Working Through Countertransference: Navigating Between Safety and Paranoia for a Client With Complex Trauma History and Borderline Personality Organization

The aftermath of complex trauma deeply impacts one's self-organization and interpersonal relationships, often resulting in clients who present to therapy with borderline characteristics and are typically labeled as difficult to treat. Further clinical complications with paranoid features may quickly place the therapist at a loss with respect to managing perceived and/or actual threats to client safety. Using psychodynamic theories, especially Kleinian understandings of psychosis and Winnicottian approaches to early disturbance and its impact on the emergence of self, this article provides a detailed case illustration that explores how a critical reflection of countertransference as “enactment,” “communication,” and “imagination” can help the therapist to understand the client's unconscious symbolic psychic struggles and to guide treatment selections in the therapy process.     

Obstructive sleep apnoea syndrome increases source‐confusion errors: A pilot study

We explored external source monitoring (i.e., discrimination between memories of two externally derived sources) in patients with obstructive sleep apnoea syndrome (OSAS). Our specific aim was to ascertain whether, relative to controls, patients exhibit more source‐confusion errors when there are similarities between two external memory sources. We recruited 22 patients with OSAS and 22 controls matched for sex, age, and education. The experimental procedure we used came in three phases. First, participants viewed a target film. Second, they were shown a mixed set of photographs, some taken from the film (target photographs), others not (photographs taken from other films not viewed by participants; lures). Lures differed either conceptually or perceptually from the target film. Third, the following day, participants were shown a set of photographs and urged to determine whether the photographs were taken from the target film or whether they were images they had seen for the first time in Phase 2. Patients correctly attributed the same number of target photographs to the target film as controls. By contrast, they incorrectly attributed more lures to the target film than controls did, especially when the lures were semantically similar to the film (perceptual lures). Both perceptual and conceptual source‐confusion errors were significantly correlated with oxygen desaturation during sleep. Results suggest that the higher number of source‐confusion errors observed in patients with OSAS was linked to an impaired ability to recollect specific perceptual details of the study items and that hypoxia is the main contributing factor to this deficit.     

Stupidity in the analytic field: Vicissitudes of the detachment process in adolescence

This paper has the objective of broadening the understanding of technical aspects in working with adolescents who defend themselves against detachment from infantile aspects through defensive organizations. These organizations numb the adolescent toward both triangular reality and narcissistic defenses. The families of such young people may be part of the organization and the analyst can also be recruited to participate in it. But the analyst's perception can become blurry and this fact makes him appear stupid. Aspects of the myths of Narcissus and Oedipus are used here as models for studying stupidity. The analysis of a psychotic teenage girl who is symbiotic in relation to her family shows how the analytical field can be invaded by defensive configurations. Collusions of idealization and domination/submission involve the young person, her family and the analyst but the defensive organizations are only identified after their traumatic breakdown. The expansion of the symbolic network allows symbiotic transgenerational organizations to be identified, while models related to enactments prove helpful for understanding technical ups and downs. The paper ends with imaginative conjectures where Oedipus, as ‘patient’, is compared to the patient discussed here. These conjectures lead to reinterpretations of aspects of the Oedipus myth. The reinterpretations, together with the theoretical and clinical study, may serve as models for understanding the technical ups and downs in working with troubled teens.     

Psychopathology and behavior problems in children and adolescents with Williams syndrome: Distinctive relationships with cognition

Several studies have documented the high prevalence of psychopathology and behavior problems in Williams syndrome (WS). However, the links between cognitive development and such symptoms need further clarification. Our study aims to expand current knowledge on levels of behavior problems and its links to cognition in a sample of Brazilian individuals with WS. A total of 25 children and adolescents with WS and their parents participated in this study. The participants’ IQs were assessed with the Wechsler Scales of Intelligence (for children or adults) and parental reports of psychopathology/behavior problems were collected using the Child Behavior Checklist (CBCL). The presence of clinically significant attention problems was a main feature in our sample of children and adolescents with WS. In the children, higher IQ scores were found to be significantly associated with less externalizing problems, while in the adolescents cognitive abilities were found to be associated with less internalizing symptoms. These results provide further insight into the links between psychopathology and behavior problems and cognitive abilities in WS, and suggest the need to take age into consideration when analyzing such relationships.     

Beyond differences between the body schema and the body image: insights from body hallucinations

The distinction between the body schema and the body image has become the stock in trade of much recent work in cognitive neuroscience and philosophy. Yet little is known about the interactions between these two types of body representations. We need to account not only for their dissociations in rare cases, but also for their convergence most of the time. Indeed in our everyday life the body we perceive does not conflict with the body we act with. Are the body image and the body schema then somehow reshaping each other or are they relatively independent and do they only happen to be congruent? On the basis of the study of bodily hallucinations, we consider which model can best account for the body schema/body image interactions.     

中医"证"本质研究的无序与有序

中医"证"本质的研究结果呈现弱特异性的.证是宏观概念,既呈现着多态性,又呈现着同态性,无序中包含着有序,有序中亦体现着无序.对于"证"研究中出现的弱特异性的研究结果,应将其看成这一证候的几种不同状态;对不同证候得出的同一研究结果的处理也是如此.具体技术上的处理包括:对研究思路更新;对证候规范化;大范围科研协作.强调了大范围科研协作.     

"证"与"辨证"之我见

以"证"与"辨证"的关系阐发有关概念,认为对证的概念不应一概而论,在此基础上把证细分为两个概念,提出有形之证和无形之证,辨证的过程就是构建一个"无形之证"理论模型的过程,用来解说有形之证,达到无形之证与有形之证的最大吻合.     

Flexible coping responses to severe acute respiratory syndrome-related and daily life stressful events

Based on the theoretical framework of coping flexibility, the present study examined the coping flexibility of university students in response to severe acute respiratory syndrome (SARS)-related and daily life stressful events. The Coping Flexibility Questionnaire was used to investigate 93 university students' coping responses toward 10 SARS-related stressful events and 10 daily life stressful events that generally occur among university students. Results showed that the patterns of coping flexibility were different for the two types of stressful events. The flexible and the active-inflexible patterns were most commonly found in coping with daily life stressful events. By contrast, the passive-inconsistent pattern was dominant when coping with daily life stressful events. Moreover, participants showed lower discriminating ability to situation controllability, and displayed poorer strategy-situation fit to cope with SARS-related events than with daily life stressful events. The theoretical and practical implications of this study are discussed.