Field Theory in Psychoanalysis,Part I: Harry Stack Sullivan and Madeleine and Willy Baranger

This is the first of two articles comparing conceptions of the field in interpersonal/relational psychoanalysis (IRP) and Bionian field theory (BFT). This article compares the thinking of the originators of IRP and BFT, Harry Stack Sullivan and Madeleine and Willy Baranger.     

Breathing Together: Reply to Harris and Shaw

These two very different but complementary discussions address two different “registers” of my thinking in my paper on patients who “live in airless intrapsychic worlds.” Harris is most interested in the meta-theoretical and historical contexts and frames of my theory and clinical approach, viewing my contribution as an example of various broad trends in contemporary relational psychoanalytic thought. Shaw, by contrast, engages with my particular insights and clinical/theoretical framework for understanding and working with patients whose struggles very much resemble and overlap with the struggles of the adult children of “traumatically narcissistic” parents, which his seminal work has focused on. In my Replies I voice my appreciation of each of their unique perspectives on my ideas, and engage with each of them regarding certain differences in our theoretical and clinical sensibilities.     

The Hard-to-Engage Patient: A Treatment Failure

I discuss the relatedness with certain hard-to-engage patients as a kind of dissociative enactment, and I present a case illustration of a man whom I liked but could not help.     

Object Relations and Interpersonal Problems in Sexually Abused Female Patients: An Empirical Study With the SCORS and the IIP

Ninety-three children from a child guidance clinic were asked to select the Rorschach card which represented their mother, their father, the card they liked best, the card they liked least, and the most frightening card. In comparing the present data with earlier findings, it was determined that no reliable selection of a parental card could be safely made. However, card X appears to represent consistently the best liked card and Card IV a negative reaction card. As in earlier studies, none of the significant results represents a majority of the group's choices for any one stimulus value.     

Transference Focused Psychotherapy for Patients with Comorbid Narcissistic and Borderline Personality Disorder

Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experience with and research data on patients with comorbid narcissistic personality disorder/borderline personality disorder (NPD/BPD). We briefly review object relations formulations of severe narcissistic pathology, as well as recent research in attachment and the allied concept of mentalization, which have provided a new lens through which to view narcissistic disorders. The research findings from two randomized clinical trials demonstrating the efficacy and effectiveness of TFP are presented. The data from the two Randomized Clinical Trials (RCT) allowed for the study of the characteristics of the subgroup of borderline personality disorder patients who have comorbid NPD/BPD. Findings on comorbidity, attachment status, capacity for mentalization, and level of personality organization of borderline patients with comorbid NPD/BPD, compared with borderline patients without comorbid narcissistic pathology (BPD), are presented. Clinical implications of the observed group differences are discussed, with a focus on refinements in the technique of TFP. Clinical case material is presented to illustrate the specific challenges posed by narcissistic patients to carrying out TFP in each phase of treatment.     

Executive functions and social skills in survivors of pediatric brain tumor

Medical advances have resulted in increased survival rates for children with brain tumors. Consequently, issues related to survivorship have become more critical. The use of multimodal treatment, in particular cranial radiation therapy, has been associated with subsequent cognitive decline. Specifically, deficits in executive functions have been reported in survivors of various types of pediatric brain tumor. Survivors are left with difficulties, particularly in self-monitoring, initiation, inhibition, and planning, to name a few. Another domain in which survivors of pediatric brain tumor have been reported to show difficulty is that of social skills. Parents, teachers, and survivors themselves have reported decreased social functioning following treatment. Deficits in executive functions and social skills are likely interrelated in this population, as executive skills are needed to navigate various aspects of social interaction; however, this has yet to be studied empirically. Twenty-four survivors of pediatric brain tumor were assessed using a computerized task of executive functions, as well as paper-and-pencil measures of social skills and real-world executive skills. Social functioning was related to a specific aspect of executive functions, that is, the survivors' variability in response time, such that inconsistent responding was associated with better parent-reported and survivor-reported social skills, independent of intellectual abilities. Additionally, parent-reported real-world global executive abilities predicted parent-reported social skills. The implications of these findings for social skills interventions and future research are discussed.     

Need Satisfaction Supportive Game Features as Motivational Determinants: An Experimental Study of a Self-Determination Theory Guided Exergame

Empirical studies have validated that basic needs satisfaction supported by video game play predicts motivation and engagement outcomes. However, few studies specifically manipulated game features for each of the three basic needs specified in the self-determination theory (SDT) to examine how the game features impact players' need satisfaction and game experience. The current study employed an in-house developed exergame and manipulated the game features in a 2 (autonomy-supportive game features: on vs. off) × 2 (competence-supportive game features: on vs. off) experiment to predict need satisfaction, game enjoyment, motivation for future play, effort for gameplay, self-efficacy for exercise using the game, likelihood of game recommendation, and game rating. The manipulated game features led to the corresponding need satisfaction. Manipulated autonomy-supportive and competence-supportive game features had main effects on most motivation and engagement outcomes. Need satisfaction of autonomy and need satisfaction of competence were both found to be mediators for the relationships between the game features and the motivation and engagement outcomes. The findings add evidence to support the underlying mechanism postulated by SDT for media enjoyment and motivation as well as the emerging entertainment research conceptualizing enjoyment as need satisfaction. The findings also have practical implications for intervention effort that intends to capitalize the motivational pull of video games.     

The precuneus and the insula in self-attributional processes

Attributions are constantly assigned in everyday life. A well-known phenomenon is the self-serving bias: that is, people’s tendency to attribute positive events to internal causes (themselves) and negative events to external causes (other persons/circumstances). Here, we investigated the neural correlates of the cognitive processes implicated in self-serving attributions using social situations that differed in their emotional saliences. We administered an attributional bias task during fMRI scanning in a large sample of healthy subjects (n = 71). Eighty sentences describing positive or negative social situations were presented, and subjects decided via buttonpress whether the situation had been caused by themselves or by the other person involved. Comparing positive with negative sentences revealed activations of the bilateral posterior cingulate cortex (PCC). Self-attribution correlated with activation of the posterior portion of the precuneus. However, self-attributed positive versus negative sentences showed activation of the anterior portion of the precuneus, and self-attributed negative versus positive sentences demonstrated activation of the bilateral insular cortex. All significant activations were reported with a statistical threshold of p ≤ .001, uncorrected. In addition, a comparison of our fMRI task with data from the Internal, Personal and Situational Attributions Questionnaire, Revised German Version, demonstrated convergent validity. Our findings suggest that the precuneus and the PCC are involved in the evaluation of social events with particular regional specificities: The PCC is activated during emotional evaluation, the posterior precuneus during attributional evaluation, and the anterior precuneus during self-serving processes. Furthermore, we assume that insula activation is a correlate of awareness of personal agency in negative situations.     

Koran reading and negotiation with jinn: strategies to deal with mental ill health among Swedish Somalis

In this paper, we discuss traditional Somali concepts of mental ill health. Qualitative interviews were conducted with some 20 Swedish Somali interviewees about factors causing mental ill health, traditional classification, strategies to deal with mental ill health, and attitudes to the mental health care services in Sweden. Social mobilisation and religious healing are cornerstones of traditional Somali measures to deal with mental suffering. Traditional Somali views of mental ill health stand in stark contrast to classification of mental ill health in the western biomedical model. These views deserve attention since they may have an impact on health-seeking behaviour among Somali immigrants in western countries. Yet a too strong focus on cultural aspects may over-shadow the fact that much mental suffering among Somali migrants must be understood within social, economic, and political contexts.