‘WITH PSYCHOSIS IN MIND’ – the reverberations of the psychotic encounter

Psychoanalytic theory offers a varied conceptual system for considering psychosis by providing a coherent representation of the anxieties and processes at work in adult patients. But at the practical clinical level, it is not enough simply to ‘think about psychosis’ and have a theoretical system in place. The therapist must also ‘have psychosis in mind’, that is, get to grips with its forms of logic, gain familiarity with its workings, and learn to understand and accept the effects it has on the therapeutic relationship and on their own expectations. Clinicians engaged in this type of work must be able to tolerate getting back in touch with processes deemed archaic at the core of their own psychological functioning, which will impact their ability to listen and think. These chaotic processes demand a change of approach since they cause a ‘desymbolisation’ that perturbs the internal mental structure of the therapist. This ‘desymbolisation’ is therefore the locus of the therapeutic work, which must attempt to render it comprehensible and represent it. A case study illustrates these processes.     

‘If I knew where the enemy,or even Germany was,we could have fired in that direction’: Bion's experience of war

The role of a child psychotherapist's gender is not often considered in terms of treatment outcome. This paper discusses how aspects of being a male child psychotherapist influenced the successful treatment of a very young boy with Asperger's Syndrome. The paper highlights how the nature of his very early relationship with his mother and the absence of his father were the basis of his difficulties resulting in that diagnosis. It shows that his desire to seize the opportunity of working with a male enabled him to understand his feelings about his father, why it was so difficult to want to be with him and not his mother, and why he could not be without her.

Le rôle joué par le sexe du psychothérapeute d'enfants dans les effets du traitement est rarement pris en compte. Dans cet article, l'auteur montre qu'à un certain niveau le fait d'être un psychothérapeute homme eut une influence sur la réussite de la thérapie d'un très jeune garçon présentant un syndrome d'Asperger. Selon l'auteur, la nature de la relation précoce entre ce petit garçon et sa mère, ainsi que l'absence de son père, étaient à l'origine des difficultés qui conduisirent à ce diagnostic. Il montre que le désir de l'enfant de se saisir de l'occasion ainsi offerte de travailler avec un homme lui permit de comprendre trois éléments essentiels : ses sentiments à l'égard de son père, la raison pour laquelle il lui était tellement difficile de vouloir être avec lui plutôt que de rester avec sa mère, et ce qui faisait qu'il ne pouvait pas se passer de celle-ci.

Die Rolle des Geschlechts des Kindertherapeuten wird nicht oft bezüglich des Behandlungsergebnis in Betracht bezogen. Dieser Artikel diskutiert, wie Aspekte dessen, ein männlicher Kindertherapeut zu sein, die erfolgreiche Behandlung eines sehr kleinen Jungen mit Asperger Syndrom beeinflussten. Der Artikel unterstreicht, wie die Art seiner frühen Beziehung zu seiner Mutter und die Abwesenheit seines Vaters die Grundlage seiner Schwierigkeiten bildeten, die zu dieser Diagnose führten. Es zeigt, dass sein Wunsch, die Gelegenheit zu ergreifen, mit einem Mann zu arbeiten, ihm ermöglichte, seine Gefühle seinem Vater gegenüber zu verstehen, warum es so schwierig war, mit ihm und nicht seiner Mutter sein zu wollen und warum er nicht ohne sie sein konnnte.

Riassunto: Il ruolo che gioca il sesso dello psicoterapeuta infantile non è solitamente considerato in relazione al risultato del trattamento. In questo articolo si discute come il fatto di avere un terapeuta maschile abbia influenzato per certi aspetti il risultato positivo del trattamento di un bambino molto piccolo che soffriva della Sindrome di Asperger. L'articolo illustra come la natura della sua primissima relazione con la madre e l'assenza del padre furono alla base delle sue difficoltà che portarono alla diagnosi. L'articolo mostra come il desiderio del bambino di lavorare con un terapeuta maschile gli ha permesso di capire i suoi sentimenti verso il padre, perché era così difficile voler restare con lui e lo stesso non succedeva con sua madre, e perché non poteva restare senza di lei.     

费尔贝恩人格客体关系理论的心理治疗观

英国精神分析学家费尔贝恩在修正与发展弗洛伊德和克莱因思想的基础之上,提出了一种纯粹的人格客体关系理论,他发展了一套修正的心理病理学思想。他认为,精神分裂是所有心理病理现象的基础;心理治疗的目标是要让病人从无意识中释放坏的客体和减少自我的分裂、达到人格的整合,而分析师与病人的关系则是心理治疗的中心。     

Destructive and reparative transference in multiple levels of group psychotherapy

Group members are challenged to form psychologically meaningful relationships with therapists, other members, and the group as a whole. The way in which individuals perceive this challenge is based on their past experiences. Early relationships establish a perceptual frame in which fears of being hurt and concern about hurting others coexist. Balance between these two ways of generating meaning enables individuals to form relatively healthy relationships. Imbalance in this perceptual frame results in distorted perceptions and maladaptive patterns emerging as transference manifestations. Working through involves repeatedly addressing distortions as members relate to therapists, others and the group as a whole.     

Development of manipulatory skills and the deployment of attention

Two independent tasks, object manipulation and auditory-visual matching, were used to examine the relationship between developing manual action skills and attention to intermodal object properties in 3.5- and 5.5-month-olds. Although handling skills improved with age, with older infants demonstrating more varied manipulation, there were no age differences for the matching task. When grouped by handling skills, a significant interaction between skill and event type was found for the two age groups combined and for 5.5-month-olds alone. Auditory-visual matching of social events did not vary with handling skills, whereas auditory-visualmatching of object events did. Infants at higher skill levels responded similarly to social and object events, whereas less skilled infants' matching preferences were weaker for object events. These findings indicate that infants increase their attention to auditory and visual properties of objects as this information becomes useful for guiding new actions. This effect is independent of age due to considerable individual variability in the development of object handling skills.     

Relations between baseline contingencies and equivalence probe performances

Following the emergence of two three-member equivalence classes (A1B1C1 and A2B2C2), 5 college students were exposed to one or more changes in the reinforcement contingencies controlling baseline conditional discriminations. AC relations were either reversed (i.e., C2 was reinforced and C1 punished when A1 was the sample; C1 was reinforced and C2 punished when A2 was the sample) or arranged randomly (i.e., C2 and C1 were reinforced and punished equally often in the presence of A1 and A2). In a third condition, the original AB and AC relations were reversed. Results showed that although baseline conditional discrimination performances were under the control of reinforcement contingencies, and performances on symmetry trials varied with baseline responding for 3 of 4 subjects when contingencies were reversed, performances on transitivity probes remained consistent with the initial equivalence class. These inconsistencies between probe and baseline performances were striking because conditional discriminations are thought to be the determinants of equivalence class performance. Similarly, the contrast between performances on symmetry and transitivity probes was of theoretical interest because equivalence classes are defined by congruent patterns of responding on probe trials.     

相对到达时间任务中飞行员对客体特征与运动特征的分离

相对到达时间任务(RAT)是判断两个运动客体哪个先到达指定目标, 可用来评估个体动态空间能力。采用RAT任务对飞行员与普通被试进行对照研究, 寻求发现两组在运动客体特征和视觉空间运动特征及其相互关系上的处理差异。设计了3个实验分别考察客体颜色、客体大小、运动方向、速率大小、视线方向以及背景特征对判断的影响。结果显示：(1)客体颜色不影响运动客体的相对时间判断, 客体大小、运动方向、速率大小、视线方向以及背景特征影响判断; (2)控制组对显示屏上从左到右的运动客体的相对时间判断好于从右到左任务, 大速率任务判断更好, 对大客体快速行驶而小客体低速行驶时的相对到达时间更易区分, 且与两眼视线方向不一致的运动方向会使控制组判断更难, 运动背景中的目标线特征改变使控制组判断绩效降低; (3)和控制组比, 飞行员反应快正确率高, 其快速判断优势集中体现在从右到左运动以及小速率任务上, 且在不同运动方向和不同速率上的反应时均无差异, 飞行员的处理优势还表现在不受客体大小、视线方向改变和目标线特征改变的影响。结论：飞行员能在变化的空间中准确处理相对速度、相对距离、相对时间等运动信息, 能分离客体大小、背景、运动方向等因素对相对到达时间判断的影响, 在运动空间中飞行员具有较高场独立性认知特征和动态空间处理能力。