Gastroesophageal reflux disease: alexithymia and attachment style

Alexithymia and its relation with attachment style were evaluated in a group of 69 patients (men, M age = 46.4 yr., SD = 12.6; women, M age = 44.2 yr., SD = 14.4) affected by Gastroesophageal Reflux Disease. Two self-evaluation questionnaires were used for psychological evaluation, the 20 item Toronto Alexithymia Scale (TAS-20) and the Attachment Style Questionnaire (ASQ). The TAS-20 analysis showed that the clinical sample taken as a whole did not score in the alexithymic range. The inverse correlations between the Confidence ASQ subscale and the Difficulty Communicating Feelings TAS-20 subscale showed that communication of emotions could develop more easily within the framework of a relational context characterized by safety and confidence. In this group of patients this was represented by the referent caregiver.     

Metacognitive Interpersonal Therapy Improves Adherence to Antiretroviral Therapies in a Man with a Severe Personality Disorder: A Case Report

Treatment adherence by patients with HIV ensures they gain the full benefit of antiretroviral medications and extend their lives. One problem which may contribute to poor adherence is deficits in metacognition or the capacity to make sense of mental states. In particular, persons who struggle to notice and think about their thoughts and feelings may be less able to direct their own recovery by taking advantage of effective treatments. This raises the possibility that treatments which lead to improved metacognitive function may enhance treatment adherence. We describe the case of a man in an advanced stage of AIDS with Kaposi’s sarcoma. The patient was treated with Metacognitive Interpersonal Therapy combined with psychoeducation about pharmacological treatment for HIV. Primary medical outcomes were suppression of viral load, increase of CD4 count and control of AIDS related conditions such as Kaposi’s sarcoma. The primary psychological outcome was reduction of personality disorders criteria. The patient was able to understand what led him to discontinue medication and then later regain full adherence. He achieved suppression of viral load and restore of CD4 count. As regard severity of personality disorder, he achieved reliable change. Interventions such as Metacognitive Interpersonal Therapy may assist patients with HIV to gain the metacognitive capacities to make sense of their medical and psychological challenges and adhere to antiretroviral therapies leading to enhanced levels of health. Future studies are needed to explore these findings in larger controlled studies.     

On the development of depressive states from a psychodynamic viewpoint

The author analyzes the temporal dimension of depression by making reference to one of the clinical cases he treated and re-examining a clinical case analyzed by Edith Jacobson. According to the result of his observations, the developmental psychodynamics of a depressive state normally appears to take place in two distinct phases: a first narcissistic loss, which gives rise to an integrative conflict and to the formation of a certain identificatory structure, is later followed by a second narcissistic loss, which leads to the real depressive state. The two phases present a specific, intrinsic connection constituted by the implication of the same identificatory element of the self, recognition of which can favour a clinical work that more closely adheres to the deep dynamics of depression.     

Hitting the Bull’s Eye in Personality Disorders Psychotherapy

Psychotherapy of personality disorders (PD) is gaining momentum, though the progress has been mostly concerned borderline PD, with the other disorders largely neglected. In parallel, many empirically tested approaches focus on a limited understanding of psychopathology, for example poor mentalization or affect dysregulation, while PD are complex entities; they require clinicians paying attention to multiple therapy targets in order to be treated effectively and for a hope of actual recovery. I contend here that a more comprehensive account of psychopathology is needed; therefore the papers in this special issue focus on some of these aspects, such as difficulties in mental state understanding, dysfunctional representations of self with others, poor affect regulation and lack of access to adaptive and healthy self-aspects. The papers included in this special issue try and provide the readers with an intensive qualitative account of how therapists can act and yield improvements in these domains, with the hope of improving clinicians’ abilities to treat PD no matter what their preferred orientation is.     

A psychoanalytic interpretation of bipolar disorder

Abstract

The author proposes viewing mania as a form of defense against the state of depression resulting from “narcissistic overidentification with the depressive object” (i.e., the object in relation to which the depressive state developed), rather than as a periodic rebellion against such an internalized object. An account of the analytic psychotherapy of a clinical case of bipolar depression serves to illustrate this point of view, linked to the author’s specific conception of the dynamics of depression.     

“Doubly Mother”: Heterologous Artificial Insemination Between Biological and Social Parenthood: A Single Case Study

In heterologous artificial insemination, the donation of gametes (either sperm or eggs) from a third person allows infertile and same-sex couples to become parents. Therefore, the child is genetically related to one parent, while the other parent is referred to as the social mother or father. This current single case study aimed at investigating this double access to parenthood in a lesbian couple who had two children after heterologous artificial insemination. In this couple, both women delivered one of the two children, so that each partner is either biological or social mother. The Clinical Generational Interview was used to assess the quality of family relationships, with a specific focus on three dimensions: the origins of each partner, the constitution of the couple, and the generational passage. Paper and pencil textual analysis was conducted following the principles of Interpretative Phenomenological Analysis and led to the identification of six dominant themes (and subthemes): (a) relationship with the family of origin; (b) couple relationship; (c) generational passage; (d) heterologous artificial insemination and “double motherhood”; (e) donor/biological father; and (f) children identity and the disclosure of their origin. This study’s findings revealed the importance of using research techniques aimed at in-depth exploration of this phenomenon consistently with the specificities of the new filiation forms. The adoption of a transgenerational perspective allows articulating conception coordinates with the history of the couple and each partner’s origins.     

Healthy Lifestyle,Well-being,Physical Activity,Sport, and Scholastic/academic Performance: Interactions and Connections

The physical activity and sport are key elements for a healthy lifestyle. However, a little-investigated element is the presence of a possible relationship between school or academic performance and the participation in physical activity and sport in groups of preadolescents and adolescents. In order to clarify the complex relationship between mind and body in preadolescence and adolescence, the present discussion investigates the causal and direct relationship between sport activity and performance; and describes how this relationship can be mediated by the sense of self-esteem and self-efficacy; and investigates the relationship between group sports practice and school or academic performance.