Discussing the therapeutic setting in child and adolescent psychoanalytic psychotherapy

The aim of this paper is to contribute to a debate on the particular characteristics of the therapeutic setting in child and adolescent psychoanalytic psychotherapy and its differences from the setting in adult therapy. In our opinion, there is a fundamental difference between these two, as in child and adolescent psychotherapy two distinct aspects co-exist and in some areas, overlap. In this paper, we attempt to delineate these two aspects, following Green’s division of the analytical setting into the active matrix and the casing. We propose that in child and adolescent psychotherapy the therapeutic contract, the active matrix, concerning the necessary conditions for making a therapy psychoanalytic – namely, the therapist’s free-floating attention and the patient’s free associations – is agreed between the therapist and the child/adolescent. We argue that in contrast, the contract regarding the casing – the timings of sessions, the fees and so on – is agreed primarily with the parents or carers of the child/adolescent. Ruptures and possible modifications in both the matrix and the casing of the setting are discussed through the presentation of clinical material.     

Make it real: Belief in occurrence within episodic future thought

While the cognitive and neural bases of episodic future thinking are well documented, questions remain as to what gives the sense that an imagined event belongs to one’s personal future. Capitalizing on previous research on metacognitive appraisals in autobiographical remembering, we propose that episodic future thinking involves, in varying degrees, a subjective belief in the potential occurrence of imagined future events and we explore the nature and determinants of such belief. To this aim, participants provided justifications for belief in occurrence for a series of past and future events. For each event, they also assessed their subjective feelings (belief in occurrence, autonoetic experience, and belief in accuracy) and rated various characteristics of mental representations that might contribute to these feelings. Results showed that belief in the occurrence of future events mostly related to their integration in a broader autobiographical context, especially their relevance to personal goals and their personal plausibility. We also found that belief in occurrence, autonoetic experience, and belief in accuracy represented distinct subjective appraisals of future events, which depended in part on different determinants. Based on these findings, we propose a new theoretical model of subjective feelings associated with episodic future thinking that conceives of belief in occurrence as arising from metacognitive appraisals that shape the sense that imagined events belong to one’s personal future.     

The Other Game: A Journey into the World of Warcraft

ABSTRACT

Many people today live out significant aspects of their internal lives online, in a digital world. Rather than analyze these worlds as mere metaphors for real life, it has become increasingly important for psychotherapists to be willing to participate in these worlds as they are described during the clinical hour. It is necessary to work within a paradox: An online fantasy world takes away from living life in the outer world; the world online offers the safety necessary to help the patient approach living his life in any world. This article explores a case in which I learn to work within the parameters of an online gaming experience—World of Warcraft?—to help a patient integrate split-off aspects of himself as he develops the capacity to own his desires. In this case, the game functioned as an “Eden project” (Hollis, 1998, p. 33), an earnest, if severely constricted, search for paradise lost. This article illustrates what was found—not Eden, but true Otherness.     

STIRPICULTURE: SCIENCE‐GUIDED HUMAN PROPAGATION AND THE ONEIDA COMMUNITY

Between 1869 and 1879, the communal Christian group the Oneida Community undertook a pioneering eugenics experiment called “stirpiculture” in upstate New York. Stirpiculture resulted in the planned conception, birth, and communal rearing of fifty‐eight children, bred from selected members of the Oneida Community. This article concerns how the Oneida Community's unique approach to religion and science provided the framework for the creation, process, and eventual dissolution of the stirpiculture experiment. The work seeks to expand current understanding of the early history of eugenics in the United States by placing its practice more than two decades earlier than is generally considered. Additionally, this article situates the Community's leader John Humphrey Noyes as an early eugenics and social scientific thinker. Finally, the treatment provides a case study for the transitional period in mid to late nineteenth century America whereby scientific modes of epistemology were accommodated within or supplanted by theological worldviews.     

Child-Oriented or Parent-Oriented Focused Intervention: Which is the Better Way to Decrease Children’s Externalizing Behaviors?

Research has tried to identify risk factors that increase the likelihood of difficulties with externalizing behavior. The relations between individual or environmental factors and externalizing behavior have been especially documented. Child-oriented and parent-oriented interventions have been designed in order to decrease externalizing behavior in preschoolers. To date, however, research has largely been compartmentalized. It is therefore not known whether child-oriented or parent-oriented intervention is more effective in reducing externalizing behavior. The aim of the current study was to answer this question by comparing two 8-week child with two 8-week parent-oriented group programs sharing a common experimental design. This was done in a pseudo-randomized trial conducted with 73 3–6-year-old children displaying clinically relevant levels of externalizing behavior who were assigned to one of the four interventions and 20 control participants who were allocated to a waiting list. The results indicate that the four programs focusing on a specific target variable, i.e., social cognition, inhibition, parental self-efficacy beliefs, or parental verbal responsiveness, are all effective in reducing externalizing behavior among preschoolers. Their effectiveness was moderated neither by their orientation toward the child or the parent nor by their content, suggesting that several effective solutions exist to improve behavioral adaptation in preschoolers. A second important highlight of this study is that, thanks to comparable effect sizes, brief focused programs appear to be a reasonable alternative to long multimodal programs, and may be more cost-effective for children and their families.     

Perceptions of Stress,Coping, and Intervention Preferences among Caregivers of Disadvantaged Children with Asthma

Asthma remains the most prevalent chronic illness among children. Despite the substantial body of literature examining children with asthma, few studies have examined parents’ perspectives of the condition and experiences of caregiver stress. Parents of children with chronic illnesses experience elevated stress and may have limited opportunities to cope with complex emotions while caring for children with asthma. Drawing from focus groups and interviews with African American and Hispanic parents of children with asthma, this qualitative study was conducted as part of a patient-centered engagement process to inform the refinement of an intervention aimed at reducing stress among parents of children with asthma. All data were transcribed and underwent three waves of inductive analysis. The content analysis indicated that the unpredictable nature of asthma and the caregiving burden associated with managing children’s asthma contributed to parents’ stress, and external contexts compounded the impact of these stressors. Parents also reported having difficulty identifying how they coped with stress and employed approaches to coping with stress that they applied intermittently but encountered several barriers to enacting known or available coping strategies. Analyses also revealed that parents desired a multimodal stress reduction intervention that emphasized building relationships, allowed for flexibility, and encouraged staff-parent communication. Whereas African American and Hispanic parents’ experiences of stress and coping strategies were similar, their preferences differed in regards to incorporating technology into the intervention, the credentials of facilitators, and the salience of language preferences. Understanding the complexities of stressors facing caregivers is important for developing interventions to support parents and children coping with asthma, and in particular when working with families from diverse backgrounds.     

Who is most likely to fat talk? A social comparison perspective

Negative talk about food, weight, or the body that occurs commonly among women – fat talk – is gaining increasing attention. Whereas its negative eating pathology and body esteem correlates have received continued empirical validation, what is not yet known is who is most likely to fat talk. We propose that social comparison processes underlie and motivate much of fat talk. In a sample of 143 college women, we found evidence for the role of social comparison. First, having a stronger tendency to socially compare directly predicts fat talk. Second, as a woman's body image concerns increase, her likelihood of engaging in fat talk increases, and this is intensified if she has a greater tendency to socially compare. Finally, social comparison propensity begins to exert its exacerbating effects at surprisingly low levels of body image concern. Results are discussed in terms of the advantages of using a social comparison perspective to better understand fat talk.     

Severity of childhood attention-deficit hyperactivity disorder--a risk factor for personality disorders in adult life?

Some evidence points to an increased rate of cluster B and C personality disorders (PDs) in adult ADHD patients. In order to assess axis II disorders comprehensively we used the diagnostic instrument of the WHO. In sixty adult out-patients with ADHD according to DSM-IV criteria PDs were assessed with the International PD Examination (IPDE) and severity of childhood ADHD with the Wender-Utah-Rating Scale (WURS). We found at least one PD in 25% of cases. Cluster C PDs were most common (36.6%) followed by Cluster B (23.3%) and A (8.3%). Avoidant (21.7%) and borderline (18.3%) were the most frequent single PD entities. ADHD patients with PD suffered from significantly more severe childhood ADHD compared to those without co-occurring PD. Applying the IPDE we confirmed a high number of PDs among adult ADHD patients. Our findings point to a higher vulnerability for the development of PDs in patients with severe childhood ADHD.     

Violence risk assessment and women: predictive accuracy of the HCR-20 in a civil psychiatric sample

Research to date has not adequately demonstrated whether the HCR-20 Violence Risk Assessment Scheme (HCR-20; Webster, Douglas, Eaves, & Hart, 1997), a structured violence risk assessment measure with a robust literature supporting its validity in male samples, is a valid indicator of violence risk in women. This study utilized data from the MacArthur Study of Mental Disorder and Violence to retrospectively score an abbreviated version of HCR-20 in 827 civil psychiatric patients. HCR-20 scores and predictive accuracy of community violence were compared for men and women. Results suggested that the HCR-20 is slightly, but not significantly, better for evaluating future risk for violence in men than in women, although the magnitude of the gender differences was small and was largely limited to historical factors. The results do not indicate that the HCR-20 needs to be tailored for use in women or that it should not be used in women, but they do highlight that the HCR-20 should be used cautiously and with full awareness of its potential limitations in women.