Moved to tears: Technical considerations and dilemmas encountered in working with a 13-year-old boy with acquired quadriplegia 1

This paper is about therapeutic work with David, a 13-year-old boy who, at the age of 5, was the victim of a hit-and-run road traffic accident resulting in quadriplegia. The circumstances leading to the accident and its sequelae reveal a particularly complex picture, which combines early emotional deprivation and trauma. Although cognitively intact and able to speak, David could not move. Yet he created movement in others through a desperate necessity, by communicating via the employment of extreme projective forces. The highly complex presentation of emotional, psychic and bodily damage in the child, and in particular, David's physical paralysis, has had a profound impact upon what I have come to think of as the ‘mindbody’ of the therapist. Winnicott has talked of the infant's ‘psyche/soma’. Here I want to extend the notion and consider the bodily impact of projections in particular and how these have a powerful emotional and physical resonance on the ‘mindbody’ of the therapist, especially in therapy with a young person whose body is damaged. In this paper, I consider technical challenges and dilemmas encountered in the work, including the complex interplay of transference/countertransference phenomena. This unusual presentation of a boy in extraordinary circumstances led to considerations of psychoanalytic method and interpretative activity, which may be viewed as being inspired by ‘emotional truthfulness’.2 2 Alex Dubinskey (Chair ACP conference 2004) commenting on aspects of this work used the term ‘emotional truthfulness’.

Dans cet article, l'auteur raconte son travail thérapeutique auprès de David, âgé de 13 ans, qui à l'âge de 5 ans fut victime d'un accident de la circulation avec délit de fuite, accident qui le laissa tétraplégique. Les circonstances qui aboutirent à l'accident et à ses séquelles forment un tableau particulièrement complexe mettant en jeu des carences affectives précoces et des traumatismes. Bien que ses capacités cognitives ne fussent nullement atteintes et qu'il fut capable de parler, David ne pouvait pas bouger. Par l'urgence désespérée de son discours, transmise grâce à des projections extrêmement puissantes, il réussissait à susciter du mouvement chez ses interlocuteurs. La présence conjointe et extrêmement complexe de dommages affectifs, psychiques et corporels chez cet enfant – et notamment sa paralysie physique – eut un impact profond sur ce que l'auteur en vient à appeler l'“ esprit-corps ” du psychothérapeute. D. W. Winnicott a parlé du “ psyché-soma ” du jeune enfant. Dans son texte, l'auteur élargit cette notion, notamment pour prendre en considération l'impact corporel des projections, ainsi que leur résonance émotionnelle et physique massive sur l'“ esprit-corps ” du thérapeute, surtout lorsque son patient est une personne jeune dont le corps est endommagé. L'auteur explore les défis et dilemmes techniques rencontrés au cours de son travail, y compris le jeu complexe de phénomènes transférentiels et contre-transférentiels. Ce traitement, inhabituel, avec un garçon dans des circonstances sortant de l'extraordinaire soulève des questions concernant la méthodologie psychanalytique et l'activité interprétative, questions qui peuvent être considérées comme étant inspirées par la “ véracité émotionnelle ”.

Dieser Artikel ist über die therapeutische Arbeit mit David, einem 13-jährigen Jungen, der im Alter von 5 Jahren das Opfer eines Unfalls mit Fahrerflucht war, der zu einer Querschnittslähmung führte. Die Umstände, die zu dem Unfall führten und seine Folgen legen ein besonders komplexes Bild dar, das frühe Vernachlässigung und Trauma kombiniert. Obwohl David kognitiv intakt war und sprechen konnte, konnte er sich nicht bewegen. Doch schaffte er Bewegung aus verzweifelter Notwendigkeit in anderen, indem er mit mithilfe der Benutzung von extremen projektiven Kräften kommunizierte. Die höchst komplexe Präsentation von emotionalem, psychischem und körpelichem Schaden in dem Kind und insbesondere Davids körperliche Lähmung, hatte eine tiefe Auswirkung auf das, was ich nun den ‘mindbody’ (Gemütskörper) des Therapeuten nenne. Winnicott sprach vom Psyche/Soma des Babies. Hier möchte ich diesen Begriff ausweiten und besonders die köperliche Auswirkung der Projektionen betrachten und wie diese eine starke emotionale und physische Resonanz auf den ‘mindbody’ des Therapeutens haben, insbesondere in der Therapie mit einer jungen Person, deren Körper beschädigt ist. In diesem Artikel betrachte ich technische Herausforderungen und Dilemmas, denen man in dieser Arbeit begegnet, einschliesslich der komplexen Wechselwirkung von Übertragungs/ Gegenübertragungsphänomenen. Diese ungewöhnliche Behandlung mit einem Jungen in aussergewöhnlichen Umständen führten zu Überlegungen zur psychoanalytischen Methode undzur Deutungsaktivität, die von ‘emotionaler Wahrheit’ inspiriert wird

Riassunto: In questo articolo si parla del lavoro terapeutico con David, un bambino di 13 anni che, all'età di 5 anni, fu vittima di un incidente stradale che portò alla quadriplegia. Le circostanze che portarono all'incidente e la sua sequela rivelano un quadro particolarmente complesso, nel quale emerge un misto di deprivazione emotiva precoce e trauma. Sebbene David fosse abile cognitivamente e potesse parlare, egli non poteva muoversi. Eppure il bambino generava movimento negli altri attraverso una disperata necessità, comunicando con l'uso di estreme forze proiettive. Il presentarsi di un danno nel bambino altamente complesso nella sua dimensione emotiva, psichica e corporea, ed in particolare, la paralisi fisica di David, hanno avuto un profondo impatto su ciò che ho iniziato a pensare come il ‘corpomente’ del terapeuta. Winnicott ha parlato dello ‘psiche/soma’ del neonato. L'autrice vuole nell'articolo estendere la nozione e considerare l'impatto corporeo delle proiezioni e come queste abbiano una risonanza emotiva e fisica molto forte sul ‘corpomente’ del terapeuta, soprattutto nella terapia con un ragazzo giovane il cui corpo è stato danneggiato. Nell'articolo considero le sfide tecniche e i dilemmi incontrati nel lavoro, compreso il gioco complesso dei fenomeni transferali e controtransferali. Il trattamento insolito con questo bambino in circostanze molto particolari ha portato a considerazioni riguardo al metodo psicoanalitico e all'attività interpretativa, che si possono considerare come ispirati da ‘verità emotiva'¹     

Processing of non-canonical word-order: A case-series on lesion-induced reorganized language and age-effects in typical development

Complex grammatical structures are mastered late in language acquisition. We studied age-effects on performance in object topicalization in 48 typically developing German-speaking participants (aged 8–30 years) and in five patients (children and adolescents) with lesion-induced atypical language representation. Production was tested by a sentence repetition task, comprehension by an acting out task. Three topicalized conditions with differing disambiguation (agreement, case, and case plus agreement) were contrasted with canonical control sentences.     

Executive function outcomes of children with traumatic brain injury sustained before three years

Traumatic brain injury (TBI) is a common cause of disability in childhood. While the outcomes of TBI sustained in school years has been heavily researched, very little is known about the impact of TBI in infants and young children. The aim of this study was to investigate the impact of TBI on executive function (EF) in children who sustained a TBI before 3 years of age. A group of 55 children, 19 with a mild TBI, 16 children with a moderate-severe TBI, and 20 uninjured comparison children participated. The EF of children aged 3 to 6 years were compared using child-based measures of attentional control and information processing. Parents completed questionnaires rating their child's EF. Severity groups differed on the child-based EF measure of attentional control with children with TBI performing below the control group. There were no significant group differences for information processing or parent-rated EF. It appears that children who sustain a TBI before the age of 3 years display impairments in some areas of attentional control 3–4 years postinjury. The findings fit with the existing EF literature for older children.     

心理负荷的评估:基于神经人因学的视角

心理负荷的评估正经历着从传统工效学向神经人因学的变革.EEG、ERPs、fMRI、fNIRS和TCD等神经科学研究技术为这场变革提供了有力的工具.研究发现:在单任务情境下,随着操作者心理负荷的增加,脑电α波活动减弱,θ波活动增强,并且前额皮层血流、左侧额下回血液氧合血红蛋白浓度变化均增加,大脑动脉血流速度也增快;在双任务情境下,随着操作者主任务心理负荷的增加,次任务的N1、新异P3和P3b等ERPs成分波幅降低.依据这些研究成果,学者们利用人工神经网络、支持向量机等模式分类算法实现了对心理负荷的实时在线评估.但是,各种研究技术在敏感性、诊断力、主任务干扰、实施需求、可接受性和信度等方面各有优势与不足.在未来研究中,要注意促进相关技术的融合、提高其可接受性,并充分利用模式识别算法提高其诊断力和敏感性.     

A Controlled Pilot-Outcome Study of Sensory Integration (SI) in the Treatment of Complex Adaptation to Traumatic Stress

This study tested whether sensory integration (SI) treatment combined with psychotherapy would improve symptom outcome over psychotherapy alone in the treatment of complex posttraumatic stress, as measured by the Disorders of Extreme Stress Not Otherwise Specified (DESNOS) clinical construct in a group of 10 adult patients with histories of childhood abuse. DESNOS symptoms were assessed at three time periods (T1, baseline; T2, after experimental group SI treatment; and T3, after wait-list control group SI treatment) using the Structured Interview for Disorders of Extreme Stress (SIDES). The Sensory Learning Program? (SLP), developed by the Sensory Learning Institute of Boulder, Colorado, was used as the SI treatment modality. Results indicated significant differential improvement for the group treated with SLP in SIDES Total Score (T1/T2 and T2/T3), Self Perception (T1/T2 and T2/T3), Affect Regulation (T2/T3), and Alterations in Meaning (T1/T2).     

Us versus them: Understanding the process of race perception with event-related brain potentials

Race is powerful social signal, imbued with a great deal of meaning and capable of affecting a wide range of behaviours and judgements. This review focuses on the use of event-related brain potentials (ERPs) to better understand the process and implications of race perception. Research to date repeatedly demonstrates the speed and automaticity with which racial category membership is encoded. The quick and relatively obligatory encoding of racial ingroup and outgroup distinctions in turn affects a variety of subsequent racially biased behaviours. Such findings not only speak to the close link between social categorization and behaviour, but also have been used to understand how the effects of race perception can be moderated.     

Dissimilar effects of task‐relevant and interpersonal threat on independent–interdependent self‐construal in individuals with high self‐esteem

Previous research has indicated that individuals with high trait self‐esteem (HSEs) become more independent and less interdependent after experiencing a task‐relevant threat. However, these studies have not investigated other sources of ego threats, such as interpersonal threats. Therefore, the moderating effects of the degree of trait self‐esteem on task‐relevant and interpersonal ego threats were investigated in relation to independent, or interdependent self‐construal. It was predicted that in HSEs, the level of task‐relevant stress would be positively–negatively related to their independence–interdependence, whereas the level of interpersonal stress would be negatively–positively related to their independence–interdependence. In individuals with low trait self‐esteem (LSEs), the two types of stresses and independent–interdependent self‐construal may not have a significant relationship. We conducted a questionnaire survey with undergraduates. Correlational analysis of the results indicated that in HSEs, greater task‐relevant stress was related to heightened independence, whereas greater interpersonal stress had the opposite effect, indicating lower independence and heightened interdependence. However, these stresses were not related to the self‐construal of LSEs. These findings suggest that task‐relevant and interpersonal threat could have differential effects on independent and interdependent self‐construal for HSEs, but not in LSEs.     

Travel behavior changes and responses to advanced traveler information in prolonged and large-scale network disruptions: A case study of west LRT line construction in the city of Calgary

The objective of this study was the investigation of travel behavioral effects of the reduction in traffic capacity resulting from the construction of the West LRT (Light Rail Transit) line in the city of Calgary, Alberta, Canada. Travelers’ responses to real-time information providing traffic updates and advisory detours due to lane/road closures were also examined. The West LRT alignment extends approximately 8.2 km from downtown into the city’s southwest. Many road closures took place in the vicinity of the LRT line construction zones, inducing significant delays to traffic. Data on travelers’ behavioral responses and responses to real-time information were obtained by conducting a survey on a sample of users of the main road affected by the construction. The survey also investigated the effects of West LRT line construction on drivers’ daily commutes, including increases in travel times, mode choices, alternate route choices, and selection of sources of information on traffic conditions. A significant change in the selection of transportation mode was caused by West LRT construction. Throughout the construction period, there was a decrease in the percentage of respondents who reported private vehicles as their first choice and an increase in the percentage of respondents who preferred public transit as their first and second choices. Radio was found to be the most preferred source for traffic updates and detour advice, followed by variable message signs (VMS). The findings of the en-route information model showed that driving experience, employment status, travel time and purpose, and desire for pre-trip information had significant effects on traveler’s rerouting decisions after getting en-route information through VMS. The results from this study are of interest for understanding behavioral changes for the purposes of traffic management, mitigation schemes and design of advanced traveler information systems in response to network disruptions.     

My word! Interference from reading object names implies a role for competition during picture name retrieval

A related word prime has been found to interfere with picture naming after unrelated intervening trials (word-to-picture interference). Recently, Stroop-type picture–word interference effects have been interpreted in terms of a postlexical response exclusion process rather than a competitive lexical selection process. An experiment is reported that examines whether word-to-picture effects could reflect response exclusion mechanisms and, more generally, strategic processing of the word prime. Forty-eight volunteer university students named aloud sequences of semantically related (and unrelated) word primes and picture targets, separated by two unrelated filler stimuli. On half of the trials, participants were asked to count backwards in threes from a random number presented immediately after naming the prime word. They were also given a surprise recall test at the end of the naming block. Results for naming times and errors indicated a main effect of relatedness; semantic interference effects were not dependent on the unfilled gap following the word prime trial and were also not tied to episodic recall of prime words. The data indicate that slowed picture naming times are more likely to emerge from processes intrinsic to word prime naming rather than controlled processing and do not readily fit the postlexical response exclusion account. The results are considered in relation to two recent accounts of interference over unrelated trials, which refer to some form of competition at, or prior to, lexical access.     

The influence of dimensional overlap on location-related priming in the Simon task

Choice reaction times are shorter when stimulus and response locations are compatible than when they are incompatible as in the Simon effect. Recent studies revealed that Simon effects are strongly attenuated when there is temporal overlap with a different high-priority task, accompanied by a decrease of early location-related response priming as reflected in the lateralized readiness potential (LRP). The latter result was obtained in a study excluding overlap of stimulus location with any other dimension in the tasks. Independent evidence suggests that location-related priming might be present in conditions with dimensional overlap. Here we tested this prediction in a dual-task experiment supplemented with recording LRPs. The secondary task was either a standard Simon task where irrelevant stimulus location overlapped with dimensions of the primary task or a Stroop-like Simon task including additional overlap of irrelevant and relevant stimulus attributes. At high temporal overlap, there was no Simon effect nor was there stimulus-related response priming in either condition. Therefore stimulus-triggered response priming seems to be abolished in conditions of limited capacity even if the likelihood of an S–R compatibility effect is maximized.