Treating the Sexual Concerns of Adult Incest Survivors and Their Partners

SUMMARY

Negative attitudes about sex and sexuality and many types of sexual dysfunction are common aftereffects of sexual child abuse and incest. The traumatic sexualization and the aversive sexual conditioning resulting from childhood abuse have long gone unrecognized, however. This article presents research findings regarding the impact of incest on sexual attitudes and functioning along with treatment recommendations.     

Psychotherapeutic work with refugees: Understanding the therapist's countertransference

Abstract

Most therapists are chosen to work with refugees because they speak the language or come from the same cultural or racial background and/or have had experiences which resonate with those of the client. They are often people who can easily understand the clients' experiences, which creates interesting and potent therapeutic dynamics. They can offer a great deal of support to the person, but often with the high risk of over-identification. This paper is an attempt to examine from the therapist's perspective the complex dynamics involved in working with refugee clients. It is a collection of thoughts and feelings expressed in psychotherapeutic and supervisory work by different types of refugee mental health workers. It is an attempt to understand the therapeutic relationship further by focusing on the therapist's psychological response to the client. The paper will outline briefly some of the common themes reported by refugees, but the primary aim is to focus on the therapist's countertransference feelings. Countertransference in this context is defined as a personal psychological response, as well as consisting of socio-political components.     

Counter-narratives in context: The role of the organisation and broader culture in psychic splitting among South African survivors of intimate partner violence

Chronic trauma, shame and psychopathology, as well as the association between them, are acutely understudied, both in South African and internationally. The focus of this article is on chronic trauma of a particular kind, intimate partner violence (IPV) and the development of a specific form or shame-related psychopathology, the splitting of self and how this splitting may be further facilitated or exacerbated by the contexts in which people live. The (counter) narratives of three women are presented. These (counter) narratives demonstrate the presence of both a concealed and shameful authentic self, and the socially conforming projected false self, two polarised parts of the psyche. It is argued that the organisational context, a shelter for survivors of IPV, which has a strong ethos centred around advocacy and human rights and which promotes a strong message of personal empowerment and agency, may unintentionally exacerbate the psychic split in women who have been subjugated at a broader (predominantly patriarchal) cultural level their whole lives. Participants’ resistance narratives were often characterised by inconsistencies and contradictions which oscillated between supporting mainstream cultural narratives and organisationally driven, active resistance against the cultural context from which they came. However, resistance narratives often felt thinly veiled and inauthentic, which is one of the problems with interventions in resource constrained settings which are necessarily time-limited. To fully and completely counter the cultural message that has been the focus of participants’ lifelong gendered socialisation, long-term and in depth interventions at organisational level are needed. These ideas are not only relevant to the South African setting, but have wider application internationally.     

Telling a traumatic story through Art: Arshile Gorky’s ‘The Artist and his Mother’

For more than a decade, through re-working a composition based on a sepia photograph, Arshile Gorky (ca. 1904–1948) tried to give form and represent that which by definition defies forms and shatters one’s capacity for representation. Having witnessed the systematic ethnic cleansing of his people as a child, Gorky began a ‘journey’ in his attempt to comprehend his traumatic ordeal through Art. In 1926, with the safety of a constructed name and life, the artist started working on ‘The Artist and his Mother’ series. Focusing on the two versions of Gorky’s early painting and using relevant aspects of psychoanalytic theory, the paper explores his work through a psychoanalytic lens. Psychoanalytic theories on extreme traumatisation along with psychoanalytic notions of temporality will be utilised in an attempt to follow the artist’s struggle to re-create and rework aspects of his traumatic history.     

Otto Rank: Pioneering Ideas for Social Work Theory and Practice

This article examines Otto Rank's psychology and its profound implications for social work knowledge-building and practice. The paper begins with a brief biographical portrait, highlighting the significance of Rank's relationship and eventual break with Freud, and contextualizing the ideas that became the basis for the Functional Approach. We discuss Rank's conception of human functioning in the social environment, his influence on later theories, and a contemporary critique of Rank's ideas. The paper concludes with a discussion of Rank's contributions to the Functional Approach and to social work practice in general.     

Ferenczi's “Confusion of Tongues” Theory and the Analysis of the Incest Trauma

Abstract

The tender-mother transference of Ferenczi's humanistic analytic orientation was as important an advance in pioneering times as was Kohut's selfobject transference in contemporary psychoanalysis. Ferenczi's clinical theory and method began a focus on pre-oedipal experiences, which eventually became an alternate to the oedipal theory. Freud was critical of Ferenczi's formulation, leading a successful attempt to suppress his work and remove it from mainstream psychoanalysis because he believed it was “regressive.” In actuality, Ferenczi's “Confusion of Tongues” theory and “Relaxation Therapy” were prophetic and pioneering attempts to understand and treat the incest trauma (ironically the clinical data upon which Freud founded psychoanalysis 100 years ago). In the case of Miss T., Ferenczi's ideas are applied to the contemporary analysis of the incest trauma.     

Conversion Hysteria in a Pre-Adolescent Girl

Abstract

This paper is a case presentation of a 10-year-old girl with classic conversion hysteria symptomatology. Psychological test material as well as the ten session treatment is presented. The original Breuer/Freud conceptualization of hysteria and its linkage with trauma is considered. Current theories of trauma with the usual presenting symptoms of dissociation, abandonment fears, and repetition are also considered.     

Efficacy of Telehealth Treatments for Posttraumatic Stress-Related Symptoms: A Meta-Analysis

This meta-analysis summarizes the findings of outcome research on the degree to which telehealth treatments reduce posttraumatic stress disorder (PTSD)-related symptoms. In a search of the literature, 13 studies were identified for inclusion in the meta-analysis and were coded for relevant variables. A total of 725 participants were included. Results indicate that telehealth treatments are associated with significant pre- to postreduction in PTSD symptoms (d = 0.99, 95% confidence interval [CI]: 0.87–1.11, p < .001), and result in superior treatment effects relative to a wait-list comparison condition (d = 1.01, 95% CI: 0.76–1.26, p < .001). However, no significant findings were obtained for telehealth intervention relative to a supportive counseling telehealth comparison condition (d = 0.11, 95% CI: ? 0.38 to 0.60, p = .67), and telehealth intervention produced an inferior outcome relative to a face-to-face intervention (d = ? 0.68, 95% CI: ? 0.39 to ? 0.98, p < .001). Findings for depression symptom severity outcome were generally consistent with those for PTSD outcome. Telehealth interventions produced a significant within-group effect size (d = 0.98, 95% CI: 0.86 to 1.10, p < .001) and superior effect relative to wait-list comparison condition (d = 0.80, 95% CI: 0.56–1.05, p < .001). Relative to face-to-face interventions, telehealth treatments produced comparable depression outcome effects (d = 0.13, 95% CI: ? 0.55 to 0.28, p = .53). Taken together, these findings support the use of telehealth treatments for individuals with PTSD-related symptoms.     

BORGES IN MY OFFICE: THE ANALYSIS OF A MAN DWELLING OUTSIDE OF TIME

This article weaves together two threads: the intricacies of the analysis of a difficult‐to‐reach yet extraordinary patient and the literary works of Jorge Luis Borges, which played a significant role in the analysis as a source of inspiration, enriching the analyst's reverie and opening up new psychic spaces. The authors demonstrate the analyst's recourse to several of Borges's stories in order to enrich his own inner world and to better understand the analysand. Some of these stories are briefly presented through the analyst's dialogue with them, and there is a discussion of their function in facilitating the process of working through issues of time, memory, mortality, and identity, contributing to the enhancement of the patient's ability to come face to face with the unwanted, split‐off parts of his self and of reality.