Psychological management and body image issues in facial transplantation

Facial transplantation, although controversial, is proposed as a major advance in facial reconstructive surgery, with the first partial transplant having taken place in France in November 2005. Although the psychological impact of facial transplantation will not be understood until several procedures have been carried out, this article examines the psychological issues likely to arise with particular reference to body image. A detailed framework for anticipation and management of psychological change is proposed. Pre-operative preparation must include thorough psychological preparation for the patient and their family. The immediate post-operative period is likely to be challenging, and a detailed management plan is proposed emphasising early return to function; subsequent psychological issues including altered body image, anxiety, shame, depression, communication and behavioural avoidance are discussed and a management strategy based on cognitive behavioural principles is proposed for the first post-operative year. Previous discussion frames psychological outcome in terms of complication and risk, tending to downplay the potential advantages of a successful procedure; the focus of this paper is on ensuring psychological adjustment as an inevitable consequence of change.     

Play Group Therapy with Psychotic Adolescent Girls

In this paper, by using the perspective of self psychology, we hope to illustrate and explicate (through clinical examples) the positive aspects of the pairing phenomenon in group therapy with the elderly. Traditionally subgrouping or pairing has been viewed as the “Achilles' heel of group therapy,” and usually interpreted as defensive and destructive to group process. In this paper we distinguish between those instances of pairing and subgrouping that are defensive and those that are reparatory of the self system (the latter involving twinship and alter ego selfobject transferences). These reparatory transferences may play a constructive role in establishing group cohesion and allaying primitive somatic anxieties, especially in the elderly patient.     

Connotative Meaning as a Determinant of Response to Test Item Content

The purpose of this study was to determine if responses of like or dislike to Perceptual Reaction Test (PRT) designs — and thus, its ability to discriminate among criterion groups — were related to the connotative meaning of the designs. Seventy-four Ss were administered the PRT designs to which they responded on the traditional like-dislike alternatives as well as rating each design on a semantic differential. Correlations between the like-dislike dimension of the PRT designs and the semantic differential ratings of those designs indicated that when a S checks like for a design, he is expressing a positive evaluation of that design and probably sees it as less potent than those designs for which he checked dislike. Expression of like or dislike for a design appears to be inconsistently related to the activity dimension of meaning.     

Facilitated Disclosure Versus Clinical Accommodation of Infidelity Secrets: An Early Pivot Point in Couple Therapy. Part 2: Therapy Ethics,Pragmatics, and Protocol

In couple therapy, one partner's private disclosure of infidelity presents a potentially polarizing issue involving the therapist's decision to facilitate disclosure or accommodate non-disclosure. Some therapists may assume accommodating an infidelity secret is the most compassionate and efficient option. We consider this decision in the context of therapy ethics of equal advocacy and confidentiality, implications for individual and relationship healing, and pragmatic aspects of conducting therapy. We conclude that measured disclosure of infidelity, determined by the aggrieved spouse, best resolves the potential collision of multilateral advocacy with confidentiality and offers the best prospects for a working therapy alliance and couple healing and renewal. A clinical protocol for facilitating disclosure of infidelity secrets is presented.     

Training Considerations for MFTs in Couple and Financial Counseling

Evidence suggests that many couples attending marital therapy report that financial concerns have a significant impact on their distress. Despite the complaint, many Marriage and Family Therapy (MFT) training programs do not offer courses that teach therapists how to properly address financial concerns as a part of their training or curriculum, leaving many practitioners unaware of the processes associated with remediating the distress. The authors address the concepts of financial literacy and financial problems, and suggest a training curriculum to guide therapists in decisions about treating financial concerns for couples. Suggestions of future research and core competencies are discussed.     

The Relationship Between Academic Oral Proficiency and Reading Performance: A Comparative Study Between English Learners and English-Only Students

This study investigates the relationship between oral proficiency and reading proficiency in English-learning children (L2 students) and native English-speaking children (NE students). A set of oral activities measuring students’ academic oral skills in science classes was developed and administered to 61 fourth graders. Both the meaning-related aspects and the formal aspects of the students’ academic oral proficiency were compared between strong and struggling readers and between NE and L2 students. The study thus used a 2 × 2 factorial design (Strong/Struggling Readers × NE/L2 Students). After controlling for the students’ nonverbal analytic and reasoning skills, this study found that strong and struggling readers showed different levels of performance with respect to the meaning-related aspects of oral academic language but not with respect to the formal aspects of language. Conversely, differences between NE and L2 students were found in components related to the formal aspects but not in those related to the meaning aspects of oral language.     

Deconstructing the unconscious saboteur: Composing a life with ambition and desire

Abstract

This paper explores the unconscious roots of women's ambition from an object relations, developmental, and hermaneutic perspective. Three high-profile women's stories illustrate the formative and deformative power of narration: those of Hilary Clinton, Tina Turner, and the heroine of Phantom of the Opera. Each narrative reveals typical deformative constrictions to the expression of female ambition, including male abrogation of female capability and the denigration of ambition as unfeminine. Through clinical vignettes, this paper explores dynamic, developmental, and cultural forces that block female ambition's full flowering. Part of the need to keep women's ambition limited stems from the unconscious needs of the masculine psyche for superiority. This is communicated to little girls through their mothers' internalized parental imagoes, including their mothers' identification with their mothers and their own oedipal struggles. Similarly, the father's unconscious anxieties in relation to his parental imagoes, particularly his preoedipal and oedipal relations with his mother, are communicated. Another constraining dynamic relates to female conflicts around separation from the mother. Composing new narratives of women's ambition with our patients can incorporate the uniquely feminine aspects of comfort with diffusion, while weaving multiple and disparate strands laced with nurturance and aggression.

Harriet Kimble Wyre. Auflösung des unbewussten Saboteurs: Aufbau eines Lebens aus Streben nach Erfolg.

Erforscht werden die unbewussten Wurzeln des Erfolgstrebens von Frauen, aus der Perspektive der Objektbeziehungen, der Entwicklungspsychologie und der Hermeneutik. Die Erfolgsgeschichten dreier hochrangiger Frauen zeigen die aufbauende und zersetzende Kraft ihrer internalisierten Lebensgeschichten: Hilary Clinton, Tina Turner, und die Heldin aus Phantom der Oper. Die Lebensgeschichten enthüllen typische deformierende Einengungen der Einschätzung von weiblichem Erfolgsstreben. Ein Aspekt davon ist die von männern oft vertretene Aberkennung von ausserordentlichen Fähigkeiten von Frauen sowie die Ansicht von Männern, Erfolgsstreben bei Frauen sei unweiblich.

Durch klinische Vignetten werden dynamische, entwicklungspsychologische und kulturelle Kräfte erforscht, die die volle Entfaltung des Erfolgstrebens von Frauen blockieren. Begrenzt werden die Wünsche der Frauen nach Erfolg zum Teil durch die unbewussten Vorstellungen der männlichen Psyche, die männliche Überlegenheit zu bewahren. Diese Haltungen werden den kleinen Mädchen durch die Mutter, gemäss deren internaliserten Elternimagos, vermittelt. Dazu gehören die Identifizierungen der Mutter mit ihrer Mutter und ihre eigenen ödipalen Auseinandersetzungen. Auf die gleiche Weise werden die unbewussten Ängste des Vaters bezüglich seiner Elternimagos vermittelt, insbesondere seine vorödipale Beziehung mir seiner Mutter. Eine weitere einengende Dynamik ergibt sich für das Mädchen aus der Ablösung von der Mutter.

Wird mit unseren Patientinnen ein neues Verständnis von Erfolgsstreben geschaffen, breitet sich eine einmalige weibliche Ausprägung von vielseitiger Befriedigung aus, getragen vom Bedürfnis zu Ernähren und die Aggressionen konstruktiv umzusetzen.

Harriet Kimble Wyre. Deconstruyendo el saboteador inconsciente: Componiendo una vida con ambición y deseo.

Este trabajo explora el origen de las raíces inconscientes de la ambición en las mujeres desde las perspectivas de las relaciones objetales, del desarrollo y la hermeneútica. Las historias de tres mujeres de alto perfil ilustran el poder formativo y deformativo del poder de la narrativa: Tina Turner, Hilary Clinton y la heroína del Fantasma de la Opera. Cada narrativa revela típicas constricciones deformativas de la expresión de la ambición femenina, incluyendo la abrogación masculina de la capacidad femenina y la denigración de la ambición como no femenina.

A través de estas viñetas, se explora las fuerzas dinámicas, de desarrollo y culturales que bloquean el completo florecimiento de la ambición en la mujer. Parte de la necesidad de mantener la ambición femenina limitada proviene de la necesidad inconsciente de superioridad de la psique masculina. Esto es comunicado a las niñas por medio de las imagos parentales interiorizadas de la madre, incluyendo la identificación de la madre con su propia madre y sus conflictos edípicos. De manera semejante las ansiedades inconscientes del padre en relación con sus imagos parentales, particularmente sus relaciones preedípicas así como edípicas con su madre son también comunicados. Otra dinámica que constriñe se refiere a los conflictos femininos alrededor de la separación de la madre. Componer nuevas narrativas acerca de la ambición en las mujeres con nuestras pacientes permite incorporar los extraordinarios aspectos femeninos de consuelo y difusión mientras teje múltiples y dispares cabos enlazados a la crianza y la agresión.     

Race and Ethnicity: An 11‐Year Content Analysis of Counseling and Values

Using the Dimensions of Personal Identity Model proposed by Arredondo and Glauner (as cited in Arredondo et al., 1996 ), the authors reviewed the last 11 years of the Association for Spiritual, Ethical, and Religious Values in Counseling's journal, Counseling and Values, specifically regarding the “A” dimensions of race and ethnicity. Twenty‐five of the 235 articles reviewed (11%) contained a multicultural perspective defined in these terms. Other aspects of cultural inclusion, such as authorship and type of study, were also considered.