A developmental approach to treating dual-career couples

Abstract

While skills development may help some dual-career couples, for others such methods may result in feelings of frustration until certain developmental difficulties are resolved. This article: 1) addresses some problem areas that dual-career couples encounter; 2) reviews proposed solutions for these problems; 3) specifies the necessary personal requirements for mastering these solutions; and 4) suggests some of the unresolved developmental conflicts that can interfere with such mastery. The list of conflicts, proposed solutions, and typical impeding developmental difficulties is not meant to be exhaustive. Rather, this article is intended to convey a way of conceptualizing “problems surrounding problem solving” for dual-career couples.     

Dual-career Couples: The Selection Dilemma in International Relocation

No one factor could have as great an impact on multinational corporations (MNCs) than the dual-career phenomena. The selection of expatriate candidates is a complex process made more arduous by the career orientation of the expatriate's spouse. The need for a social support network is essential for the dual-career family to increase the probability of successfully completing an expatriate assignment.     

Happiness in dual-career couples: Changing research,changing values

This article offers a framework for understanding contradictory findings in the field of the dual-career couple by presenting two patterns: (1) the early, conventional one of the 1960s, which viewed married women's participation in the labor force as threatening marriage and the family, and (2) the contemporary view, which emerged during the 1970s and which admits that women can happily combine career with family. The article suggests that there is little evidence to support the view that dual-career couples experience increased rate of marital conflict, marital dissatisfaction, and role blur; rather, the intellectual and psychological benefits in dual-career couples seem to outweigh the disadvantages, particularly for wives.     

The parables of a green-eyed monster: Two tales about envy

Abstract

This paper describes how the dynamics of envy infiltrate interactions if envy is not contained. An interactive model of a 'giver' and 'recipient' is presented as a way of looking at envy and is applied to a clinical and organizational example. An analysis is made in terms of utilizing symbiosis defensively in order to avoid coming to grips with envy.     

The Therapeutic Alliance in Multicultural Practice

Abstract

The therapeutic relationship rests on both an emotional bond with the therapist and a rational, “working” connection. Both dimensions of the alliance have relevance for multicultural clinical work. There have been many contributions to multicultural practice that emphasize either cognitive or emotional levels of the alliance. This paper uses both empirical studies and clinical papers to synthesize both the emotional and the rational perspectives on the multicultural alliance. Examples are drawn from literature, published case examples, and the author's own clinical practice.     

Clinical Relevance of Social Character and Social Unconscious

The author discusses his recollection of Erich Fromm's views on psychoanalytic work with patients, including the author's treatment of a patient. The remembrance involves Fromm's clinical thinking on social character and the social unconscious, and its relevance to present-day clinical work. The author presents, in detail, his treatment of a 37-year old successful woman which addresses certain of today's clinical views on gender differences that resonate and differ with Fromm's thinking on the treatment of the marketing personality.     

A Comment on teurnell's “the piggle—a sexually abused girl?”

Abstract

In his comment on Teurnell's paper “The Piggle—a sexually abused girl?” the author points to the risk of organizing a complicated clinical material around one single idea and briefly describes other ways of understanding the material in Winnicott's book. To the author's mind, the richness and depth of the material and the subtleness and aesthetics of the interplay between Winnicott and the Piggle, in Teurnell's way of reading, collapse into one single question: the possibility of a sexual trauma. At the end of the comment the role of the Piggle's father is shortly discussed.     

Time Limited Treatment and C. G. Jung's Analytical Psychology

Abstract

The work of C. G. Jung has been largely neglected in recent discussions of time-limited psychotherapy. Notwithstanding this state of affairs, this paper argues that much is to be gained from familiarity with Jung's view on treatment. A brief overview of Jung's general system of psychology is presented, and contrasts are drawn to the work of Freud. Several distinctive characteristics of Jung's view of the clinical process are then identified, and a discussion of the course of treatment is provided with a brief reference to a case of Jung's and to the author's experience working with gay men.     

Clinical Flexibility in the Psychoanalytic Situation: The Elasticity Principle

Abstract

This paper explores the development of the Elasticity Principle, first introduced by Ferenczi based upon his clinical observations. This important shift away from classical neutrality was inspired by Ferenczi's human approach to psychoanalysis. Learning from his analysands, he not only determined that in order to reduce resistances the analyst should present any interpretations in a tactful, empathetic manner, but also that the analytic work should bend or yield toward the analysand. The paper traces the evolution of the Elasticity Principle to The Grand Experiment, which was Ferenczi's analysis of Elizabeth Severn utilizing provision as an analytic tool. The paper follows the contemporary extensions of the Elasticity Principle in the development of Self Psychology and in the Relational perspective. A clinical example illuminates aspects of the Elasticity Principle in the work with a difficult analysand.     

Conjoint Couple's Treatment for Intimate Partner Violence

Abstract

Despite lingering concerns in the field about the wisdom of seeing couples conjointly when there has been Intimate Partner Violence (IPV), the research literature and clinical practice experience both indicate that this approach can be safe and effective for at least some couples. In this paper, we briefly review the existing outcome research on Couple's treatment for IPV and then suggest best clinical practices for this work. Best practices, in our view, include seeing Couple's treatment of IPV as a clinical specialty necessitating specific training, working as part of a coordinated community response to IPV, modification of the structure of therapy to increase safety, as well as careful screening of couples and on-going assessment of the propriety of conjoint treatment.     

Androgyny,stress, and satisfaction: Dual- career and traditional relationships

Forty-one female and 61 male assistant professors, of whom 46% were involved in dual-career relationships, responded to a mail questionnaire that assessed (1) androgyny; (2) satisfaction at work, home, and in their personal life; (3) stress at work, home, and in their personal life. A 2×2×2 analysis of variance was conducted to evaluate the effects of relationship status, androgyny, and sex of subject. The results indicated that being androgynous was associated with increased work stress, but simultaneously increased personal satisfaction. A significant interaction between androgyny and relationship status demonstrated that androgynous dual-career persons reported highest personal satisfaction; androgynous nondual-career persons reported highest work satisfaction. Dualcareer status increased personal and work stress, as well as relationship satisfaction. The importance of considering each person's specific life situation when evaluating androgyny as a positive or negative attribute is discussed.     

Religious issues in diagnosis: The V-Code and beyond

This paper addresses the issues around considering clients' religious and spiritual functioning as a matter of client diversity. Such issues may be under appreciated by many clinicians. The introduction of a religious and spiritual problem V-Code (V62.89) into the DSM-IV provided a significant accommodation of client religious and spiritual functioning in contemporary psychodiagnostics. The V-Code allows for explicit identification of a non-pathological religious or spiritual focus in treatment. The nature of and history of the V-Code's inclusion in DSM-IV is briefly reviewed. The strengths and limitations of the V-Code for raising clinician awareness of the religious and spiritual domain of client functioning is discussed and illustrated by a number of case examples. The V-Code approach is contrasted with Hathaway's (2003) clinically significant religious impairment concept. Both are viewed as making complementary contributions to a religiously and spiritually sensitive clinical practice.     

Love and death in the transference: The case of the Hungarian poet Attila József

SUMMARY

This paper gives an account of working as psychoanalytic psychotherapist in a GPs' surgery from a base within a local Psychotherapy Department. Particular attention is paid to how the GPs regard the therapist's work, as evidenced by their referrals and other contact with the therapist. An evolving relationship between the therapist and the GPs is described, and material from clinical work and meetings with the GPs is used to illustrate this. The idea of ‘Practice as patient’ is introduced as a model whereby the therapist considers how most usefully to engage with the GPs, and how this can enhance the understanding of the clinical task.     

The Pathway Toward Clinical Self Confidence

This study was designed to determine the most common pathway toward the development of clinical self-confidence for therapists during the first year of client contact. Telephone interviews were conducted with 39 recent graduates of a master's level marriage and family therapy program. Subjects were asked to graph their development of clinical self-confidence over the first 12 months of their clinical experience. Results reveal a three-stage model of therapist development. The implications for training within each stage of development are identified with an emphasis on the role of the supervisor.     

Clinical Supervision and Professional Development Using Clients from Literature,Popular Fiction,and Entertainment Media

Abstract

The use of clinical supervision is central to mental health work. In this article, the authors propose using practice cases drawn from characters found in literature, popular fiction, biographies, television, and movies as one method for clinical supervision and professional development in the mental health skill areas of client assessment, case conceptualization, diagnosis, and treatment planning. The method is illustrated with clinical formulations pertaining to four practice clients: Scarlett O'Hara; Maya Angelou's Marguerite Johnson; the fairytale character, Hansel; and the Wicked Queen of Disney's Snow White and the Seven Dwarfs. Applications and limitations of the method are discussed.     

Can Psychoanalysis Become Empirically Supported?

The article discusses the application of the ideas of evidence-based medicine or empirically supported treatment to the field of psychoanalysis. The author argues that empirical support is gradual rather than categorical, and that the randomized clinical trial (RCT), which is commonly heralded as the appropriate method of support, confounds patient suitability factors with treatment 'as such'. As a consequence of the exclusive reliance on the RCT, empirical validation of psychological treatments has generally favoured cognitive-behavioural treatments, although there is ample evidence - albeit non-RCT - for the beneficial effects of short-term and long-term psychoanalytic treatment. The author argues for a suitability matching approach to empirical validation, where each treatment is tested, as powerfully as feasible, on samples based on selfselection (patient's choice, clinical assignment, suitability judgments etc.). The paper concludes by referring to two recent studies, indicating that there is reason to evaluate alleged empirical support with caution.     

Starting from scratch: Developing clinical psychology training and services in Bangladesh

Abstract

This paper outlines the author's personal experience of contributing to the development of the first ever training in clinical psychology in Bangladesh. This was part of a link project between University College London and Dhaka University. It examines the challenges posed by such an enterprise through the author's experience of teaching and assessing patients in the local psychiatric wards. It questions the validity of exporting Western models of psychotherapy – psychoanalysis in particular – to a non-Western culture.     

Trauma and deprivation: The relationship between early object relations and the constitution of a sense of self

Abstract

The paper analyzes the relationship between deprivation and trauma, based on a clinical vignette of a male child, born to a psychotic mother and adopted by a foreign couple when he was seven years old. Based on the importance of maternal care and of a holding environment for the constitution of a sense of self during infancy and childhood, this paper will discuss the factors that facilitated this child's capability to form emotional ties and to constitute a psychical reality even when faced with a very precarious life situation and maternal loss.     

Interpretive acting-out: Unavoidable and sometimes useful

Abstract

Using one detailed case presentation, this paper examines the clinical hardship of making accurate and helpful interpretations that do not become part of the patient's defensive system. The author argues that interpretive acting-out is inevitable in the psychoanalytic process. But, if properly monitored, understood, and contained, these interpretive enactments can sometimes actually be a profit to the overall treatment. Issues of projective identification, countertransference, and the importance of realizing our transference role in the patient's changing phantasies are discussed throughout the case material.     

Pertinence clinique en population dépressive d’un médiateur thérapeutique axé sur les ressources personnelles : évaluation par protocole individuel de type arrêt—reprise sur une patiente hospitalisée pour dépression

IntroductionThe low to moderate benefit of current care on optimal functioning in depressed patient encourages the development and evaluation of new interventions in this area.ObjectiveThis study aims at the clinical evaluation by single case of a serious game focused on personal resources in depressed population.MethodThe recommendations of the Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) Statement were respected to design and report the results of this single-case research (Tate et al., 2016). A Withdrawal/Reversal ABA design has been applied to a young patient hospitalized for depression. Each phase contained 3 measurement opportunities spaced 7 to 10 days apart. In intervention phase B, a serious game was introduced in positive psychotherapy workshops without replacing the patient's usual care.ResultsIn the patient, serious game had a clinically significant benefit on depression, psychological well-being and affects. On the other hand, an increase in stress and anxiety levels, as well as a progressive decrease in the feeling of autonomy were also observed.ConclusionSerious game as a therapeutic mediator seems to have demonstrated its effectiveness for the patient. The reduction in depression coupled with the increase in stress and anxiety points out a favourable progression of the patient's problem. Elements specific to the patient's intra-individual problem were highlighted and could shed light on her clinical management.