Moved to tears: Technical considerations and dilemmas encountered in working with a 13-year-old boy with acquired quadriplegia 1

This paper is about therapeutic work with David, a 13-year-old boy who, at the age of 5, was the victim of a hit-and-run road traffic accident resulting in quadriplegia. The circumstances leading to the accident and its sequelae reveal a particularly complex picture, which combines early emotional deprivation and trauma. Although cognitively intact and able to speak, David could not move. Yet he created movement in others through a desperate necessity, by communicating via the employment of extreme projective forces. The highly complex presentation of emotional, psychic and bodily damage in the child, and in particular, David's physical paralysis, has had a profound impact upon what I have come to think of as the ‘mindbody’ of the therapist. Winnicott has talked of the infant's ‘psyche/soma’. Here I want to extend the notion and consider the bodily impact of projections in particular and how these have a powerful emotional and physical resonance on the ‘mindbody’ of the therapist, especially in therapy with a young person whose body is damaged. In this paper, I consider technical challenges and dilemmas encountered in the work, including the complex interplay of transference/countertransference phenomena. This unusual presentation of a boy in extraordinary circumstances led to considerations of psychoanalytic method and interpretative activity, which may be viewed as being inspired by ‘emotional truthfulness’.2 2 Alex Dubinskey (Chair ACP conference 2004) commenting on aspects of this work used the term ‘emotional truthfulness’.

Dans cet article, l'auteur raconte son travail thérapeutique auprès de David, âgé de 13 ans, qui à l'âge de 5 ans fut victime d'un accident de la circulation avec délit de fuite, accident qui le laissa tétraplégique. Les circonstances qui aboutirent à l'accident et à ses séquelles forment un tableau particulièrement complexe mettant en jeu des carences affectives précoces et des traumatismes. Bien que ses capacités cognitives ne fussent nullement atteintes et qu'il fut capable de parler, David ne pouvait pas bouger. Par l'urgence désespérée de son discours, transmise grâce à des projections extrêmement puissantes, il réussissait à susciter du mouvement chez ses interlocuteurs. La présence conjointe et extrêmement complexe de dommages affectifs, psychiques et corporels chez cet enfant – et notamment sa paralysie physique – eut un impact profond sur ce que l'auteur en vient à appeler l'“ esprit-corps ” du psychothérapeute. D. W. Winnicott a parlé du “ psyché-soma ” du jeune enfant. Dans son texte, l'auteur élargit cette notion, notamment pour prendre en considération l'impact corporel des projections, ainsi que leur résonance émotionnelle et physique massive sur l'“ esprit-corps ” du thérapeute, surtout lorsque son patient est une personne jeune dont le corps est endommagé. L'auteur explore les défis et dilemmes techniques rencontrés au cours de son travail, y compris le jeu complexe de phénomènes transférentiels et contre-transférentiels. Ce traitement, inhabituel, avec un garçon dans des circonstances sortant de l'extraordinaire soulève des questions concernant la méthodologie psychanalytique et l'activité interprétative, questions qui peuvent être considérées comme étant inspirées par la “ véracité émotionnelle ”.

Dieser Artikel ist über die therapeutische Arbeit mit David, einem 13-jährigen Jungen, der im Alter von 5 Jahren das Opfer eines Unfalls mit Fahrerflucht war, der zu einer Querschnittslähmung führte. Die Umstände, die zu dem Unfall führten und seine Folgen legen ein besonders komplexes Bild dar, das frühe Vernachlässigung und Trauma kombiniert. Obwohl David kognitiv intakt war und sprechen konnte, konnte er sich nicht bewegen. Doch schaffte er Bewegung aus verzweifelter Notwendigkeit in anderen, indem er mit mithilfe der Benutzung von extremen projektiven Kräften kommunizierte. Die höchst komplexe Präsentation von emotionalem, psychischem und körpelichem Schaden in dem Kind und insbesondere Davids körperliche Lähmung, hatte eine tiefe Auswirkung auf das, was ich nun den ‘mindbody’ (Gemütskörper) des Therapeuten nenne. Winnicott sprach vom Psyche/Soma des Babies. Hier möchte ich diesen Begriff ausweiten und besonders die köperliche Auswirkung der Projektionen betrachten und wie diese eine starke emotionale und physische Resonanz auf den ‘mindbody’ des Therapeutens haben, insbesondere in der Therapie mit einer jungen Person, deren Körper beschädigt ist. In diesem Artikel betrachte ich technische Herausforderungen und Dilemmas, denen man in dieser Arbeit begegnet, einschliesslich der komplexen Wechselwirkung von Übertragungs/ Gegenübertragungsphänomenen. Diese ungewöhnliche Behandlung mit einem Jungen in aussergewöhnlichen Umständen führten zu Überlegungen zur psychoanalytischen Methode undzur Deutungsaktivität, die von ‘emotionaler Wahrheit’ inspiriert wird

Riassunto: In questo articolo si parla del lavoro terapeutico con David, un bambino di 13 anni che, all'età di 5 anni, fu vittima di un incidente stradale che portò alla quadriplegia. Le circostanze che portarono all'incidente e la sua sequela rivelano un quadro particolarmente complesso, nel quale emerge un misto di deprivazione emotiva precoce e trauma. Sebbene David fosse abile cognitivamente e potesse parlare, egli non poteva muoversi. Eppure il bambino generava movimento negli altri attraverso una disperata necessità, comunicando con l'uso di estreme forze proiettive. Il presentarsi di un danno nel bambino altamente complesso nella sua dimensione emotiva, psichica e corporea, ed in particolare, la paralisi fisica di David, hanno avuto un profondo impatto su ciò che ho iniziato a pensare come il ‘corpomente’ del terapeuta. Winnicott ha parlato dello ‘psiche/soma’ del neonato. L'autrice vuole nell'articolo estendere la nozione e considerare l'impatto corporeo delle proiezioni e come queste abbiano una risonanza emotiva e fisica molto forte sul ‘corpomente’ del terapeuta, soprattutto nella terapia con un ragazzo giovane il cui corpo è stato danneggiato. Nell'articolo considero le sfide tecniche e i dilemmi incontrati nel lavoro, compreso il gioco complesso dei fenomeni transferali e controtransferali. Il trattamento insolito con questo bambino in circostanze molto particolari ha portato a considerazioni riguardo al metodo psicoanalitico e all'attività interpretativa, che si possono considerare come ispirati da ‘verità emotiva'¹     

Acute exercise suppresses judgments of facial emotion intensity

The ability to recognize others’ facial expressions is critical to the social communication of affective states. The present work examined how transient states of high physiological arousal during aerobic exercise influence recognizing and rating morphed facial expressions. Participants exercised at either a low or high work rate. While exercising and then during cool-down and rest periods, participants performed a version of the morphed faces task that involved animated faces changing into or away from five target affective states (happy, surprise, sadness, anger, and disgust); they were asked to stop the animation when the face first corresponded to a target state, and rate its emotional intensity. Results demonstrated no differences in animation stop data, but overall lower ratings of perceived emotion intensity during high versus low work rate exercise; these effects dissipated through cool-down and rest periods. Results highlight important interactions between physiological states and processing emotional information.     

Race and Ethnicity: An 11‐Year Content Analysis of Counseling and Values

Using the Dimensions of Personal Identity Model proposed by Arredondo and Glauner (as cited in Arredondo et al., 1996 ), the authors reviewed the last 11 years of the Association for Spiritual, Ethical, and Religious Values in Counseling's journal, Counseling and Values, specifically regarding the “A” dimensions of race and ethnicity. Twenty‐five of the 235 articles reviewed (11%) contained a multicultural perspective defined in these terms. Other aspects of cultural inclusion, such as authorship and type of study, were also considered.     

Is It What You Do,or When You Do It? The Roles of Contingency and Similarity in Pro‐Social Effects of Imitation

Being imitated has a wide range of pro‐social effects, but it is not clear how these effects are mediated. Naturalistic studies of the effects of being imitated have not established whether pro‐social outcomes are due to the similarity and/or the contingency between the movements performed by the actor and those of the imitator. Similarity is often assumed to be the active ingredient, but we hypothesized that contingency might also be important, as it produces positive affect in infants and can be detected by phylogenetically ancient mechanisms of associative learning. We manipulated similarity and contingency between performed and observed actions in a computerized task. Similarity had no positive effects; however, contingency resulted in greater enjoyment of the task, reported closeness to others, and helping behavior. These results suggest that the pro‐social effects of being imitated may rely on associative mechanisms.     

Envy: the canker in the bud

This paper explores the relevance of the concept of moral masochism as a response to early trauma and the implications of this for psychotherapy.

Consideration is given to early conceptualisations of moral masochism within the psychoanalytic literature, in particular, the move from drive theory to object relations. More recent developments in relation to trauma and defences, such as disassociation, are explored. It is suggested that a more complex and fuller understanding requires thinking about the subtle and shifting interaction of both these levels. This allows the possibility of building a more nuanced understanding which can look at both behaviour, as described in the trauma literature, and meaning which is the core of a more classical psychoanalytic approach.

Case histories are used to illustrate the linkages between moral masochism and trauma and the transference and countertransference dynamics and challenges involved. Progress varied in these cases, with both positive and negative outcomes. This theoretical background is used to suggest why this may be so.     

The Blicket Within: Preschoolers' Inferences About Insides and Causes

Four experiments examined children's inferences about the relation between objects' internal parts and their causal properties. In Experiment 1, 4-year-olds recognized that objects with different internal parts had different causal properties, and those causal properties transferred if the internal part moved to another object. In Experiment 2, 4-year-olds made inferences from an object's internal parts to its causal properties without being given verbal labels for objects or being shown that insides and causal properties covaried. Experiment 3 found that 4-year-olds chose an object with the same internal part over one with the same external property when asked which object had the same causal property as the target (which had both the internal part and external property). Finally, Experiment 4 demonstrated that 4-year-olds made similar inferences from causal properties to internal parts, but 3-year-olds relied more on objects' external perceptual appearance. These results suggest that by the age of 4, children have developed an understanding of a relation between an artifact's internal parts and its causal properties.     

A Multi-Case Report of the Pathways To and Through Genetic Testing and Cancer Risk Management for BRCA Mutation-Positive Women Aged 18–25

Much of the extant literature addressing the psychosocial aspects of BRCA1/2 mutation testing and risk management aggregates mutation carriers of all ages in study recruitment, data analysis, and interpretation. This analytic strategy does not adequately address the needs of the youngest genetic testing consumers, i.e., women aged 18–25. Despite low absolute cancer risk estimates before age 30, BRCA1/2 mutation-positive women aged 18–25 feel vulnerable to a cancer diagnosis but find themselves in a management quandary because the clinical utility of screening and prevention options are not yet well defined for such young carriers. We present three cases, selected from a larger study of 32 BRCA1/2 mutation-positive women who completed or considered genetic testing before age 25, to demonstrate the unique developmental, relational and temporal influences, as well as the challenges, experienced by very young BRCA mutation-positive women as they complete genetic testing and initiate cancer risk management. The first case describes the maturation of a young woman whose family participated in a national cancer registry. The second addresses the experiences and expectations of a young woman who completed genetic testing after learning that her unaffected father was a mutation carrier. The third case highlights the experiences of a young woman parentally bereaved in childhood, who presented for genetic counseling and testing due to intense family pressure. Together, these cases suggest that BRCA1/2-positive women aged 18–25 are challenged to reconcile their burgeoning independence from their families with risk-related support needs. Loved ones acting in ways meant to care for these young women may inadvertently apply pressure, convoluting family support dynamics and autonomous decision-making. Ongoing support from competent healthcare professionals will enable these young women to remain informed and receive objective counsel about their risk-management decisions.     

Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives

Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.     

Complex span and n-back measures of working memory: A meta-analysis

Working memory is a construct of primary relevance to many areas of psychology. Two types of tasks have been used to measure working memory, primarily in different research areas: Complex span tasks are commonly used in behavioral studies in the cognitive and individual-differences literature, whereas n-back tasks have been used more frequently in cognitive neuroscience studies investigating the neural underpinnings of working memory. Despite both categories of tasks being labeled as “working memory” measures, previous empirical studies have provided mixed evidence regarding the shared amount of overlapping processes between complex span and n-back tasks. The present meta-analysis showed that the complex span and n-back tasks are weakly correlated, although significant heterogeneity across studies was observed. A follow-up analysis of unpublished data indicated that the sample composition affects the relationship between the complex span and n-back tasks, following the law of diminishing returns. Finally, a separate meta-analysis indicated that the simple span and n-back tasks are correlated to the same extent as are the complex span and n-back tasks. The present findings indicate that the complex span and n-back tasks cannot be used interchangeably as working memory measures in research applications.     

Differential attentional allocation and subsequent recognition for young and older adult faces

Studies examining own-age recognition biases report inconsistent results and often utilize paradigms that present faces individually and in isolation. We investigated young and older adults' attention towards young and older faces during learning and whether differential attention influences recognition. Participants viewed complex scenes while their eye movements were recorded; each scene contained two young and two older faces. Half of the participants formed scene impressions and half prepared for a memory test. Participants then completed an old/new face recognition task. Both age groups looked longer at young than older faces; however, only young adults showed an own-age recognition advantage. Participants in the memory condition looked longer at faces but did not show enhanced recognition relative to the impressions condition. Overall, attention during learning did not influence recognition. Our results provide evidence for a young adult face bias in attentional allocation but suggest that longer looking does not necessarily indicate deeper encoding.