Transference-Focused Psychotherapy for Borderline Adolescents: A Neurobiologically Informed Psychodynamic Psychotherapy

In this article we first contextualize and then outline a model of TFP adapted for working with adolescents with Borderline Personality Disorders. We discuss how to take the normal developmental challenges of adolescence, such as separation-individuation in consideration, and how to support this in the context of the therapeutic work, while at the same time stimulating curiosity through clarification and confronting the adolescent with self-defeating and destructive patterns and dangerous behavior. Furthermore, we give examples of working with split–off parts of self and other representations through clarification to increase self-awareness and confrontations with contradictions within the adolescents communication and nonverbal behavior, with the aim of facilitating the integration of identity.     

Defensive Sexualization: A Neurobiologically Informed Explanatory Model

Sexualization is a defense mechanism frequently referred to in clinical psychoanalytic literature. Despite this, there is no research linking the theoretical nature of this observed phenomenon to social or neurobiological theory. This discussion paper proposes an interaction between social learning and neural maturation in the development of sexualized tendencies. When anxiety within peer interactions is alleviated repeatedly through sexualized behavior, learned associations develop. This explanation allows understanding and empathy for individuals demonstrating a broad spectrum of sexualized responses since such learning is argued to be functional within their historic social climate.     

Group Psychotherapy: A Behavioral Approach

Abstract

This clinical report highlights some of the processes arising in a therapy group of persons with persistent and chronic psychiatric illnesses as they cope with the stress of their long–standing therapist’s impending retirement. Members were initially disbelieving that the therapist would leave and were also concerned about their future care, particularly in terms of medications. Gradually they were more able to experience their feelings of loss and their genuine caring for the therapist and the group, using higher level defenses and increasing their ability to tolerate strong affects. They became increasingly able to demonstrate empathy, notably in their ability to consider the therapist’s emotions. The clinical material also illustrates the therapist’s personal involvement, countertransferences and expressions of concern.     

The Dialectics of Relational Psychoanalysis and Group Psychotherapy: Commentary on Paper by Robert Grossmark

In this commentary, I address the question of why so few psychoanalysts become group therapists as I respond to the thoughtful and impressive paper written by Robert Grossmark on his work with a psychotherapy group, now in its 10th year of meeting. Prior to discussing the clinical material, and to set the stage for a discussion of Grossmark's work, I comment on my sense of the prevailing attitudes on group affiliations and group therapy within our culture and field as they have progressed over time. I then discuss my reactions to Grossmark's handling of his group session. Many of his conceptualizations of group treatment are in accordance with my own beliefs. There are some differences, however, in how I view my role as a leader and some ideas I have about group treatment that Grossmark did not address.     

Psychotherapy and Recovery from Schizophrenia: A Model of Treatment as Informed by a Dialogical Model of the Self Experience in Psychosis

Since the term schizophrenia was coined, the disorder has been linked to experiences of self-diminishment. This link calls for theoretical work that helps us understand experiences of diminishment wherein persons find themselves less than they once were but nevertheless able to recognize and describe their diminishment. In response this paper describes how dialogical psychology may help us both understand this feature of schizophrenia and inform the practice of psychotherapy. In particular, we suggest that some alterations in sense of self in schizophrenia may proceed from a range of losses in a person’s ability to sustain intrapersonal and interpersonal dialogues. Moreover, we suggest that these losses lead to at least three different forms of disturbed self experience: barren, monological and cacophonous selves. We then explore the unique challenges each poses to psychotherapy and suggest that attention to dialogical deficits may enrich self-experience if it attends to aspects of self-experience that emerge within session.     

Taking the Sting Out: Manifesting Aggression and Containing Difficult States in a Relational Group Psychotherapy

This paper describes ways of handling aggression and difficulty in containing intense emotional experiences in group psychotherapy. The clinical vignette illustrates how, in cases of overprotectiveness, an external trigger may sometime serve as a vehicle of liberation and ventilation. The therapist’s enactment in response to the sudden penetration of a wasp into the room is discussed by relating to the functions it serves in the process of encountering aggression, as well as the group and therapist’s capacity to move from “twoness” to a “co-created third.” Whereas aggression, in general, is difficult to deal with, in a group it might prove to be extremely threatening, posing dangers unique to groups. Moreover, openly discussing the group conductor’s aggressiveness is especially challenging in a group. The paper illustrates the fruitful intersection of group analytic thinking and relational psychoanalytic conceptualization.     

The Stress of Organisational Change: A Dynamic Process Model

Plongées dans un marché mondial, les organisations ne cessent de subir de profonds changements. Encore que la plupart de ces changements soient nécessaires et souvent retardés, ils présentent comme inconvénient le risque de coûts élevés en terme d'accroissement des dépenses de santé, de pertes de productivité, de baisse de la satisfaction professionnelle et de chute du moral. Ces coûts peuvent être directement imputés à la détresse qui frappe les salariés d'une organisation confrontée à des changement permanents. Cet article propose un modèle dynamique permettant d'aborder les articulations complexes entre le changement organisationnel et le stress subi par les individus. A partir de ce modèle, des interventions prenant en compte tous les aspects du problème pourront être conçues pour aider les salariés à gérer le stress provoqué par les mutations des organisations.
Organisations in the global marketplace continue to experience tremendous change. Although most of these changes are necessary and long overdue, the downside includes the risk of huge costs in terms of increased health care expenses, lost productivity, lower levels of job satisfaction, and low morale. These costs may be directly attributed to the distress that is created when an organisation's employees encounter constant changes. This paper establishes a dynamic framework from which we can begin to understand the complex interplay between change at the organisational level and stress at the individual level. Using this framework, comprehensive interventions can ultimately be developed to help employees manage the stress of organisational transitions.     

Analytic Group Psychotherapy: A Uniquely Effective Crisis Intervention

This paper describes the author's experience doing crisis intervention with survivors of the 9/11 attack on the World Trade Center in New York City. It focuses on enhancing the understanding of and potentially expanding the theory and technique of analytic group therapy as applied to this unique situation.Private practice in     

A Follow-up Study of Group Psychotherapy Patients

The usefulness and efficacy of group psychotherapy with a variety of adolescent problems has been well documented. Far less has been reported with respect to group treatment approaches for youthful depressives, however. Currently available treatments lack specificity, making replication difficult. Additionally, they often focus on a narrow range of deficit areas rather than addressing the multifaceted range of dysfunction characteristic of depression in adolescents. This paper critically reviews the available literature on group treatments with depressed adolescents, explores some of the shortcomings inherent in these reports, and suggests alternatives for future group protocols. It is proposed that subsequent interventions be manualized and that they target affective, behavioral, and cognitive aspects of adolescent depression. Such an approach would be more amenable to scientific investigation, replication, and comparison with alternative approaches.