symbolization of this reality, recovering the injured mind and elaborating the trauma. So the patient creates a triangular space to dream and think.     

U.S. ethnic minorities' attitudes towards Whites: The role of shared reality theory in intergroup relations

In the current research, we suggest that shared reality, the belief that one perceives the world the same way as another group, can predict attitudes towards that group. We tested shared reality theory in the context of American ethnic minority groups' (i.e., African Americans, Asian Americans, and Latinas/os) attitudes towards White Americans. In surveys of two samples recruited from different geographical locations in the USA, we tested predictions derived from different theories of intergroup relations. Using mediational analysis, we defined models to assess the extent to which shared reality theory predicted—directly and indirectly—prejudicial attitudes towards Whites. We tested the model derived from shared reality theory against other theoretical alternatives. Taken together, the results of the research indicated that shared reality predicts attitudes towards White Americans among these three ethnic groups. Thus, shared reality is a relevant, though largely overlooked, factor in intergroup dynamics.     

The use of virtual reality in the study, assessment, and treatment of body image in eating disorders and nonclinical samples: a review of the literature

This article reviews research into the use of virtual reality in the study, assessment, and treatment of body image disturbances in eating disorders and nonclinical samples. During the last decade, virtual reality has emerged as a technology that is especially suitable not only for the assessment of body image disturbances but also for its treatment. Indeed, several virtual environment-based software systems have been developed for this purpose. Furthermore, virtual reality seems to be a good alternative to guided imagery and in vivo exposure, and is therefore very useful for studies that require exposure to life-like situations but which are difficult to conduct in the real world. Nevertheless, review highlights the lack of published controlled studies and the presence of methodological drawbacks that should be considered in future studies. This article also discusses the implications of the results obtained and proposes directions for future research.     

Trauma and traumatic neurosis: Freud's concepts revisited

The authors examine Freud 's concepts of 'trauma', 'protective shield against stimuli ' and 'traumatic neurosis' in the light of recent findings. 'Protective shield against stimuli' is regarded as a biological concept which appears in mental life as the striving to avoid unpleasant affects. 'Trauma' is a twofold concept in that it relates to mental experience and links an external event with the specific after-effects on an individual 's psychic reality. A distinction needs to be made between mentally destructive trauma and affective trauma. A destructive trauma does not break through the protective shield but does breach the pleasure-unpleasure principle, so that in the course of its subsequent mastery it leads to a traumatic neurosis. An affective trauma can be warded off under the rule of the pleasure-unpleasure principle and leads to a psychoneurosis.     

Betingad avslappning vid migrän

Some psychotherapists believe that certain experiences are so overwhelmingly traumatic that some victims become incapable of remembering their worst trauma except under special circumstances (e.g. therapy) many years later. Unfortunately, clinicians who endorse this concept of traumatic amnesia often misinterpret the very studies they adduce in support of it. More specifically, they misinterpret other, unrelated memory phenomena as evidence for traumatic amnesia, such as ordinary forgetfulness, psychogenic amnesia, organic amnesia, incomplete encoding of traumatic experiences, non‐disclosure of remembered trauma, and simply not thinking about something for a long time. The purpose of this article is to dispel confusions rampant in this literature.     

Positive and negative intergroup contact and shared reality: Contact effects among host society and refugees

Two cross-sectional studies examined the relationship between positive and negative intergroup contact and shared reality from a majority and a minority group perspective and indirect effects via two types of intergroup threat (threat to identity for the majority, discrimination fear for the minority) and differential closeness. Research was conducted in the context of German–Syrian relations to contrast contact effects on shared reality among German host society members and Syrian refugees. Study 1 revealed unique and asymmetrical effects of valenced contact on shared reality and indirect effects via threat to identity and differential closeness (N = 226). In Study 2, positive contact among Syrian refugees (N = 121) increased shared reality via differential closeness. Negative contact showed no relation to shared reality, but mediation analyses indicated an indirect effect via discrimination fear. Differences between majority and minority contact effects on shared reality are discussed along with the studies’ limitations and implications.     

The analyst's narrative function: Inventing a possibility

This article describes a psychic function common to analysts that was gradually revealed through clinical work with children. It is a psychic quality derived from function α, which involves analysts’ capacity for reverie – their narrative function. The author presents two clinical situations where this function developed in the analytic field in relation to patients’ difficulty in symbolizing. In the first case there was an early traumatic experience unavailable for representation. The analyst lent the patient her ability to represent and produced a narrative that made it possible to create a world of phantasies and transform nightmares into ‘dreamable’ dreams. In other words, she removed the quality of unbearable, irrepresentable reality that characterized those raw experiences encrypted in the psyche. In the second case the analyst's narrative function sought to connect with the isolation, the shell that housed a child suffering from an autistic disorder whose ability to represent had not been established. The analyst provided meaning for the patient's repetitive, stereotyped play, thus weaving the child's subjectivity and gradually introducing a notion of alterity. The author seeks to show how this function, in the thematic construction of the session, facilitated both the working‐through of a traumatic situation (with the ability to share representations) and the constitution of the psychic fabric.     

Trauma Competency: An Active Ingredients Approach to Treating Posttraumatic Stress Disorder

Meta‐analytic studies have extracted 4 common elements among effective posttraumatic stress disorder treatments: cognitive restructuring and psychoeducation, a deliberate and continually improving therapeutic relationship, relaxation and self‐regulation, and exposure via narrative of traumatic experiences. The authors present a clinical treatment structure catalyzing these active ingredients into discrete therapeutic tasks that counselors can focus on to maximize treatment effectiveness. The 4 tasks represent an attempt to identify critical competencies and baseline standards for the field of trauma counseling.     

虚拟现实暴露疗法在社交焦虑中的应用:效果、机制及展望

由于传统干预方法的诸多局限,虚拟现实暴露疗法(virtual reality exposure therapy,VRET)逐渐应用于对社交焦虑的干预,VRET是将虚拟现实技术与传统行为暴露治疗相结合而形成的一种新的干预方法。文章总结了VRET的三个发展阶段及其研究范式,述评了在VRET过程中的作用机制。未来研究可致力于设计更加自然的人机交互技术,实现技术与社交焦虑治疗的深度融合以及关注第三人称视角应用的作用及机制。     

Reflections on trauma,symbolization and psychic pain in a case of neurosis and a case of psychosis

This paper seeks to advance some considerations on trauma, historical reality, its symbolization and the psychic pain generated by the investigation of unconscious processes in psychoanalytic treatment. These themes will be explored by demonstrating the differences arising between traumatic experiences and their expression in phantasy, as they occurred in a case of neurosis and another of psychosis. In each case, the differences in the features of the symbolization and the processes of working through shall also be taken into consideration. Particular attention shall be paid to the specific difficulties encountered by the analyst in the interpretative treatment of the trauma resulting from the amount of psychic pain induced in the patient, which at times proves to be an insurmountable barrier and a destructive distortion of the process.     

Anxiety Sensitivity Taxonicity: a Concurrent Test of Cognitive Vulnerability for Post‐Traumatic Stress Symptomatology Among Young Adults

This study evaluated the anxiety sensitivity taxon using the 16‐item Anxiety Sensitivity Index in relation to 2 criteria relevant to post‐traumatic stress disorder; post‐traumatic stress disorder symptom severity as indexed by the Post‐Traumatic Diagnostic Scale, and post‐traumatic cognitions as indexed by the Post‐Traumatic Cognitions Inventory. Taxometric analyses of data collected from 331 young adults indicated that the latent structure of anxiety sensitivity was taxonic with an estimated base‐rate range of 11–12%. As predicted, an 8‐item Anxiety Sensitivity Index Taxon Scale accounted for significant variance above and beyond that accounted for by negative affectivity and the full‐scale Anxiety Sensitivity Index total score in terms of both criteria. Moreover, after accounting for variance explained by the full‐scale Anxiety Sensitivity Index total score and negative affectivity, the sum score for the 8 Anxiety Sensitivity Index items not included in the Anxiety Sensitivity Index Taxon Scale was associated with significant variance in these same dependent measures, but the relation was in the opposite direction to that predicted by theory. These findings are discussed in terms of theoretical and clinical implications for the study of anxiety sensitivity and post‐traumatic stress disorder vulnerability.     

The language of absence

This paper will focus on the concept of 'absence', which describes a continuum of non-responsiveness and misattunement of the environment in the stage of absolute dependence; it refers to concepts like lack, failure, non-recognition, impingement, neglect, tantalizing, ranging to mental, physical and sexual abuse. An extreme external absence causes shock and fear. The automatic survival response is an inner absence, an intrapsychic absence, a dissociation of parts of the self. The external and the inner absence are the negative image of each other. The concept of absence points to the synchronicity of outer and inner reality and portrays the non-responded-to needs of the self. This point of view of the development of psychopathology of the self on the basis of massive dissociation is inherently an intersubjective-field-theory. As the inner absence is created as a reaction to an absence of the other, in analysis - the analyst has an active role in reviving it. This paper will explore the language of absence, that is, the derivatives and consequences of these situations in the inner realm, and in the relations with the analyst. It is the author's contention that understanding and speaking this language has important clinical and technical implications. Understanding the language of absence enables the analyst to recognize its intersubjective and its intrapsychic presence, to provide an environment that allows for its revival, and to facilitate and regulate the annihilation anxiety that awakens when dissociated self-states are experienced. When the absence is present, i.e. when the traumatic experience and the dissociated reactions to it are experienced in an attuned relationship, it is rendered with meaning, symbolization, and validation, and enables the survival mode of dissociation to be relinquished.     

The day the earth stood still: The presence of trauma in time experience

The experience of time is commonly perceived as developing within the context of the early relationship between mother and infant. The beginning of life occurs in an adapted environment, aimed to protect the child from internal and external disruptions. Through healthy development, the mind acquires a feeling of continuity that gradually becomes a cohesive sense of personal identity. However, in cases of traumatic interruptions to the primary environment, the defensive shield of the self is penetrated and the individual becomes prematurely aware and adapted to the external reality. This forced acknowledgement of time and reality could be manifested in various types of time disturbances, such as disorientation about time or difficulties in following a schedule. In therapeutic relationships, this drama would be enacted in a struggle against the psychoanalytic setting, which disrupts the continuity of being with the therapist. Importantly, these patients express a deep conscious or unconscious fantasy to live in a timeless world, in which they would not be forced to adapt themselves to others’ expectations or needs. Clinical examples are used to illustrate how traumatic history is evident in the patient’s time experience and in the psychoanalytic dialogue.     

Creating shared reality in interpersonal and intergroup communication: the role of epistemic processes and their interplay

We describe research on the creation of shared reality in communication, emphasizing the epistemic processes that allow communicators to achieve confident judgements and evaluations about a communication topic. We distinguish three epistemic inputs: (1) the communicator’s own judgement about the topic (judgement of communicator); (2) the communicator’s perception of the audience’s judgement about the topic (judgement of audience); and (3) the communicator’s message to the audience about the topic (message of communicator). We argue that the influence of each input increases with the communicator’s confidence in the validity of that input. We review a variety of empirical studies in terms of this framework. We also address barriers to shared-reality creation in intergroup communication and describe interventions that work by increasing the validity strength of judgement of an outgroup audience. We discuss the relation between the present research and other approaches to social influence and social sharing.     

The generalization of shared reality: When communication about one target shapes evaluations of other targets

Communicators often tune their message about a target to the audience's attitude toward that target. This tuning can shape a communicator's own evaluation of the target, which reflects the creation of a shared reality with the audience. So far, evidence for shared‐reality creation has been confined to one specific target. In two experiments, we examined whether and when a shared reality would generalize to other targets. In Experiment 1, shared‐reality creation about an ambiguous sexist target generalized to the evaluation of a new ambiguous sexist target for which no audience attitude was provided. However, this happened only when there was high (vs. low) commonality with the audience regarding previous judgments. In Experiment 2, we investigated conditions for the temporal persistence of generalization. One week after message tuning to a high‐commonality audience, a shared reality generalized to a new ambiguous sexist target when participants recalled the shared‐reality creation about the initial target, but it did not generalize in conditions without such recall. Also, no generalization occurred for non‐ambiguous or non‐sexist targets. Results suggest that shared reality generalization depends on perceived commonality with the audience, recollection of shared reality at time of judgment, and similarity between new and initial targets.     

The unwelcome child and his dreams: reconceptualization of dreaming in trauma

Based on the concepts of Sándor Ferenczi on trauma and vincularity, the author examines the operation of the mechanisms of dreaming in the processing of early traumatic situations and their clinical utilization. The difference is established between dreams of “repetition”, which lack dream imagery and contain a great amount of anguish, consisting of bodily sensations which may last on awakening, and the “secondary dream” with imagery, into which the first type can be transformed when the capacity of the psychic apparatus to process the traumatic situation is increased through therapeutic work. This “secondarization” of the repetitive dream has a traumatolytic effect, allowing the patient to reach psychoanalytically the mechanisms and mental states prevailing in the traumatic situation, through the mechanism of dream autorepresentation described by Silberer. In some cases, as illustrated in the clinical material, it is possible to anticipate the event of episodes of somatic disease before they become clinically evident.?The detailed analysis of dreams in patients with these characteristics is presented and discussed.     

The concept of psychical trauma: A bridge in interdisciplinary space1

The concept of trauma currently occupies a central position in interdisciplinary dialogue. Using the concept of psychical trauma as a bridge, the author attempts an interdisciplinary dialogue with psychiatry, biology and neuroscience. Beginning with the concept of psychical trauma in Freud, the author reviews the evolution of Freud's thinking, and links it with the ideas of Ferenczi and post‐Freudian psychoanalytical authors. From a different framework, he considers the present state of research on post‐traumatic stress disorder in current psychiatric nosography and attempts an interdisciplinary approximation to the concept of psychical trauma. Interesting ideas like the traumatic situation, trauma spectrum and psychopathological spectrum emerge, which enable a better understanding of the concept of psychical trauma through its relatedness, as a bridge connecting a broad psychopathological range extending from normality to psychosis. The ensuing possible relative loss of nosographical rigour is more than compensated by the resulting increased understanding and enlarged therapeutic possibilities. In the second part of the paper, the author attempts a dialogue with neuroscience, taking into account new advances in current research on emotion and memory, and making them compatible with the psychoanalytical concept of trauma. In this sense, the paper underlines the importance of emotion and crucially of memory, regarded as a fundamental axis of the subject explored in this paper. Here a substantial distinction which is pertinent for analytical work appears: declarative memories versus non‐declarative or procedural memories. In a concluding discussion the author argues that, taking into account the implications of these current notions regarding a number of theoretical and technical aspects, psychoanalysis currently holds a privileged position, both in its potential for prevention and regarding the treatment of patients, in so far as, through interdisciplinary dialogue, psychoanalysis can be receptive to and be enriched by the contributions of other disciplines, just as it enriches them with its own contributions.