Psychic skin: psychotic defences, borderline process and delusions

In this paper, I apply the concept of psychic skin to analytic work with people suffering from personality disorders and psychoses. When psychoses emerge, the defensive skin which protects the ego is breached and violent unconscious forces rip through the personality. Some of the patients diagnosed as schizophrenic with whom I work have identified with archetypal characters such as Christ, Satan, John Lennon and the Queen. I attempt to show how the adoption of these inflated personas can serve as secondary psychic skins. Such delusional identifications can provide a protective shield to hide the denuded self and prevent intrusion from the external world. Through clinical example, I try to demonstrate how these archetypal 'second skins' can preserve life until internal and external conditions make it possible for the self to emerge. I contrast such psychotic identifications with 'thin-skinned' and 'thick-skinned' narcissism as well as 'defences of the self' in borderline states where the psychic skin may be damaged but does not disintegrate. I also look at the ways in which Jung's own personal experience was different from this and how he managed to avert psychotic breakdown.     

Response to commentary: is collaboration a viable target for family therapists?

In response to Zimmerman's commentary, ‘Is collaboration a viable target for family therapists?’ we explore more conventional perspectives of therapeutic collaboration featured in the family therapy literature, including Zimmerman's commentary. In particular, we critique essentialist and universal formulations that portray the client–therapist relationship to be inherently unequal as inconsistent and limiting. We conclude by addressing what appear to be some misunderstandings in Zimmerman's commentary and clarify what we see as differences between his ideas and our stance on collaboration and power in family therapy.     

The space of reflection: thirdness and triadic relationships in family therapy

This article explores ideas about threes and the triadic space of reflection. Early family therapy theory offered rich ideas about triadic relationship patterns. Contemporary practice frameworks have generated reflective therapeutic practices and an attention to reflexivity. Meanwhile, a contemporary theory constellation allied with psychoanalysis has studied the capacity for ‘thirdness’ in intersubjective relating, reflective functioning and mentalization, and the triadic space of thinking. The article reviews this psychoanalytic theory, explores symbolic thirdness alongside actual triadic relating, and maps an understanding of the space of reflection as triadic and relational. Thinking about the space of reflection as triadic and relational offers one way of orienting ourselves to reflective processes and an inclusive frame for valuing both the earlier family therapy attention to relationship patterns and the different, current contemporary family therapy practices of reflection.     

Is systemic thinking really extraneous to common sense?

Systemic therapists assume, but have not yet proved that ordinary people: (i) normally do not use triadic thinking and (ii) are able, thanks to therapists' interviewing techniques, to construct triadic explanations. To test these assumptions this study analyses the explanations provided by 400 undergraduates of an unexpected piece of behaviour framed in four stimulus situations where the breadth of the observation field was manipulated. The results show that triadic explanations are unusual and increase with the widening of the field of observation from the monad to the triad. It is the ‘enigmatic’ triadic situation – adding a puzzling discrepancy between the actors' forms of behaviour – that elicits more triadic explanations. This suggests that therapists should explore with clients the contradictions disclosed by the widening of the field of observation and support reframings actively co‐constructed with them instead of ‘pre‐packaged’ ones.     

The uses of humor in life,neurosis and in psychotherapy: Part 2

Abstract

The first part of the paper focused on the dynamics of wit in life, literature, and psychoanalysis; the second part of this paper is devoted to the use of humor in therapy. The central concept is Freud's psychoanalytic method, as distinguished from Freud's various theories of disorder, or neurosis, with a further elaboration of Freud's inherently interpersonal conception of the analytic process, already present in the cathartic phase of the therapeutic technique. The cathartic, or discharge, function of humor is connected to reciprocal free association (a term coined by the author) to define the mutual and reciprocal free association in analysand and analyst, playing an essential role in the genesis of insight and interpretation. Humor has its role in loosening repression, facilitating the emergence of unconscious emotions and ideas, bringing to light character defenses, and thus driving the process of analysis.     

Factors Related to Play Therapists' Social Justice Advocacy Attitudes

The authors used a correlational research design to examine how belief in a just world, political ideology, socioeconomic status of family of origin, and percentage of racial minority clients were related to social justice advocacy attitudes among play therapists. A multiple regression was used to analyze the data. Results indicated that belief in a just world and political ideology were related to social justice advocacy. Implications for play therapy training and future directions for research are discussed. Los autores emplearon un diseño correlacional de investigación para examinar cómo la creencia en un mundo justo, la ideología política, el estatus socioeconómico de la familia de origen y el porcentaje de clientes de minorías raciales estaban relacionados con actitudes de apoyo de la justicia social entre consejeros que usan terapia de juego. Se empleó una regresión múltiple para analizar los datos. Los resultados indicaron que la creencia en un mundo justo y la ideología política estaban relacionadas con la defensa de la justicia social. Se discuten las implicaciones para formación en terapia de juego y direcciones futuras para investigación.     

Using Cognitive Behavior Therapy in Clinical Work With African American Children and Adolescents: A Review of the Literature

A comprehensive review of the literature on clinical work with African American youth with cognitive behavior therapy (CBT) is presented. The strengths and limitations of CBT in relation to this population are outlined. Although CBT shows promise in helping, research on the efficacy and effectiveness of CBT in this group is lacking. Se presenta una reseña exhaustiva de la literatura sobre trabajo clínico con jóvenes Afroamericanos usando terapia cognitiva conductual (TCC). Se perfilan los puntos fuertes y las limitaciones de la TCC en relación a esta población. A pesar de que la TCC muestra signos prometedores para servir de ayuda, no hay suficiente investigación sobre la eficacia y efectividad de la TCC en este grupo.     

Change and processes of change within interventions to promote adjustment to multiple sclerosis: Learning from patient experiences

This qualitative study was nested within a trial of cognitive behaviour therapy (CBT) and supportive listening for patients with multiple sclerosis (MS). It aimed to enrich understanding of the changes made during therapy and to explore processes of change. In-depth interviews with 30 participants from the treatment trial were analysed inductively and five main themes were developed. The benefits that participants described experiencing as a result of the interventions were highly variable, idiosyncratic and often departed from outcomes measured within the trial. Tuning into and sharing one’s thoughts and feelings and learning specific strategies for living with MS appeared to be important processes for change, and participants identified the latter as particularly important for sustaining long-term benefits from therapy. Whether participants fully engaged with the interventions appeared to be related to their perceptions of being the right sort of candidate for the intervention, their expectations and motivations, the therapeutic relationship, adequate tailoring of the intervention, and practical issues. This study builds on previous research on factors and processes involved in adjustment to MS, the benefits of CBT for this population and highlights important issues to consider when developing psychosocial interventions for people with MS.     

Exposure Therapy for Posttraumatic Stress Disorder: A Meta-Analysis

This meta-analysis compares the findings of empirical studies that employ either a traditional form of cognitive–behavioral-based exposure therapy or virtual reality exposure therapy (VRET) for the treatment of posttraumatic stress disorder (PTSD) to determine which is more viable and effective. Statistical analyses were performed on 26 studies to determine pre- to posttreatment effect sizes and interactions. Results demonstrated a trend toward significance in favor of traditional exposure therapy showing lower posttreatment PTSD. Limitations included a restricted number of relevant studies; future research on VRET for PTSD should orient more to experimental designs, larger samples, and increased use of control groups.