Interpretive acting-out: Unavoidable and sometimes useful

Abstract

Using one detailed case presentation, this paper examines the clinical hardship of making accurate and helpful interpretations that do not become part of the patient's defensive system. The author argues that interpretive acting-out is inevitable in the psychoanalytic process. But, if properly monitored, understood, and contained, these interpretive enactments can sometimes actually be a profit to the overall treatment. Issues of projective identification, countertransference, and the importance of realizing our transference role in the patient's changing phantasies are discussed throughout the case material.     

Sleep Symptoms as a Partial Mediator Between Combat Stressors and Other Mental Health Symptoms in Iraq War Veterans

Sleep symptoms are a prominent feature of mental health disorders like PTSD and depression. However, it is unknown whether sleep symptoms mediate the relationship between combat stress and these disorders. We examined the mediating role of sleep symptoms on the relationship between combat stress and PTSD; and the relationship between combat stress and depression using data from 576 Army veterans of the Iraq War surveyed in 2004. Correlational analyses revealed that when insomnia was included in the model, the correlation between combat stressors and other depression symptoms decreased by 65%; and when nightmares were included in the model, the correlation between combat stressors and other PTSD symptoms decreased by 69%. We replicated these analyses using individual items assessing PTSD and depression and found that the insomnia and nightmare items had the largest and second largest mediation effect between combat stressors and PTSD and depression symptoms. Our result support the theory that sleep symptoms contribute to the development and/or maintenance of other mental health symptoms and that early treatment of sleep symptoms may mitigate the other mental health consequences of combat stress.     

Clinical Commentary

This paper describes a lengthy period of psychotherapy with a child. This treatment began only after a prolonged contact with other child and adolescent mental health services during which the child's difficulties, which had initially seemed to be ordinary behavioural problems, had proved puzzlingly intractable to a variety of interventions. Subsequent psychotherapy revealed a profound disorder of development which lay bath the Surface presentation. In a climate where Asperger's syndrome is often felt to be untreatable, this paper argues that some children, at least, can benefit from psychotherapy and can be helped towards real mental growth. Asperger's syndrome in children bears some striking similarities to narcissistic personality disorder as described in the adult psychoanalytic literature and this paper discusses some of the theoretical and clinical implications of the innate origins of Asperger's syndrome.     

Effect of the Healthy MOMs Lifestyle Intervention on Reducing Depressive Symptoms Among Pregnant Latinas

Depression during the prenatal and postpartum periods is associated with poor maternal, perinatal and child outcomes. This study examines the effectiveness of a culturally and linguistically tailored, social support-based, healthy lifestyle intervention led by trained community health workers in reducing depressive symptoms among pregnant and early postpartum Latinas. A sample of 275 pregnant Latinas was randomized to the Healthy MOMs Healthy Lifestyle Intervention (MOMs) or the Healthy Pregnancy Education (control) group. More than one-third of participants were at risk for depression at baseline. MOMs participants were less likely than control group participants to be at risk for depression at follow-up. Between baseline and 6 weeks postpartum, MOMs participants experienced a significant decline in depressive symptoms; control participants experienced a marginally significant decline. For MOMs participants, most of this decline occurred during the pregnancy intervention period, a time when no change occurred for control participants. The change in depressive symptoms during this period was greater among MOMs than control participants (“intervention effect”). From baseline to postpartum, there was a significant intervention effect among non-English-speaking women only. These findings provide evidence that a community-planned, culturally tailored healthy lifestyle intervention led by community health workers can reduce depressive symptoms among pregnant, Spanish-speaking Latinas.     

The neural correlates of statistical learning in a word segmentation task: An fMRI study

Functional magnetic resonance imaging (fMRI) was used to assess neural activation as participants learned to segment continuous streams of speech containing syllable sequences varying in their transitional probabilities. Speech streams were presented in four runs, each followed by a behavioral test to measure the extent of learning over time. Behavioral performance indicated that participants could discriminate statistically coherent sequences (words) from less coherent sequences (partwords). Individual rates of learning, defined as the difference in ratings for words and partwords, were used as predictors of neural activation to ask which brain areas showed activity associated with these measures. Results showed significant activity in the pars opercularis and pars triangularis regions of the left inferior frontal gyrus (LIFG). The relationship between these findings and prior work on the neural basis of statistical learning is discussed, and parallels to the frontal/subcortical network involved in other forms of implicit sequence learning are considered.