Methods for Assessing Quality of Life and Well-Being in Frail Older People

The appropriateness, reliability and convergence of differing methods and associated instruments for the assessment of quality of life and well-being in frail older people was examined in 60 ( S 65 years of age) nursing home residents. The feasibility of measuring quality of life and well-being via a variety of instruments was explored through observation (an adaptation of Dementia Care Mapping), structured interview (Schedule for the Evaluation of Individual Quality of Life - Direct Weighting), and proxy questionnaire (Pleasant Events Schedule - Alzheimer Disease; Apparent Emotion Rating Scale). The observational assessment and Pleasant Events Schedule demonstrated good reliability. Significant associations were found between well-being as assessed by observation, and active social interaction and engagement in recreation as assessed by observation, quality of life as assessed by structured interview, and enjoyment of activities as assessed by proxy questionnaire. These findings indicate the importance of social activity in later life, and the potential of different approaches for the appropriate assessment of key aspects of quality of life in frail older people.     

Effects of divided attention in the word-fragment completion task with unique and multiple solutions

A study with 114 young adults investigated the correlations of intelligence factors and working-memory capacity with reaction time (RT) tasks. Within two sets of four-choice RT tasks, stimulus–response compatibility was varied over three levels: compatible, incompatible, and arbitrary mappings. Two satisfactory measurement models for the RTs could be established: A general factor model without constraints on the loadings and a nested model with two correlated factors, distinguishing compatible from arbitrary mappings, with constraints on the loadings. Structural models additionally including factors for working memory and intelligence showed that the nested model with correlated factors is superior in fit. Working-memory capacity and fluid intelligence were correlated strongly with the nested factor for the RT tasks with arbitrary mappings, and less with the general RT factor. The results support the hypothesis that working memory is needed to maintain arbitrary bindings between stimulus representations and response representations, and this could explain the correlation of working-memory capacity with speed in choice RT tasks.     

The influence of position and context on facial attractiveness

It has been shown that a person's position in a group influences how that person is evaluated, with people in the middle perceived as more important than people on the fringe of a group. Four experiments examined whether the position of a face, in a line of five faces, influenced facial attractiveness. The middle position influenced the perceived attractiveness of the target face but the direction of this effect depended on the attractiveness of the target and the surrounding faces. Attractive faces were perceived as less attractive when in the middle of unattractive faces, or faces of average attractiveness. Conversely, unattractive faces were perceived as more attractive when in the middle of other unattractive faces. These results have wide implications, suggesting that the more central a stimulus is in a context then the greater the influence of the context on the judgment of that stimulus.     

Animation and the location of beauty

This paper discusses the development of animation and imaginative activity in a case in which there has been previous severe deprivation. Clinical material from work with an 8-year-old boy will illustrate how omnipotent behaviour, which has the function of keeping fear and feeling from consciousness, can give way to imaginative interaction with the environment. I suggest that, when internal objects have been frozen, it may be safer for the child to see animation outside the room. This may be a necessary stage before a child can begin to play with the therapist inside the room. I am using the term 'animation' in the sense of new imaginative play that has been stimulated by an apprehension of beauty in nature. This is contrasted with driven manic defending against awareness of self and others.     

Psychotherapy of an adolescent presenting a mystical delusion: an illustration of splitting processes and their consequences

The paper discusses the psychotherapy of an adolescent who, during a psychotic breakdown, developed a mystical delusion on a religious theme. Splitting processes and the narcissistic defences that accompany them are illustrated. After showing how the patient had recourse to splitting and how the split-off parts of the ego took refuge inside an internal object, the ego's efforts to make contact once more with these split-off aspects and to reintegrate them are highlighted. With the help of certain concepts developed by, for example, Rosenfeld and Meltzer - specifically those relating to the organization of internal groupings or 'gangs' and their destructiveness and the compartmentalization of internal objects - the author shows how certain particularities of the patient's internal world can be understood in terms of these splitting processes. In addition the clinical material presented raises several technical questions, in particular those relating to dissociative processes and delusion or delusional theories as they become manifest in the treatment.     

The Symbiosis between a Mother and Her Schizophrenic Son in a Group Therapeutic Process

Abstract

In psychoanalytical practice important, but less studied, transformative functions are performed by verbal comments which do not correspond to the classic model of mutative interpretations proposed by Strachey. The Authors describe some characteristics of such clinical situations, without coming into the better known categories of variations in technique. Such enunciations seem not to have a “strong”, (already clearly defined) meaning in the mind of the analyst, but contain rather a “weak” semantic potential, which can only develop with the active cooperation of the patient. In the light of these experiences, the Authors reconsider the general nature of psychoanalytical interpretation and emphasize the intersubjective and dialogical nature of the interpretive work carried out in analysis.     

Trauma Lives in Speech

The author approaches the topic through infant observation. At the age of eight months the baby moves in the borderland between the physical and the symbolic. When the baby hurts herself, she needs the mother's arms to protect her: at the same time, her budding spoken symbol "mama" is comforting in itself, it carries the memory of the mother's arms. Can speech - tone of voice, rhythm, pauses - and the moments of loss, absence, the losing of self also be intertwined? The author discusses the question of how trauma starts to live in speech through two patients. She talks about "a silent language" which speaks in between the words and sentences - changes the rhythm of speech, makes lose words, tears a hole in speech. This "silent language" talks about trauma, reaches for its very essence - a bodily experience and meaning to the wholeness/disruption of self.     

Controversies and Conflicts in the Institution of "Open" Psychoanalysis: Cases from the History of the Therapeia Foundation

The institution of psychoanalysis has included controversies, dissensions and expulsions at both the theoretical-methodological and personal-organizational levels. There have also been several intra- and intergroup conflicts in the history of psychoanalysis, and in constructing and patterning the future of psychoanalytic knowledge. In the context of Finnish psychoanalysis, the Therapeia Foundation (founded in 1958) met from the start with resistance from official psychiatry and also from the IPA. For example, in the mid-1960s, D. W. Winnicott, as the President of the IPA, supported the orthodox Finnish psychoanalytic study group (later to become the Finnish Psychoanalytical Society), and pronounced that the Therapeia group was too loose and was not strictly able to use the IPA-recognized designation "psychoanalytic." The Therapeia Foundation and its Training Seminar combined classical psychoanalysis and its new versions with existentialphenomenological views, anthropological medicine, research on "social pathology" and even modern theological research. On the basis of their Swiss analytic training, three Finnish psychiatrists, Martti Siirala, Kauko Kaila and Allan Johansson, organized Therapeian training to incorporate sciences and arts, and skills involving the therapeutic "carrying" of burdens. The multifacted nature of open psychoanalysis was seen to find its proper organizational expression when the Training Seminar of the Therapeia Foundation became, in 1974, a Member of the IFPS.     

A Farewell to Countertransference

The "discovery" of countertransference provided a much-needed corrective to the one-sided view of transference and a patient's pathology. Even if its usefulness in the development of psychoanalysis was indisputable, its days are numbered. When I present my clinical work at conferences, I am often asked questions about my countertransference. These questions contain numerous assumptions that are challenged in this paper. Treatment is discussed from a self psychological perspective to highlight the therapeutic value of enabling the patient to engage a selfobject transference. The concept of "projective identification" is also challenged. Systems theory, in which the therapeutic relationship is understood as a co-construction between therapist and patient, is proposed as a more effective model to deal with the issues formerly included under transference-countertransference.