General principles for treating personality disorder with a prominent inhibitedness trait: towards an operationalizing integrated technique

Psychotherapists need to perform tasks such as being empathetic, performing an ongoing assessment of cases, self-disclosing, making explicit treatment contracts, validating patients' experiences and promoting awareness of psychological experience, if they are to be effective in treating personality disorder (PD). Successful therapy also requires a systematic accurate PD model. We suggest here that it is still unclear how, when, and according to what session markers therapists need to perform specific operations to maximize therapeutic gains. This article describes and operationalizes a step-by-step procedure for organizing and delivering the interventions necessary for effective outcomes, such as maintaining a good therapeutic relationship, increasing understanding of mental states, reducing symptoms and improving social adaptation. The procedure is illustrated by reference to the treatment of cases of emotionally overly-constricted PDs. We include a theoretical proposal to facilitate the development of measures for evaluating the efficacy of therapist actions.     

The ‘I’ and the ‘Me’ in self-referential awareness: a neurocognitive hypothesis

The nature of the ‘self’ and self-referential awareness has been one of the most debated issues in philosophy, psychology and cognitive neuroscience. Understanding the neurocognitive bases of self-related representation and processing is also crucial to research on the neural correlates of consciousness. The distinction between an ‘I’, corresponding to a subjective sense of the self as a thinker and causal agent, and a ‘Me’, as the objective sense of the self with the unique and identifiable features constituting one’s self-image or self-concept, suggested by William James, has been re-elaborated by authors from different theoretical perspectives. In this article, empirical studies and theories about the ‘I’ and the ‘Me’ in cognition and self-related awareness are reviewed, including the relationships between self and perception, self and memory, the development of the self, self-referential stimulus processing, as well as related neuroimaging studies. Subsequently, the relations between self and different aspects of consciousness are considered. On the basis of the reviewed literature and with reference to Block’s distinction between phenomenal and access consciousness, a neurocognitive hypothesis is formulated about ‘I’-related and ‘Me’-related self-referential awareness. This hypothesis is extended to metacognitive awareness and a form of non-transitive consciousness, characteristic of meditation experiences and studies, with particular reference to the notion of mindfulness and other Buddhist constructs.     

Narrative Derivatives of Alpha Elements: Clinical Implications

The author considers both the psychoanalytic field and the ways in which the characters of a psychoanalytic session can be understood. He then develops one of Bion's ideas, the dream in the waking state, by isolating the derivatives of such dreams or rather the alpha elements they consist of. The author implies a theory of technique which takes account of all the signals "the bi-personal field" gives the analyst about the functioning of the analytic couple by means of "narrative derivatives". This enables continual changes to be made in interpretation     

Analysts in Search of an Author: Voltaire or Artemisia Gentileschi? Commentary on “Field Theory in Psychoanalysis,Part 2: Bionian Field Theory and Contemporary Interpersonal/Relational Psychoanalysis” by Donnel B. Stern

The authors comment on Stern's characterization of differences between interpersonal and relational psychoanalysis and Bionian field theory. The critical points on which a consensus is not, for the time being, readily possible concern the relationship between the external and internal worlds and the various conceptions of unconscious experience. They believe that, before forging a link with the external world (whose role we would be foolish to deny), it is clinically more useful to apprehend this internal world as rigorously and over as wide a range as possible—which they do by radically transforming the external world into a dream of the field. Conversely, in their view we may be reassured but partly misled by the concept of a dialectic between the external and internal worlds that fails to take account of the utter pervasiveness of the unconscious and the fact that it speaks even when seemingly silent—not only negatively in micro- and macroenactments but also positively in waking dream thought, which is an expression of its poetic activity that unceasingly confers meaning on experience.     

Disorganized Narratives: Problems In Treatment And Therapist Intervention Hierarchy

The way in which patients tell therapists their stories has an impact on treatment. They try to put their emotions and the events generating them, their goals and the behavior they adopt to achieve them, and so on, together in a coherent discourse. But some patients fail in organizing their narratives. They might describe a diffuse arousal without letting the reasons for their discomfort be known, switch from one subject to another without any apparent connection, or pile up one topic after another, thus overwhelming a listener, who is unable to see which is the main one. We call such narratives disorganized. They do not help a patient to make sense of experience or achieve consistency in behavior. A therapist listening has difficulty in planning treatment and often reacts negatively to such patients. Here we propose a series of interventions aimed at improving narrative coherence, creating a sound therapeutic relationship and making treatment effective. We will describe the therapy with a seriously dissociated patient in which this intervention has proven useful.     

Visual marking and change detection

The preview benefit from prior exposure of response-irrelevant (distracter) objects in visual search has been accounted for in terms of top-down inhibition (i.e. visual marking), bottom-up abrupt onset capture, or asynchrony-dependent perceptual segregation. We assess the relative contribution of abrupt onset and visual marking in a paradigm combining visual search with a visual working memory task. We investigated time-based selection of multiple objects for storage in visual working memory, using a change detection paradigm (Luck and Vogel in Nature 390:279–281, 1997) with distracter preview. We varied preview exposure (short vs. long), in a series of three experiments. The contribution of asynchrony-related perceptual segregation was assessed across experiments by varying the complexity of the stimuli (colored squares, oriented bars and oriented T-shapes) and the type of change detection (color or orientation), resulting in different levels of perceptual segregation between visual elements. The results suggest that bottom-up abrupt onset, visual marking and perceptual segregation factors co-operate in time-based selection for storage in visual working memory.     

Acquiring contextualized concepts: a connectionist approach

Conceptual knowledge is acquired through recurrent experiences, by extracting statistical regularities at different levels of granularity. At a fine level, patterns of feature co-occurrence are categorized into objects. At a coarser level, patterns of concept co-occurrence are categorized into contexts. We present and test CONCAT, a connectionist model that simultaneously learns to categorize objects and contexts. The model contains two hierarchically organized CALM modules (Murre, Phaf, & Wolters, 1992). The first module, the Object Module, forms object representations based on co-occurrences between features. These representations are used as input for the second module, the Context Module, which categorizes contexts based on object co-occurrences. Feedback connections from the Context Module to the Object Module send activation from the active context to those objects that frequently occur within this context. We demonstrate that context feedback contributes to the successful categorization of objects, especially when bottom-up feature information is degraded or ambiguous.