Winnicott's invitation to ‘further games of Jung‐analysis’

Winnicott signs off his celebrated review of Jung's (1963) autobiography Memories, Dreams, Reflections with the warning that translation of ‘erreichten’ as ‘attained’ (implying assimilation) rather than as ‘reached to’, could ‘queer the pitch for further games of Jung‐analysis’. This subtly underscores his view that Jung—who he described earlier as ‘mentally split’ and lacking ‘a self with which to know’—remained essentially dissociated. However, Winnicott, whilst immersed in this work on Jung, wrote a letter to Michael Fordham describing himself as suffering ‘a lifelong malady’ of ‘dissociation’. But this he now reported repaired through a ‘splitting headache’ dream of destruction, dreamt ‘for Jung, and for some of my patients, as well as for myself’ (Winnicott 1989, p. 228). Winnicott's recurrent concern during his last decade was with ‘reaching to’—that quintessential Winnicottian term—some reparative experience that could address such difficulties in constellating a ‘unit self’. This is correlated with his engagement with Jung and tracked through his contemporaneous clinical work, particularly ‘Fear of Breakdown’ (1963). Themes first introduced by Sedgwick (2008) and developed by the author's earlier ‘Winnicott on Jung; destruction, creativity and the unrepressed unconscious’ (2011) are given further consideration.     

Relational Psychoanalysis and the Tragic-Existential Aspect of the Human Condition

I suggest we may benefit by opening relational thinking to a certain aspect of a classical psychoanalytic worldview. Opening to what we can call the tragic and existential dimensions of the human condition: the universal experience of a certain inner dividedness, hiddenness, and self-deception—a strangeness within the “otherness” that constitutes ordinary, good-enough human environment; as well as the equally universal experience of impermanence—lack, inevitable loss, and finitude. Such openness entails listening to themes we hear in many critiques of relational thinking—critiques that often devolve into caricaturing relationality as avoiding the dark, internally divided side of our nature. It entails listening well enough to these universal themes in ourselves and in our patients so that we can radically reframe them—without recourse drives—in expanded, relational terms. As in Mitchell’s words, “dialectical tensions not taken as polarities … but rather as interpenetrating and, in some sense, as mutually creating each other.”     

Worker Well-Being: What it Is,and how it Should Be Measured

Applied Research in Quality of Life - Worker well-being is a hot topic in organizations, consultancy and academia. However, too often, the buzz about worker well-being, enthusiasm for new programs...     

The development and content of an interpersonal psychotherapy group for postnatal depression

Postnatal depression (PND) usually causes distressing symptoms for sufferers and significant impairments in relationships. Group Interpersonal Psychotherapy (IPT-G) provides the experienced therapist with a brief, focused, and manualized approach to helping women recover from the debilitating effects of PND. This paper describes the background and development of IPT-G for PND. The evidence for the effectiveness of individual and group IPT formats with this population is summarized. The triad of theories underpinning IPT are discussed with an emphasis on the important role of attachment styles during the transition to parenthood. Its strengths, which include its unique package of targets, tactics, and techniques, are highlighted. The benefits and challenges of IPT-G are also explored, and the results of a randomized controlled trial are summarized. Finally, a case study illustrates how IPT-G specifically addresses the social role transitions, conflicts, losses, and social isolation that mothers commonly experience.     

A latent class regression analysis of men's conformity to masculine norms and psychological distress

How are specific dimensions of masculinity related to psychological distress in specific groups of men? To address this question, the authors used latent class regression to assess the optimal number of latent classes that explained differential relationships between conformity to masculine norms and psychological distress in a racially diverse sample of 223 men. The authors identified a 2-class solution. Both latent classes demonstrated very different associations between conformity to masculine norms and psychological distress. In Class 1 (labeled risk avoiders; n = 133), conformity to the masculine norm of risk-taking was negatively related to psychological distress. In Class 2 (labeled detached risk-takers; n = 90), conformity to the masculine norms of playboy, self-reliance, and risk-taking was positively related to psychological distress, whereas conformity to the masculine norm of violence was negatively related to psychological distress. A post hoc analysis revealed that younger men and Asian American men (compared with Latino and White American men) had significantly greater odds of being in Class 2 versus Class 1. The implications of these findings for future research and clinical practice are examined.     

Age at injury and long-term behavior problems after traumatic brain injury in young children

Objective: This study examined the effects of age at injury on the persistence of behavior problems and social skill deficits in young children with complicated mild to severe traumatic brain injury (TBI). Method: A concurrent cohort/prospective research design was used with repeated assessments of children with TBI (n = 82) or Orthopedic Injury (OI) (n = 114). Parents completed the Child Behavior Checklist, the Behavior Rating Inventory of Executive Functions, and the Preschool and Kindergarten Behavior Scales or the Home and Community Social and Behavior Scales shortly after injury to assess preinjury functioning, and at an extended follow-up an average of 38 months postinjury. Generalized linear modeling was used to examine the relationship of age at injury to the maintenance of behavior problems, and logistic regression was used to examine the persistence of clinically significant behavior problems. Results: At the extended follow-up, severe TBI was associated with significantly greater anxiety problems relative to the Group OI. With increasing time since injury, children who sustained a severe TBI at an earlier age had significantly higher levels of parent-reported symptoms of ADHD and anxiety than children who were older at injury. Conclusions: Findings suggest that longer-term treatment for behavior problems may be needed after severe TBI, particularly for those injured at an earlier age. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Symposium on Ripstein's Force and Freedom: Introduction

This introduction provides a very brief sketch of the fundamental claims of Arthur Ripstein's Force and Freedom before locating the criticisms of his interlocutors in relation to those claims. Valentini and Sangiovanni are situated as critics of the Kantian frame, while Ronzoni and Williams are critics situated within that frame.     

The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.     

Long-Term Executive Function Deficits in Children With Traumatic Brain Injuries: Assessment Using the Behavior Rating Inventory of Executive Function (BRIEF)

Long-term deficits in executive functions following childhood traumatic brain injuries (TBI) were examined using the Behavior Rating Inventory of Executive Function (BRIEF). Parents completed the BRIEF approximately 5 years postinjury as part of a prospective study of children injured between the ages of 6 and 12. The children were between 10 and 19 years of age at the time of the assessment, and included 33 with severe TBI, 31 with moderate TBI, and 34 with orthopedic injuries. Parents also rated children's adaptive functioning and completed several other measures of parent and family functioning. Children were administered a neuropsychological test battery that included several measures of executive functions. The groups displayed a significant linear trend in BRIEF scores, with the largest deficits in executive functions reported in children with severe TBI. BRIEF scores were related consistently across groups to a test of working memory, but not to other neuropsychological measures. BRIEF scores also predicted children's adaptive functioning and behavioral adjustment, as well as parent psychological distress, perceived family burden, and general family functioning. The findings indicate that TBI results in long-term deficits in executive functions that are related to children's psychosocial outcomes, as well as to parent and family functioning.