‘Emotional turbulence’: the development of symbolic thinking in the psychotherapeutic treatment of an adolescent girl

Abstract

This paper is drawn from doctoral research which analysed clinical data from the once weekly psychotherapy of a young person who experienced both gender identity dysphoria and an eating disorder and whose depression had proved resistant to other interventions. Based on the psychoanalytic thinking of Klein, Segal, Bion and others regarding the role of symbolisation in development, the links between symbol formation, the depressive position and the negotiation of the Oedipus complex are outlined. Special attention is given to current thinking about the nature and genesis of gender identity dysphoria in the light of these concepts. The association with autistic features for a number of cases is briefly explored. In the light of these theoretical links, findings from the study are used to investigate and illustrate the movement this patient made within her therapy from an emotionally turbulent position where concrete thinking was manifest, to a more symbolic way of thinking that allowed emotional change, and less concrete acting out. Clinical narrative excerpts as well as findings from the study are used to discuss the progress made by the patient and to evaluate how her journey may inform future practice.     

The crystal structure of Al20.6Ta22.4 and its relation to Frank–Kasper phases

The monoclinic phase in the Al–Ta system has been identified by means of X-ray single-crystal structure analysis as Al_{19+ x} Ta_{24? x} (x?=?1.6), Pearson symbol mP86. Al_20.58Ta_22.42 crystallizes in the space group P2₁/n, with a?=?987.86?pm, b?=?990.12?pm, c?=?1489.45?pm and β?=?99.958°. Twinned crystals of the title compound can be obtained by iodine-promoted reactions of the elements. In the experiments described here, the reactions took place in sealed tantalum ampoules at 1400°C. Single-phase samples were obtained by a metallurgical powder method, which minimizes aluminium loss by incongruent vapourization. The composition was found to span the range 0.51?≤?x _Ta?≤?0.53. Al_{19+ x} Ta_{24? x} decomposes in the solid state at 1450°C into Al₆₉Ta₃₉ and σ-AlTa₂. The crystal structure is analyzed in relation to tetrahedral close-packed structures. The kinship with Cr₃Si-type and H-type structures is accentuated.     

重视肠黏膜屏障功能障碍的防治

肠黏膜屏障损伤是严重创伤、感染、手术、休克时常见的病理生理过程,可造成细菌及内毒素移位、肠源性感染,甚至导致全身炎症反应综合征（SIRS）及多器官功能不全（MODS）等。因此对肠黏膜屏障功能障碍的认识与防治尤为重要,积极纠正肠屏障功能障碍将有助于提高疗效、改善患者预后。     

Trying to enter the long black branches: some technical extensions of the work of Frances Tustin for the analysis of autistic states in adults

The author suggests a number of technical extensions/clinical applications of Frances Tustin's work with autistic children, which are applicable to the psychoanalysis of neurotic, borderline and psychotic adults. These are especially relevant to those individuals in whom early uncontained happenings (Bion) have been silently encapsulated through the use of secretive autosensual maneuvers related to autistic objects and shapes. Although such encapsulations may constitute obstacles to emotional and intellectual development, are consequential in both the relational and vocational spheres for many analysands and present unending challenges for their analysts, the author demonstrates ways in which it may be possible to detect and to modify these in a transference-centered analysis. A detailed process of differential diagnosis between autistic states and neurotic/narcissistic (object-related) states in adults is outlined, along with several clinical demonstrations of the handling of a variety of elemental terrors, including the 'dread of dissolution.' The idiosyncratic and perverse use of the analytic setting and of the analyst and issues of the analysand's motivations are considered and illustrated. A new model related to 'objects in the periphery' is introduced as an alternative to the more classical Kleinian models regarding certain responses and/or non-responses to transference interpretation. Issues a propos the countertransference are also taken up throughout.     

The exclusion of the other2

The author begins by noting that the subject of obsessions and obsessional neurosis seems to have fallen out of favour with the analytic community in spite of the important part it played in the formation of Freud's theories, and notwithstanding the significance of its mechanisms in the maturation of the ego. He then discusses some theoretical considerations regarding the development of the taboo on touching and, by extension, contact. Attention is drawn to the parallels with autistic functioning emphasised by other authors. Particular importance is attached to the distinction between internal and external reality that arises during the anal‐sadistic phase and that leads to polarisation and splitting in obsessional neurosis. Following a discussion of the transference' countertransference situation with obsessional patients and of their concretistic experience in the treatment situation, as also featured in the literature, an extensive case history exemplifies the author's contentions and shows how the patient concerned developed during the course of his analysis. After pointing out the importance of the avoidance of identifications as a mechanism of obsessional defence, the author concludes the paper with a brief comparison of obsessional and hysteriform functioning and a characterisation of the obsessional defence as the excessive recourse to perverted thought functions so as to ward off paranoid anxieties.     

The Theory of Transformations and Autistic States Autistic Transformations: A Proposal1

This work integrates two areas of thinking: one in which the author develops considerationsregardingobservationmethodsofmentalphenomenainpsychoanalysis according to Bion's theory of transformations; the other in which she is concerned with the investigation of primitive mental states‐protomental states‐more specifi cally, the autistic states of neurotic patients, described by Tustin. Some ideas on the ‘philosophical’ position underlying transformations theory are elaborated, particularly emphasizing the idea that the same phenomenon in psychoanalysis may be considered from different perspectives, as long as it is situated within the theoretical reference frame to which it belongs. The author considers the idea that this method of phenomenon observation is part of a wider context of general human knowledge, in which uncertainty and relativity of concepts are the main components. By adopting transformations theory as a perspective of phenomena observation that pervades the analytical meeting, the author questions whether it is possible to include other groups of transformation of emotional experiences in this theory, which shows particular phenomena with specifi c qualities, distinct from those emphasized by Bion. She hypothesizes that autistic phenomena present in neurotic patients, characterizing autistic states, may be considered and detached, making up a particular group of transformation of emotional experience, which analysts often face in their daily practice. She names this group ‘autistic transformations’.     

The effectiveness of a scientific reasoning intervention for conspiracy theory beliefs

Conspiracy theory (CT) beliefs have become an important policy-relevant research area since the events of the COVID-19 pandemic. Increasing interest has been directed towards strategies that might reduce people's susceptibility to conspiratorial beliefs. In this study, we examined whether encouraging a stronger orientation towards critical scientific appraisal of conspiratorial accounts could reduce CT acceptance. After completing baseline measures of COVID-19 related beliefs and analytical and scientific reasoning abilities, a total of 700 adults were randomly allocated to a control or scientific reasoning manipulation. People assigned to the scientific reasoning condition were found to display significantly lower CT belief endorsement post-intervention as compared to the control group. As well as having implications for the design of future intervention studies, the results of this study encourage a greater focus on specific reasoning skills that may be amenable to a psychoeducation approach, in order to further develop methods to prevent CT beliefs.     

Self-stimulatory behavior and perceptual reinforcement.

Self-stimulatory behavior is repetitive, stereotyped, functionally autonomous behavior seen in both normal and developmentally disabled populations, yet no satisfactory theory of its development and major characteristics has previously been offered. We present here a detailed hypothesis of the acquisition and maintenance of self-stimulatory behavior, proposing that the behaviors are operant responses whose reinforcers are automatically produced interoceptive and exteroceptive perceptual consequences. The concept of perceptual stimuli and reinforcers, the durability of self-stimulatory behaviors, the sensory extinction effect, the inverse relationship between self-stimulatory and other behaviors, the blocking effect of self-stimulatory behavior on new learning, and response substitution effects are discussed in terms of the hypothesis. Support for the hypothesis from the areas of sensory reinforcement and sensory deprivation is also reviewed. Limitations of major alternative theories are discussed, along with implications of the perceptual reinforcement hypothesis for the treatment of excessive self-stimulatory behavior and for theoretical conceptualizations of functionally related normal and pathological behaviors.     

TRAINING PARENTS TO USE THE NATURAL LANGUAGE PARADIGM TO INCREASE THEIR AUTISTIC CHILDREN'S SPEECH

Parents of four nonverbal and four echolalic autistic children were trained to increase their children's speech by using the Natural Language Paradigm (NLP), a loosely structured procedure conducted in a play environment with a variety of toys. Parents were initially trained to use the NLP in a clinic setting, with subsequent parent-child speech sessions occurring at home. The results indicated that following training, parents increased the frequency with which they required their children to speak (i.e., modeled words and phrases, prompted answers to questions). Correspondingly, all children increased the frequency of their verbalizations in three nontraining settings. Thus, the NLP appears to be an efficacious program for parents to learn and use in the home to increase their children's speech.