Boundaries and intimacies: Ethics and the (re)performance of “The Law” in psychoanalysis

The notion of a boundary as it pertains to psychoanalysis is explored, and the distinctiveness of psychoanalysis as a healing science that is ethical and amoral is discussed. The difference between such a science and psychotherapies, which are committed to ideological ideals of maturation and adaptation, is elucidated. Five characteristics of psychological boundaries are discussed, and the significance of each individual's “encounter” with the incest taboo is elaborated, in terms of the dynamic formation of the repression barrier. In this context, the strict ethicality and moral neutrality of psychoanalytic practice is understood in terms of the emancipative way in which free-associative discourse works and plays along the repression barrier.     

Diagnoses,Relational Processes and Resourceful Dialogs: Tensions for Families and Family Therapy

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), given its psychiatric focus on mental disorders in individuals, presents families and family therapists with challenges. Despite considerable controversies over its adoption, the DSM‐5 extends a process of standardizing a language for human and relational concerns. No longer a diagnostic language of professionals alone, its use is medicalizing how mental health funders and administrators, as well as clients, respond to human concerns. For family therapists who practice systemically, particularly from poststructuralist and strengths‐based orientations, many tensions can follow when use of the DSM‐5 is expected by mental health administrators and funders, or by clients who present concerns about themselves or a diagnosed family member. In this paper, I explore how such DSM‐5 related tensions might be recognized, navigated, and negotiated in the practice of family therapy with clients, and with administrators and funders.     

The Symptom as Ally,not Enemy

The practice of the Western medicine often identifies the symptom with the disease itself, but a current of thought and medical practice considers it as the important message of an organic imbalance. In fact, in standard therapies symptoms are usually suppressed, thus interrupting a normal physiological process and risking severe reactions due to the organic imbalance. Dr. Hahnemann, the father of homeopathy, founded his diagnostic and therapeutic model on the interpretation of the symptoms and maintained that symptoms are an expression of altered physiology. The same concept is to be found in Dr. Reckeweg's “reactivity” and homotoxicology; he believed that diseases are the expression of the struggle of the body against toxins. Reckeweg's contribution was particularly important in considering the inflammation process as a biologic process through which the body restores its health. Also PNEI (psycho-neuro-endocrino-immunology) proposes a model where the symptom is interpreted as information and as the result of an imbalance. Several other medical approaches address particular attention to the meaning of symptoms. The Bach Flower Therapy, for instance, is guided exclusively by the negative moods, which can become the cause of functional and organic diseases; balance is restored thanks to superior harmonic energetic vibrations conveyed by the superior energy living in some flowers. This interpretation of the nature of symptoms is becoming a more and more relevant issue among both the specialistic and the general public.     

Building a Life Worth Living During a Pandemic and Beyond: Adaptations of Comprehensive DBT to COVID-19

Our team at the Jefferson Center City Clinic for Behavioral Medicine has recently been challenged to find a synthesis between the need to adapt to circumstances associated with the COVID-19 pandemic, while at the same time retaining the spirit and essential components of comprehensive DBT. This fine balance between unwavering centeredness and compassionate flexibility is central to DBT (Linehan, 1993), and has proven essential during these times of uncertainty. This short article highlights challenges and innovations faced by our DBT Team, Skills Group, individual DBT sessions, phone coaching, and also our community at large, as we strive to help our patients and team members build a life worth living during and following a pandemic.     

Constructing We‐ness: A Communal Coping Intervention for Couples Facing Chronic Illness

Communal coping occurs when relationship partners view a stressful health problem as “ours,” rather than yours or mine, and take collaborative action to deal with it. Although research employing linguistic (we‐talk) and other measures of communal coping demonstrates relevance to a variety of chronic illnesses, the literature offers little about how clinicians can actively promote we‐ness and teamwork to help patients and their partners achieve the health benefits this appears to confer. This paper highlights clinical and supporting scientific features of a narrative intervention designed to foster communal coping by couples in which one partner has a chronic illness. The illustrative illness is diabetes, but with modification the protocol is suitable for other chronic conditions as well. Grounded in systemic and narrative models of problem maintenance and change, the communal coping intervention represents a distillation of research and clinical experience with family consultation over several decades. In contrast to more directive and educational approaches, the intervention consists entirely of questions, with no direct suggestions or instruction about how patients, partners, or couples should change. These questions comprise 8 sequential modules (Coping Challenges, Trajectory and Focus, Illness as External Invader, You as a Couple, Past Teamwork in Overcoming Adversity, Present and Future Teamwork, Obstacles to Teamwork, and Wrap‐Up), described here in manual‐like detail.     

Effectiveness of the ‘Hold me Tight’ Relationship Enhancement Program in a Self‐referred and a Clinician‐referred Sample: An Emotionally Focused Couples Therapy‐Based Approach

While evidence‐based couple therapies are available, only a minority of troubled couples seek help and they often do this too late. To reach more couples earlier, the couple relationship education (CRE) group program “Hold me Tight” (HmT) based on Emotionally Focused Couples Therapy (EFCT) was developed. This study is the first to examine the effectiveness of HmT. Using a three‐wave (waiting period, treatment, and follow‐up) within‐subject design, HmT was delivered to 79 self‐referred couples and 50 clinician‐referred couples. We applied a comprehensive outcome measure battery. Our main findings were that (1) self‐referred couples significantly improved during HmT on all measures, that is relationship satisfaction, security of partner‐bond, forgiveness, daily coordination, maintenance behavior, and psychological complaints, with a moderate‐to‐large mean effect size (d = .63), which was maintained (d = .57) during the 3.5 month follow‐up; (2) in clinician‐referred couples, who were vulnerable in terms of insecure attachment status and psychopathology, the improvement during HmT was moderate (d = .42), but this was reduced during the 3.5‐month follow‐up to a small effect (d = .22); (3) emotional functioning (typical HmT target) as well as behavioral functioning (typical Behavioral Couples Therapy‐based CRE target) improved during HmT; and (4) individual psychological complaints, although not specifically targeted, were reduced during HmT. These findings suggest that HmT is a promising intervention for enhancement of relationship functioning. Clinical implications are discussed.     

Delivered as Described: A Successful Case of Cognitive Processing Therapy With an Older Woman Veteran With PTSD

Cognitive processing therapy (CPT) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD). Little is known, however, about the use of CPT for older adults. As the United States population continues to grow and age, an understanding of the utility of CPT for older adults is vital. We present a case study describing the assessment and cognitive treatment of a 74-year-old woman veteran with PTSD secondary to military sexual trauma. CPT was associated with decreased PTSD symptoms as measured before and after treatment. Factors contributing to the veteran’s response, as well as contextual and environmental factors, are discussed. The case demonstrates that CPT may be effective for older adults without major modification.     

Scaffolding a community of competent practitioners: positioning and agency in a training program for narrative counseling

This article explores the scaffolding of learning experiences in a postgraduate program in New Zealand that offers training in narrative counseling. The authors draw on positioning theory to identify student shifts in learning, and in agency, that help build an increasingly skilled and peer-generated context for learning. We describe a selection of exercises and one key assignment, introduced in the course in a particular order, that we believe enable students to step into positions of agency which ultimately allow a competent community of learner-practitioners to emerge. We also describe a dance of positioning for ourselves as teachers in this program. We suggest that, at any given time, our own positioning is tied up with possibilities for student positioning. Acknowledging relationships of power in classrooms, we explore ways to align poststructuralist counseling practices and the teaching of these practices.