The Cocreation of Crazy Patchworks: Becoming Rhizomatic in Systemic Therapy

In the field of systemic therapy, there has been much discussion recently about the narrative self. This concept refers to the idea that the self is narratively constructed in and through the stories which someone tells about him/herself. The story is thereby not only viewed as a metaphor for selfhood: Selfhood is not compared to a story, it is a story. But what kind of story are we talking about here? If the self is a story, what does that story look like? These questions are explored in this article. Starting from the possibilities and limitations of traditional and postmodern visions on the self as a story, an alternative vision is illustrated. By considering the self as a rhizomatic story, we not only create a useful view of the way narrative selfhood is constructed within a therapy context, but we also stimulate therapists to coconstruct—together with their clients—patchworks of self‐stories. By using story fragments of our own practice, we illustrate the rhizomatic thinking and its possibilities in therapy.     

The development of a culturally informed, family-focused treatment for schizophrenia

With the changing demographics in the United States, there is an increasing need for psychotherapy interventions that have been tailored for and empirically evaluated with culturally diverse groups. This article discusses the development and evaluation of a family-focused, culturally informed therapy for schizophrenia (CIT-S) that is currently being pilot tested at the University of Miami. Case examples of CIT-S with participating families are provided, along with a discussion of interesting and challenging cultural issues that we have encountered during the pilot phase of this treatment study.     

Using a metaperspective to clarify the structural-narrative debate in family therapy

The debate in family therapy between structural and narrative therapists often seems irreconcilable. Drawing from work in theoretical sociology that identifies the basic structure of existing social theory, a metaperspective is introduced to clarify a discussion between leading figures in the debate. Disparate views of family interactions are examined in terms of more fundamental disagreements about the center of attention in therapy. Narrative and structural modes of presentation are examined as separate traditions that could not be further apart conceptually. Efforts to identify common ground are discussed in terms of more significant differences that are minimized by drawing out similarities. This analysis provides a framework for standing outside entrenched arguments to see more clearly the unique contributions of each approach.     

Two Theories of Just War

As it is traditionally conceived, Just War Theory is not well suited for dealing with nation vs non-nation wars. It thus makes sense to create a second Just War Theory to deal with these wars. This article explores the differences and similarities between the two theories.

Cognitive-behavioral therapy of insomnia: A clinical case series study of patients with co-morbid disorders and using hypnotic medications

Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.     

Techniques of Structural Family Assessment: A Qualitative Analysis of How Experts Promote a Systemic Perspective

The trajectory of assessment in structural family therapy moves from a linear perspective, in which problems are located in the identified patient, to an interactional perspective, in which problems are seen as involving other members of the family. Minuchin, Nichols, & Lee (2007) developed a 4‐step model for assessing couples and families consisting of: (1) broadening the definition of the presenting complaint to include its context, (2) identifying problem‐maintaining interactions, (3) a structurally focused exploration of the past, and (4) developing a shared vision of pathways to change. To study how experts actually implement this model, judges coded video recordings of 10 initial consultations conducted by three widely recognized structural family therapists. Qualitative analyses identified 25 distinct techniques that these clinicians used to challenge linear thinking and move families toward a systemic understanding of their problems. We discuss and locate these techniques in the framework of the 4‐step model.     

Greed is good? Assessing the relationship between entrepreneurship and subclinical psychopathy

Despite the stereotype of entrepreneurs as corporate psychopaths, there has been little research on the overlap between individual differences in entrepreneurship and subclinical psychopathy. In line with this issue, the current study investigated whether primary and secondary psychopathy are linked to a measure of entrepreneurial tendencies and abilities, as well as entrepreneurial activities and achievements. Participants were 435 working adults. Structural equation models revealed that individual differences in entrepreneurial tendencies and abilities were positively related to primary psychopathy, but unrelated to secondary psychopathy. Secondary psychopathy did not predict entrepreneurial activity; primary psychopathy predicted some entrepreneurial outcomes, albeit modestly, providing partial support for the ‘corporate psychopath’ stereotype. Implications for entrepreneurship research and practice are discussed.     

“My graduation is my mother's funeral”: Transformation from the paranoid-schizoid to the depressive position in fear of success,and the role of the internal saboteur

Abstract

Freud's conflation of neurotic and existential guilt is challenged in this paper. A study of fear of success in a female analysand is presented that illustrates the resolution of this syndrome through a mourning process in which the neurotic guilt of Melanie Klein's paranoid-schizoid position is transformed into the existential guilt of Klein's depressive position. An evolution within the depressive-position existential guilt is seen as the analysand mourns and separates from an internal mother and father, who are hostile to her developmental needs. This evolution involves the transformation of an idealizing transference, symptomatically enacted through gradations of vicarious living through the analyst, being profoundly transformed into the analysand's active creation of an identity in the world. Simultaneously, the internal world becomes alive in psychic fantasy. This transformation also involves the modification of an internal sabotaging psychic structure, which had been compelled by the dissociated punitive reaction of an internalized angry mother of separation trauma, employing the unconscious re-enactment of an early infant illness. Split-off envy and split-off self-sabotage become consciously owned through the grieving of existential guilt, as visceral experience is converted into symbolization.

Susan Kavaler-Adler. “Meine Graduierung ist das Begräbnis meiner Mutter”: Transformation von der paranoidschizoiden zu der depressiven Position in der Furcht vor Erfolg – und die Rolle des innerenSaboteurs.

Freuds Verschmelzung von neurotischer und existentieller Schuld wird in dieser Arbeit in Frage gestellt. Eine Studie der Furcht vor Erfolg bei einer weiblichen Analysandin wird dargestellt und sie zeigt die Auflösung dieses Syndroms durch einen Trauer-Prozess in dem die neurotische Schuld von Melanie Klein′s paranoid-schozoider Position in die existentielle Schuld von Klein′s depressiver Position umgewandelt wird. Eine Evolution innerhalb der depressiven Position und existentieller Schuld wird gesehen als die Analysandin trauert und sich von der inneren Mutter und dem Vater trennt, die gegenüber ihren Entwicklungsbedürfnissen feindlich eingestellt sind. Bestandteil dieser Evolution ist die Umwandlung einer idealisierenden Übertragung, symptomatisch inszeniert durch Abstufungen vikariierenden Lebens durch die Analytikerin und gründlich umgewandelt in die aktive Schöpfung einer Identität in der Welt der Analysandin. Simultan wird die innere Welt in psychischer Phantasie lebendig. Diese Umwandlung involviert auch die Modifikation einer inneren seelischen Struktur, die durch die dissoziierte strafende Reaktion einer internalisierten ärgerlichen Mutter eines Trennungs Traumas aufgezwungen worden war, wobei eine unbewußte Reinszenierung eines frühen kindlichen Traumas eingesetzt wurde. Abgespaltener Neid und abgespaltene Selbst Sabotage werden dem Bewußtsein zugänglich durch ein sich Grämen in existentieller Schuld so wie viszerale Erfahrung in Symbolisierung umgesetzt wird.

Susan Kavaler-Adler. “Mi graduación es funeral de mi madre”: La transformación desde la posición esquizoparanoide a la depresiva en el miedo al éxito, y el rol del saboteador interno.

La combinación de la culpa neurótica y la culpa existencial de Freud is puesta en duda. Se presentará un estudio sobre el miedo al éxito de una analizanda mujer para ilustrar la resolución de este síndrome a través de un proceso de duelo en el cual la culpa neurótica de la posición esquizo-paranoide de Melanie Klein se transforma en la culpa existencial de la posición depresiva de Klein. Como una evolución dentro de la posición depresiva la culpa existencial es vista mientras la analizanda hace el duelo y se separa de su padre y madre internalizados, quienes son hostiles hacia sus necesidades de desarrollo. Esta evolución involucra la transformación de una transferencia idealizada actuada sintomáticamente a través de gradaciones de formas de vida sustitutivas a través de la analista, para pasar a ser una de transformación profunda en la activa creación de la identidad de la analizanda en el mundo.Simultáneamente su mundo interno toma vida en la fantasia psíquica. Esta transformación también involucra la modificación de la estructura psíquica interna saboteadora, que había sido impuesta por la reacción punitiva disociativa de una madre enojada internalizada por el trauma de separación, empleando la reactivación inconsciente de una enfermedad de la infancia temprana. La envidia y el autosabotage escindidos se vuelven conscientes a través de la aflicción de la culpa existencial, así como la experiencia viceral es convertida en simbolización.