A Program Intervention for Pediatric Bipolar Disorder: Preliminary Results

The effectiveness of a behaviorally based day treatment program for young children diagnosed with Pediatric Bipolar Disorder (PBD) was evaluated using pretreatment and posttreatment mean scores from the Child Behavior Checklist (CBCL). Data were evaluated in aggregate and using the clinically significant change method for children diagnosed with PBD, Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Adjustment Disorder, and no diagnosis/clinical and subclinical groups. Significant effects were found for all groups except the no diagnosis/subclinical group on the Internalizing scale and for all groups on the Externalizing scale. Clinically significant change was supported for the PBD, ADHD, ODD, and Adjustment Disorder groups. Implications and limitations of the study are discussed.     

Creativity,perversion and the violations of expectations

Abstract

Violations of expectations provide a motive for both creativity and perversion. The term “violations of expectations,” derived from empirical studies of early development, includes surprise, shock, betrayals of trust, as well as the possession of extraordinary talents. In the creative area, violations of expectations are illustrated through aspects of the life and work of Marc Chagall and Richard Wagner, and in perversion through the lives and actions of serial killers.

Lachmann FM. Kreativität, Perversion und die Verletzungen von Erwartungen

Verletzungen von Erwartungen liefern ein Motiv für beides: Kreativität und Perversion.Diese Benennung, aus empirischen Untersuchungen früher Entwicklung abgeleitet, schließt sowohl Überraschung, Schock, Verrat von Vertrauen ein wie auch die Verfügung über außergewöhnliche Talente. Im kreativen Bereich werden Verletzungen von Erwartungen durch Aspekte von Leben und Werk von Chagall und Richard Wagner illustriert und im Bereich der Perversionen durch Leben und Aktionen von Serien-Mördern.

Lachmann FM. Creatividad, perversión y violación de las expectativas.

La violación de las expectativas provee un motivo para ambas, la creatividad y la perversión. Este término, derivado de estudios empíricos sobre el desarrollo temprano, incluye sorpresa, shock, revelación de la verdad, así como la posesión de talentos extraordinarios. En la creativa violación de expectativas se ilustran aspectos de la vida y del trabajo de Marc Chagall y Richard Wagner y en la perversión a través de sus vidas y acciones de asesinos en serie.     

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.     

The role of childhood sexual seduction in the development of an erotic transference: Perversion in the psychoanalytic situation

Abstract

Based on Ferenczi's Confusion of Tongues theory of trauma we proposed the following hypothesis: “An erotic transference is an enactment in the here-and-now of the psychoanalytic situation of a childhood seduction of sexual trauma”. We delineate the relational approach to the analysis of the incest trauma, both theoretically and clinically. The concept of enactment helps us understand the emergence of the incest trauma in the psychoanalytic situation as an indication of an earlier childhood experience. Three clinical examples are discussed which illustrate ways of using the hypothesis within the analytic process. The clinical examples demonstrate the value of enactments that are contained in the unconscious communication that the erotic transference represents.

Rachman AWM et al. Die Rolle sexueller Verführung in der Kindheit bei der Entwicklung einer erotischen Übertragungsperversion in der psychoanalytischen Situation

Basierend auf Ferenczi′s Konfusion der Zungen Trauma Theorie schlugen wir die folgende Hypothese vor: Eine erotische Übertragung ist eine Inszenierung im Hier und Jetzt der psychoanalytischen Situation einer Kindheits Verführung als sexuellem Trauma. Wir entwerfen den relationalen Ansatz theoretisch und klinisch in Bezug auf die Analyse des Inzest Traumas. Das Konzept der Reinszenierung hilft uns das Auftauchen des Inzest Traumas als ein Anzeichen einer früheren Kindheitserfahrung in der psychoanalytischen Situation zu verstehen. Es werden drei klinische Beispiele diskutiert, die die Wege illustrieren, die Hypothese innerhalb des analytischen Prozesses anzuwenden. Die klinischen Beispiele zeigen den Wert von (Re-) Inszenierungen, die in der unbewußten Kommunikaton enthalten sind, welche die erotische Übertragung repräsentieren.

Rachman A WM et. al. El rol de la seducción sexual infantil en el desarrollo de una transferencia erótica: perversión en la situación analítica.

Basado en la teoría del trauma de la confusión de lenguas de Ferenczi, proponemos la siguiente hipótesis: una transferencia erótica es un enactment en el aquí y el ahora de la situación analítica del trauma de la seducción sexual infantil. Trazamos la aproximación relacional del análisis del trauma del incesto. El concepto de enactment nos ayuda a entender la emergencia del trauma del incesto en la situación psicoanalitica, como indicación de una experiencia infantil temprana.

Se presentan tres ejemplos clínicos que ilustran formas de uso de la hipótesis desde el proceso analítico. Estos ejemplos clínicos demuestran el valor de los enactments contenidos en la comunicación inconsciente que representa la transferencia erótica.     

Searching for the enriching sense of otherness: The psychoanalytic psychotherapist as a meaning-bearing other

Abstract

This paper is a theoretical and clinical examination of the patient's search for the otherness of the therapist as a prerequisite for change and development in relational psychoanalytic psychotherapy. A basic assumption is that being in a relationship as well as being a personal self, is to be understood, as being with a “meaning-bearing other”; that is, someone who allows for the possibility of meaningful thoughts and feelings, either through an actual communicative presence or as a consciously, prereflective, or unconsciously imagined communication partner. The term “meaning-bearing other” is used to differentiate distinct, although often synchronic, modes of relatedness. The need for intersubjective “depth”—that is, to discover the otherness of the other, and for oneself to be recognized as an experiencing subject—is regarded as a main motivational force. Winnicott's, as well as Sullivan's developmental approaches, Mitchell and Aron's views on psychoanalytic interaction, and Heidegger and Gadamer's phenomenology and hermeneutics are used as theoretical points of reference for the present discourse. The theoretical points of view are examined and discussed through excerpts from twice-a-week psychotherapy with a six-year old girl.     

Seduction,date rape,and aborted surrender

Abstract

This paper clarifies the dual-layered nature of the “demon lover complex,” with its background of both pre-Oedipal trauma and Oedipal-level desire. It draws on an object relations understanding of the unconscious and dissociated addiction to an internal demon object that has derivations in the personalities of the actual parents, and in the internalization of these parents. The dramatic case of early trauma compounded by adult date rape trauma serves to illustrate how a “developmental mourning process” in treatment can resolve such trauma. It also illustrates how reparation with the mother that partially heals pre-Oedipal trauma cannot immunize anyone against Oedipal-level attractions to a “demon lover” father, as represented in a displacement, resulting in victimized behavior, and in an aborted surrender to heterosexual desire. However, this victimization can be resolved, as seen in the clinical illustration, when the psychoanalyst has an understanding of the mourning process in developmental terms, working with a natural interaction between mourning and transference evolutions in treatment. The case also demonstrates the transitional object role of the psychoanalyst who is involved with the healing of pre-Oedipal trauma through mourning.     

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.