To know or not to know: an application of Bion’s K and –K to child treatment1

The authors discuss an application of Bion’s conceptualisation of thinking and non-thinking states (K and –K links) to the treatment of a nine-year-old girl. The authors consider Bion’s interrelated concepts such as K and –K, container/contained, maternal reverie, and the development of thinking through alpha function to be highly applicable to child treatment. The afore-mentioned conceptual elements are used to elucidate case material over two consecutive hours. A K link is established between therapist and patient, the fragility of which link is then demonstrated by its deterioration into a –K link. Complex issues about knowing and not knowing are central in this girl’s clinical presentation. She was conceived through in vitro fertilisation (IVF), and subsequently diagnosed with cerebral palsy. The authors consider the emotional impact of this origin story and how the parents relate to it. The authors discuss how parents sometimes cope with perceived losses by wishing to shield or protect their children. This can have repercussions for children’s efforts to know (K) and not to know (?K). The fear that emotional knowledge will be too painful to bear can interfere with ‘learning from experience’. Bion’s premise that the purpose of analysis is the growth of the mind is synonymous with the child analyst’s goal of fostering development and understanding impediments to development.     

Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.     

Moral worry and religiosity in US and Canadian college samples

The objective of this study was to investigate the presence of worry about personal moral attitudes and behaviors in two college samples, and to check associations with religiosity, age, gender, personality traits, and geographic region. The study sample was drawn from college students in Minneapolis, Minnesota (N?=?333) and Sydney, Nova Scotia (N?=?137). Instruments consisted of moral worry and religiosity questionnaires, and the Eysenck Personality Questionnaire. Principal-components analysis was used to develop components for the worry and religiosity scales, and MANOVA for correlations between variables. Moral worry emerged as a domain distinct from worry about practical issues. Moral worry was not related to religiosity, age, gender, or Eysenck personality traits. Whereas the US sample scored higher in religiosity than the Canadian sample, the Canadian sample scored higher on moral worry. The present study supports our previous work and that of others that worry about one's moral emotions and behaviors is an important aspect of daily life. As such, consideration should be given to including some inquiry about moral worries (guilt, shame, regret, remorse, and others) in psychiatric assessments.     

A reappraisal of medieval mysticism & hysteria

This paper examines the historical association between medieval mysticism and asceticism and the psychopathological condition of hysteria. We first review the particular forms of medieval mysticism and asceticism that seem to have inspired modern psychiatrists and reductive historians to dismiss these phenomena as indubitably neurotic behaviours. Then we review the concept of hysteria as it evolved during the last two centuries for points of convergence with mysticism. Finally, we question the validity of value-laden diagnostic formulations in the domain of personality assessment. A few highly dramatic but culturally endorsed religious behaviours occuring in an otherwise well functioning individual does not constitute a basis for any psychiatric diagnosis, let alone a condemnatory characterological one such as hysteria. We propose a perspective for looking at medieval mystical states of mind and behaviours in context that moves beyond ahistoric assumptions that employ modern Western standards as the yardstick for medieval health and illness.     

Patterns of paralexia: A psycholinguistic approach

A sample of the literature on acquired dyslexia is reviewed with special reference to the nature of paralexic errors. Linguistic studies of six cases of dyslexia are presented, with appropriate neurological and psychological details; there are two cases of each of three hypothesized types of impairment, visual dyslyxia, surface (grapheme-phoneme) dyslexia, and deep (syntactico-semantic) dyslexia. Finally, a scheme for acquired dyslexia is proposed and related to the error patterns observed in normal adult readers and in children learning to read; our approach to lexical look-up is one that the diagram makers may have found sympathique.This is a revised version of paper presented at the International Neuropsychology Symposium, Engelberg, Switzerland, June 1971.