Treating the Sexual Concerns of Adult Incest Survivors and Their Partners

SUMMARY

Negative attitudes about sex and sexuality and many types of sexual dysfunction are common aftereffects of sexual child abuse and incest. The traumatic sexualization and the aversive sexual conditioning resulting from childhood abuse have long gone unrecognized, however. This article presents research findings regarding the impact of incest on sexual attitudes and functioning along with treatment recommendations.     

Trauma-Related Negative Cognitions Mediate the Relationship Between Avoidant Personality Beliefs and Impeded Response to Psychotherapy for PTSD

There is strong research evidence for the association of personality pathology and posttraumatic stress disorder (PTSD), as well as trauma-related negative cognitions (TRNC) and PTSD symptoms. However, the relationship between personality pathology and TRNC in the context of PTSD is mostly unknown. In the present study, we aimed to examine whether avoidant and borderline personality beliefs (PB, indicator of personality pathology) could predict therapy outcome in PTSD, and whether the relationship between PB and therapy outcome could be mediated by TRNC. Sixty patients with PTSD were assessed for PB, TRNC and PTSD symptoms at baseline, and for PTSD symptoms at the termination of Prolonged Exposure Therapy. Baseline avoidant PB predicted significant variance in PTSD symptoms at termination over and above baseline PTSD symptoms (16% reduction in treatment effect per SD on avoidant PB). Moreover, TRNC at baseline fully mediated the relationships between baseline avoidant PB and PTSD symptoms at termination. This is the first study to show that avoidant PB predicts treatment response in PTSD, and that patients with avoidant beliefs are more vulnerable to have TRNC, which are associated with impeded therapy response. Our results highlight the importance of targeting both dysfunctional PB and TRNC in PTSD interventions.     

Cancer and the body: Reflections from a Lacanian perspective

This paper discusses psychotherapeutic work with cancer patients using a Lacanian approach to illness. In the first part of the paper, some of Lacan's notions of the body are discussed. In the second half, Lacan's understanding of the body is used to show how an appreciation of Lacan's work might enhance clinical/psychotherapeutic work with cancer patients.     

Eyes wide open: Facilitating student therapists’ experiences with the unfamiliar

Psychotherapists and counsellors work increasingly with culturally different or unfamiliar clients in the context of global migration and relocation. This paper explores the learning processes of trainee therapists within a South African community clinic context which confronts trainees with cultural diversity and a range of complex and traumatic presenting problems. Learning within this context entails interfacing with the ‘unfamiliar’, a process which challenges students both culturally and personally. Drawing upon the ideas of Wilfred Bion we suggest the importance of supervisory reverie in helping students convert raw sensory data into reflective practice. We suggest that working within community clinic contexts prompts personal anxieties as well as context-related anxieties of persecution or annihilation, of narcissistic injury and of contamination. It is hoped that a psychodynamic understanding may prompt further debate regarding the training of therapists working with diverse populations and problems.     

Editorial: Sex,Shit, Money and Marxism – The Continued Demise of the ‘Third Way’

Existential phenomena such as ‘thrownness’, ‘angst’, authenticity, being-with-others, co-constitutionality, being-in-time and death are linked to aspects of the transition to retirement such as ageing, choice paralysis, identity, persona use, continuity, nostalgia, conformity, friendships and the end of existence. The attempt to integrate these two different but overlapping perspectives upon experiencing the transition to retirement is intended to promote a broader perspective for those counsellors and psychotherapists with clients who have retired or are close to doing so.     

‘Things said or done long ago are recalled and remembered’: The ethics of mindfulness in early Buddhism,psychotherapy and clinical psychology

I argue that current theoretical understandings of mindfulness as an attention regulation strategy for psychological stress reduction and enhanced adaptation to society may produce de-ethicised therapeutic applications. I show how understandings of mindfulness in early Buddhism, psychotherapy and clinical psychology have changed over time. Current understandings of mindfulness as a skill or technique of bringing non-judgmental awareness (or bare attention) to present moment experience are historically recent and differ from early Buddhist understandings in at least one crucial respect: definitions of mindfulness as attentional control or metacognitive awareness lack an emphasis on deep ethical reflection. As such, we need to re-ethicise our conceptual understanding of mindfulness by remembering early Buddhist texts, where mindfulness involves the cultivation of an ethically sensitive style of remembering, which has largely been lost in contemporary definitions.     

‘Poor girl’: a case of active psychosis': clinical commentary

This paper presents the Clarkson Intervention Priority Sequencing Model for clarification and decision making in counselling, psychotherapy, supervision, consultancy As well as in the training and supervision of practitioners in these fields. The model can assist professionals to differentiate whether the focus for most urgent intervention in any part of the supervisory system primarily concerns areas of Danger, Confusion, Conflict, Deficit or Development and gives examples referring to health psychology and cultural diversity as well as providing some guidelines for application.     

Approaches to evaluation

This paper offers some informal thoughts about audit and research studies in a psychotherapy or counselling context, drawing on the author's background in a difficult area of evaluation: the outcomes of psychoanalytic psychotherapy for children and adolescents. Reasons for therapists' difficulties with the idea of evaluation studies are considered, and possible designs for feasible research projects are briefly discussed. Examples of different strategies within one area are given, to illustrate the way in which different approaches can be patched together to yield important findings, and to overcome the limitations of any one approach. the place of audit in relation to research is also briefly discussed.