Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol

Attention-Deficit/Hyperactivity Disorder (ADHD) is prevalent among adolescents enrolled in behavioral health services but remains undertreated, and the first-line treatment option, stimulant medication, is underutilized. To address this gap, this article introduces the Medication Integration Protocol (MIP): ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about integrating medication interventions into primary care; managing medication priorities for adolescents with multiple diagnoses, including substance use problems; and the compatibility of MIP with everyday practice conditions.     

Beyond the representation field

Abstract

This article outlines the importance of representation and several Freudian concepts such as Vorstellung, Trieb, and word and object representations. The author refers to the division of the analytical process into two main fields: the field of representation, and the field of the Real, which is characterized by impossibility. He then states that this field is the proper field of psychoanalysis. The author presents two clinical vignettes in an attempt to demonstrate the significance of the analytical act as a tool to deal with such extreme psychic situations.     

In dialogue with Daniel Stern: A review and discussion of The Present Moment in Psychotherapy and Everyday Life

Abstract

Daniel Stern's concepts of “present moment” and “now moment,” with impending kairos, are described. In the latter, the patient demands the authentic presence of the analyst. If the analyst can open himself to the patient, he proposes that this will result in more profound changes in the patient's implicit knowing than verbal interpretations in the narrative domain would lead to. The value of intersubjectively relating and dwelling more in the phenomenal than in the narrative dimension is highlighted. A similarity to the works of the existential psychoanalyst Harold Kelman is shown. The author agrees with, but also problematises, a tendency to favour the implicit, devaluing verbal understanding and interpretation, which may result in the patient not seeing the primitive levels in his inner life. For this purpose, works from D. W. Winnicott, Jessica Benjamin and Christopher Bollas, as well as others, are used. The author concludes that object relations and intersubjective theory need to complement each other that further, there is a need to give words to the middle-ground between the phenomenal and narrative dimensions.     

Primal Scene Fantasies and Cathexis of Self as Reflected in the Psychoanalytic Situation

Close parallels are pointed out between the Jewish and the psychoanalytic way of structuring central patterns in their respective thinking. The central power in existence is The Undescribable One or That which is undescribable. The primary task of enlighted man is to remember and hope. An arch is raised from the past into the future and the creation appears as a so-far unfinished process—the final answers will be given first with the return of the profet Elias and Messiah. Thus, the preliminary nature of all our attempts at solutions is underscored.     

The theme of love in Henrik Pontoppidan's Nattevagt (Night watch) and other short novels

The subject of love may not seem an appropriate topic of scientific discourse, for we prefer turning to poetry to learn something meaningful about love. Nonetheless, we find three texts on the subject in Freud's work, all of which underline an internal division in love. He discussed the contrast between the affectionate and sensual aspects of love, while Lacanian writers have supplemented by pointing to the division between pleasure and desire. This article illustrates these concepts with cases taken from the Danish author Henrik Pontoppidan, one of the most prominent Danish writers from the turn of the 19^th century. He is well-known for his novels and for his short novels. One of these, Nattevagt, from 1894, has been read by critics as a marital conflict between the painter Jørgen Hallager and his fragile wife Ursula Branth, who succumbs to the brutality of her husband. The author supplements this simple version of the story with aspects made visible through the idea of an internal division in sexuality, which Freud elaborated into his theory of the death drive around 1920. By way of introduction, a few words are said about Pontoppidan, focusing on the theme of love in his short novels. Following is a brief summary of the plot of Nattevagt. Finally a more detailed reading of the dialogue between the two protagonists, Jorgen and Ursula, opens the way for a psychoanalytic interpretation of the tragic outcome of their love.     

Primary shame,mortal wound and tragic circularity: Some new reflections on shame and shame conflicts

Invited to contribute some thoughts on recent developments in psychoanalytic thinking about shame, the author starts off with Aristotle's prescient analysis of shame and then focuses on accumulating experiences in the psychoanalytic treatment of patients with severe neuroses, in particular the close relationship of severe traumatization and chronic states of shame, and how this is reflected in shelfdestructive repetitions. Reminiscent of what we know from tragedy and the tragic dimension of human existence, this repetition compulsion shows a built‐in circularity. These circular dynamics have at their core struggles with deep woundedness that can variably be conceived of as primary pain, primary shame and primary anxiety. Consequently, throughout the experiences with these patients goes the absoluteness both of their conscience and of their ideal, what we know as the “archaic superego:”     

Seeing patterns in the noise

How do observers detect the presence of objects or features in visual images? Stochastic stimuli (for example, white noise) have become popular choices for providing a linear characterization of early sensory mechanisms. A recent paper by Neri and Heeger takes this type of methodology a step further, and succeeds in isolating and characterizing non-linear mechanisms responsible for the detection and identification of a specific visual target.     

Using the Theory of Gender and Power to Examine Experiences of Partner Violence,Sexual Negotiation,and Risk of HIV/AIDS Among Economically Disadvantaged Women in Southern India

This article uses the Theory of Gender and Power to examine women's vulnerability to HIV/AIDS in order to: understand the vulnerability of female sex workers/poor women due to poverty and lack of educational resources; explore women's vulnerability in the context of client/partner violence, alcohol use, male partner's high-risk behaviors, and women's lack of control in their intimate relationships; and explore the role of traditional heterosexual gender norms in the outcomes of sexual negotiation. Ethnographic data were collected from 32 women and 38 men in India as part of an ongoing National Institute of Mental Health study. Results highlighted women's vulnerability to HIV/AIDS stemming from partner violence, alcohol use, poverty, dangers of sex work environments, and tacit acceptance of cultural/gender norms.     

Psychoanalyse mit Traumatisierten

Extreme and complex traumatisation represents a severe problem in today’s world. There is a need to develop treatment approaches that are efficient for traumatised persons who often live under very difficult circumstances. There are moreover certain societal conditions that are important for the treatment and rehabilitation of the traumatised patient. The paper will discuss how psychoanalytic therapy may be helpful for severely traumatised patients and what are the mechanisms of change in the therapeutic process. A focus is on how traumatic experiences are actualised in the transference and brings the analyst in a situation where enactments inevitably occur. It will be demonstrated how these processes may lead to symbolisation of these traumatic experiences. What are the therapeutic and societal preconditions for treating traumatised patients?