Processing trauma in psychoanalysis in ‘real’ time and in dreams: the convergence of past,present and future during COVID-19

In the current collective unrest, we and our analysands are living in real time and need vantage points from which to make meaning, as subjective experience of time is collapsing. For many analysands, the past is being relived in the present, with no imaginable future. During the time of COVID-19, dreams are providing a valuable mechanism in working with atemporal emotional trauma, previously uncontextualized. Dream metaphor can provide a transitional space to move around in within the analytic framework. This paper explores a variety of dreams from individual analysands demonstrating different ways of conceptualizing personal and collective experience, bridging between the past, present, and future. Parallels between feeling states related to the current condition and unprocessed implicit memories from the past will be examined, as a vehicle for processing past trauma. Dreams expressing current states of dread for an unimaginable future, as well compensatory dreams showing a hopeful vision of the future will be considered.     

Intersections of personal vs. collective trauma during the COVID-19 pandemic: the hijacking of the human imagination

This paper explores how the deadly shadow of COVID-19 passing over the Earth constitutes a collective trauma that frequently opens up or ‘triggers’ un-remembered personal trauma, and it provides clinical examples of these intersections. The paper further explores how the human imagination, which we normally utilize to make meaning out of traumatic experience, can be hijacked by fear – leading to avoidance of suffering and to illusory formulations and alternative realities such as conspiracy theories. Alternatively, the imagination can be employed in more realistic and creative ways – leading through conscious suffering to healing and wholeness. Which path the imagination takes is shown to depend on the capacity of individuals to feel the full reality of the human condition in general and the exquisite vulnerability of our existence as fragile human beings at this moment in history. Ernest Becker’s analysis of our ‘denial of death’ and his urgency to embrace our common human vulnerability is explored in relation to Jung’s early tendency to deny the body. The author proposes that the more creative uses of the imagination, connected to a more humble and realistic apprehension of our common destiny, may be seen in the ‘Black Lives Matter’ movement that swept the world in the aftermath of the COVID-19 outbreak.     

替代性创伤与具身情绪

具身情绪是在近年来大热的具身认知领域影响下提出的便于研究情绪的理论,主要表现为情绪是由生理反应及情境等共同作用影响的; 而替代性创伤是用以描述心理工作者因长期接触创伤后患者对其进行危机干预,而出现类似的创伤反应和身心不良症状的概念。这两者在形成结构上存在相似之处。本文对这两个概念进行介绍,从具身的视角描述了替代性创伤的成因,最后结合实际对未来研究探讨与展望。     

The Lived Experiences of Addiction Counselors After Marijuana Legalization

This qualitative study examines the perceptions of counselors who work with populations with addictions in states where marijuana has been legalized. Findings include themes related to client experiences, counselor experiences, specific interventions, and lack of understanding.     

Brief Cognitive-Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated in psychiatric patients following discharge from inpatient care. Despite this vulnerability, there has been limited research investigating suicide prevention protocols that take into account the unique system characteristics of this setting (e.g., short lengths of stay, crisis stabilization treatment model, multidisciplinary team coordination). Cognitive-behavioral therapy (CBT) has demonstrated efficacy for improving suicide risk in outpatients, but has not been validated with inpatients. The current study was a treatment development and pilot feasibility open trial that modified brief cognitive-behavioral therapy (BCBT) for an inpatient setting (BCBT-I). Key treatment modifications included administering up to 10 sessions (depending on patient length of stay), daily, and in a standardized order, with core crisis management skills introduced during the first three sessions. In addition, coordination with the inpatient treatment team was included in BCBT-I implementation. Six adult inpatients with a recent suicide attempt enrolled and completed an average of 4.67 BCBT-I sessions (SD = 1.36). The treatment was highly acceptable (Client Satisfaction Questionnaire total score M = 3.49, SD = 0.73). Pre- to posttreatment effect sizes demonstrated improvements in suicidal ideation (d = 0.97), depression (d = 1.33), and suicidal implicit associations (d = 1.28). All but one of the participants (83%) completed follow-up assessments 1-, 2-, and 3-months postdischarge. Over follow-up, two participants reported suicidal ideation (both without intent), and none reported suicide attempts, preparatory acts or behaviors, or nonsuicidal self-injury. This study provided preliminary evidence supporting the feasibility of CBT to treat suicidal inpatients. Future research is needed to validate BCBT-I in a larger, randomized controlled trial to determine whether BCBT-I reduces suicide risk beyond that afforded by inpatient treatment alone.     

Conducting Prolonged Exposure for PTSD During the COVID-19 Pandemic: Considerations for Treatment

The unprecedented effects and duration of the COVID-19 crisis are likely to elevate the population’s level of anxiety due to psychological stress, economic hardship, and social isolation. This effect may be especially potent for individuals with preexisting mental health conditions, such as posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) therapy is a highly effective treatment for PTSD across trauma-exposed populations, and has been implemented effectively via telehealth. Nevertheless, PE implementation via telehealth may require specific adaptations during the COVID-19 crisis due to public health mandates calling for sheltering in place and physical distancing. This paper discusses strategies for implementing PE for PTSD during the COVID-19 pandemic, which may also be applied to other situations in which physical distancing must be considered.     

Comparing computer‐based training and lecture formats to teach visual analysis of baseline‐treatment graphs

Accurate analysis of data is vital to the validation of interventions. As such, there has been a recent increase in studies evaluating visual analysis training procedures. However, past investigations have not evaluated direct and indirect visual analysis training methods with matched instructional content that was systematically designed. Furthermore, training has rarely included assessment of generalization and maintenance of visual analysis skills. The purpose of the current dissertation study was to compare the effectiveness and efficiency of (a) computer‐based training, (b) lecture formats with and (c) without the opportunity to pause, and (d) a no‐training group to teach visual analysis of AB graphs to university students. To make these formats directly comparable, the instructional content was equated by ensuring information and examples were identical across the three training procedures. Eighty‐three students were randomly assigned to one of the four groups. Results showed that all three training formats produced increases in accurate responding compared to the no‐training group. Visual analysis skills generalized to novel graphs and maintained approximately 2 weeks following all trainings. These results suggest that structured approaches that are carefully designed to train visual analysis are effective and lead to gains that generalize and maintain in the absence of training.     

Beyond trigger warnings: Toward a trauma‐informed andragogy for the graduate theological classroom*

Although development of trauma‐informed pedagogy for elementary and secondary classrooms has developed significantly, a dearth of resources for trauma‐informed andragogy in graduate theological classrooms remains. Theological classrooms are a unique context in which many students and professors carry experiences of trauma with them. This article makes the case for the need for a trauma‐informed andragogical model for the graduate theological classroom by: discussing the pervasiveness of trauma; providing definitions of key terms that need to be understood for elaborating a trauma‐informed andragogy; recommending trauma‐informed principles for course design and class‐session planning based in safety, trust, choice, collaboration, and empowerment; and identifying a few next steps for cultivating trauma‐informed classrooms and institutions at the graduate level.     

Perceptions of War Trauma and Healing of Marital Relations Among Torture-surviving Congolese Couples Participating in Multicouple Therapy

Citizens of the Democratic Republic of Congo (DRC) experienced widespread torture during national wars between 1998 and 2003. Couples who survived and stayed intact suffered tremendous relationship stress. This study used a critical ethnography framework to explore the prewar, wartime, and postwar experiences of 13 torture-surviving couples who participated in a 10-session Torture-Surviving Couple Group in 2008 in the DRC. The group was designed to address the relational effects of torture and war trauma. Participants reported profound negative effects of the war on their relationships; mostly positive experiences during the group, including marital and peer connection and relationship growth; and a number of improvements in their relationship after the group. Implications include support for the use of relational interventions informed by both treatments for traumatic stress and couple approaches to promote trauma healing. Future directions call for increased funding, research, training, and clinical action to treat the effects of traumatic stress on relational family dynamics.