Promoting psychoanalytic understanding in the core professions: The case against establishing a new profession of adult psychotherapist

Currently there is much enthusiastic talk about the possibility of establishing a new National Health Service profession of Adult Psychotherapist. This paper questions the assumption that such a development would be rational and advantageous. Four main points are discussed here: there are problems arising from training in a uni-dimensional context when returning to work in amulti-dimensional context; there are dangers in taking a method-oriented stance rather than one which is service-oriented; there is something peculiar about the notion of a profession based on a single method or mode of treatment; one of the most important contributions of psychoanalysis to the core professions is the creation of an analytic space for thinking.     

The Gnostic Syndrome: Anorexia nervosa

‘The Gnostic Syndrome’ discusses anorexia nervosa in terms of its poetics and in the context of a developmental object-relations theory. One case is used to illustrate the problems of therapy and the antecedents of the anorexia in childhood and adolescence. The paper forms an investigation into pre-moral states and the interaction of anorexia with character structure.     

Disavowal and assessment for psychotherapy

The concept of disavowal is described and its part in the pathology of a certain group of patients is discussed. Particular emphasis is placed upon the difficulties posed by the pervasive use of this defence mechanism during the assessment of such patients. Clinical vignettes from assessment interviews are presented. The longer-term psychotherapeutic management of these patients is discussed and this is illustrated by clinical material.     

A Review of: Growing Up With Autism: Working With School-Age Children and Adolescents With Autism,edited by Robin L. Gabriels and Dina E. Hill (Eds.).

The influence of adult presence, peer smiling, and peer praise on the unprogrammed generalization of physical sharing over time was investigated. During free play three groups of five preschool children were taught to share toys via a behavioral training package composed of instructions, modeling, behavior rehearsal, prompts, and praise. Immediately following free play the children were given art materials and observed in the presence of different adults. An ABA design with a manipulation of adult presence nested within east phase was used. For all three groups, regardless of the adult presence manipulation, treatment facilitated sharing in both settings. In addition, two groups continued to share in both settings after termination of the training. The presence of an adult was necessary for unprogrammed maintenance of treatment gains in both settings whereas peer smiling and peer praise were not. Observer presence suppressed physical sharing and smiling prior to, during, and after treatment. Implications for behavioral assessment and applied significance are discussed.     

Treatment of Obsessive Compulsive Disorder in Young Children: An Intervention Model and Case Series

This article presents an intervention model for young children with obsessive-compulsive disorder (OCD). The intervention, designed to reduce compulsive behavior and improve parenting practices, was tested using a multiple baseline design with 7 children (M = 6 years old; 57% female) in which participants were randomly assigned to 1, 2, or 3 weeks of baseline (i.e., no treatment). All children were diagnosed with OCD using a semi-structured diagnostic interview. Baseline and weekly ratings of obsessive-compulsive (OC) symptoms and family accommodation were obtained. In addition, at pre- and post-treatment and 1-month follow-up, independent evaluators and/or parents completed measures assessing the severity and impact of OC symptoms and child and family functioning. Findings revealed that participants had a 33–66% reduction in OC symptoms (as measured by the Children's Yale-Brown Obsessive Compulsive Scale; CYBOCS) at posttreatment and 6 of the 7 children were rated as treatment responders on the Clinical Global Impression-Improvement (CGI-I) Scale. At the 1-month follow-up, participants had a 17–82% reduction in OC symptoms. Treatment was also effective in reducing parental accommodation of child OC behaviors. Overall treatment satisfaction was high and parents found most core treatment ingredients (e.g., psychoeducation, exposure and ritual prevention, contingency management) very helpful. Implications for further developing and testing psychosocial treatments for young children are discussed.     

A Review of: “Editor's Note”

Three components of a self-regulation approach-self instruction, self-monitoring, and self-reinforcement-were used in training programs for three hyperactive, disruptive boys. Hyperactive behaviors and academic performance during reading and math were monitored in both clinic and school settings. Self-instructional training did not improve performance in the absence of adult supervision and self-monitoring did not significantly affect responding. A combination of self-monitoring and self-reinforcement techniques, introduced first in the clinic and then in the school environment, resulted in improved levels of academic performance and reciprocal decreases in hyperactive behaviors. The investigation represents an initial step toward teaching hyperactive children the skills necessary for successful self-regulation and improvement of their academic performance in the absence of direct adult surveillance.     

The Contribution of the Dyadic Parent-Child Interaction Coding System (DPICS) Warm-Up Segments in Assessing Parent-Child Interactions

This study evaluated the inclusion of uncoded segments in the Dyadic Parent-Child Interaction Coding System, an analogue observation of parent-child interactions. The relationships between warm-up and coded segments were assessed, as well as the segments’ associations with parent ratings of parent and child behaviors. Sixty-nine non-referred parent-child dyads engaged in the observation. Parents completed measures about their parenting and children's behaviors. Significant differences were observed between the first situation's warm-up and coded segments, whereas minimal differences were found for the second situation. Findings suggest that the second warm-up segment may not be necessary for optimal assessment of parent-child interactions.     

Measuring Change During Behavioral Parent Training Using the Parent Instruction-Giving Game with Youngsters (PIGGY): A Clinical Replication

This is the second study to investigate the clinical use of the Parent-Instruction Game with Youngsters (PIGGY) which is a structured observation system derived from the Dyadic Parent-Child Interaction Coding System II (DPICS-II; Eyberg, Bessmer, Newcomb, Edwards, & Robinson, 1994) and the Behavior Coding System (BCS; Forehand & McMahon, 1981 Forehand , R. L. , & McMahon , R. J. ( 1981 ). Helping the noncompliant child . New York , NY : Guilford Press . [Google Scholar]). In a previous study, the PIGGY demonstrated strong reliability and validity as well as clinical utility (Hupp, Reitman, Forde, Shriver, & Kelley, 2008). The present study is a replication of the previous research on clinical utility by using the PIGGY to monitor changes in parent and child behavior during and after behavioral parent training.     

ABA-Based Programs for Children Diagnosed With Autism Spectrum Disorder: Parental and Professional Experiences at School and at Home

Having a child diagnosed with Autism Spectrum Disorder (ASD) poses a range of challenges to families, many of which can be addressed through appropriate intervention. A study of parental (n = 95) and professional (n = 67) experiences was carried out in relation to two settings: (a) schools that provided intensive interventions based on the science of Applied Behavior Analysis (ABA), and (b) non-intensive ABA-based home programs. Results show that parents whose children attend ABA-based schools were generally more satisfied with their child's educational provision, monitoring procedures, and level of staff training, than parents who were not offered ABA-based education in schools.     

Treatment of Comorbid Conduct Problems and Depression in Youth: A Pilot Study

The purpose of this study was to pilot a cognitive behavioral treatment protocol for adolescents with co-occurring conduct problems and depression. A non-concurrent multiple baseline design was used to assess the effectiveness of the intervention. A sample of five adolescents, aged 11 to 14 years, participated; all five families completed the protocol. Results indicated that symptoms of oppositionality were significantly reduced. Moreover, maternal ratings suggested significant improvements in emotion regulation in their children and cohesion in the family. However, symptoms of depression showed little improvement. Results of this study have implications for improving treatment outcomes for youth with these comorbid conditions and may lead to increased conceptual understanding of these comorbid problems.