Implications of attachment theory for working in psychoanalytic psychotherapy

John Bowlby's Attachment Theory is being increasingly operationalised in the world of developmental research, but as yet its implications for clinical work are relatively less discussed. This paper addresses the issue of the measurement of attachment patterns and how knowledge of these can inform psychoanalysts’ work with their patients. It looks at the implications of Attachment Theory at all stages of the therapeutic process, but concentrates particularly on how it can help with the crucial phase of building the working alliance.     

The psychodynamics of forensic mental health nursing

Abstract

The aim of this paper is to clarify some important interpersonal dynamics that underpin forensic patients’ presentations within the clinical environment, in a way that is accessible to nurses. The world of forensic mental health nursing is often difficult to describe to those who have not experienced first hand prolonged clinical contact with patients at the therapeutic interface of secure services. Even then, the characteristic, intense emotional phenomena that tend to arise out of interpersonal relationships with patients and colleagues is not easy to articulate. Yet, for those of us who consider our professional identity to be one of “forensic mental health nurse,” it seems important to find a way to put words to what appears to occupy a large component of our working lives. More importantly, if we can develop a way to make sense of the way our work makes us feel and the way we can find ourselves relating to others within our professional roles, we will be in a better position to harness our energy and enthusiasm in the service of supporting forensic patients towards effective care and treatment pathways. Of course, forensic patients are supported through services with or without a framework for articulating emotional and interpersonal experiences. However, this frequently occurs in the context of significant struggle. For patients, this struggle is often characterized by difficulty communicating what their needs are, and for nurses this struggle is often characterized by feeling emotionally overwhelmed by their task of providing containing, therapeutic relationships for patients whose interpersonal needs are not clear to them. This article will use case examples to describe some of the complex interpersonal and emotional challenges faced by forensic nurses, and explain how a psychodynamic framework could support nursing practice in each of the case examples.     

Fibromyalgia: Predicting openness to counselling referrals

Fibromyalgia (FM) is a chronic pain condition that can negatively impact on all aspects of patients’ lives. The purpose of this study was: first, to explore the biopsychosocial factors that may contribute to adjustment to FM symptoms; second, to investigate how referrals to counselling related to patients’ ratings of their relationship with their physicians; and, last, to examine if self-reports of illness distress, emotional problems, and practical problems can predict who will be open to counselling referrals. For this cross-sectional study, data from 190 people were collected through an online survey. Statistical analysis revealed that emotional problems reported were the best predictor of variance in illness distress and contentment scores. Further, results indicated that referrals made in accord with patients’ perceptions that they would benefit from counselling may have a positive influence on how patients rate their relationships with their physicians. Finally, self-reported scores of illness distress, number of emotional problems, and number of practical problems accurately predicted who would be open to counselling referrals in 67% of cases. Research results provide support for addressing emotional issues to facilitate adjustment to FM symptoms, and for use of psychosocial measures to determine when patients with FM will be open to counselling referrals.     

Examining adversarial growth in illness: The factor structure of the silver lining questionnaire (SLQ-38)

The Silver Lining Questionnaire (SLQ-38) is purported to measure 10 aspects of adversarial growth in illness. To date however, no empirical evidence exists to support this claim. Hence the aim of this study was to investigate the factor structure of the SLQ-38 in a sample of 560 individuals with multiple sclerosis (MS), cancer, cardiac, and renal disease. The results demonstrate that 24 SLQ-38 items can be factored into five subscales: improved personal relationships, greater appreciation for life, positive influence on others, personal inner strength and changes in life philosophy, all of which are in accordance with the literature on adversarial growth. Individuals with MS experienced lower adversarial growth compared to other illness groups. Gender, age and time since diagnosis were unrelated to adversarial growth in illness. The utility of the revised SLQ-38 is discussed along with suggestions for future research on the convergent and divergent validity of this revised instrument.     

Alcohol use affects sleep duration among military couples

Alcohol misuse and sleep disorders are highly comorbid, prevalent among service members and their romantic partners, and affected by relationship interdependence. As most military health research focuses on either service members or their spouses, the current study examined dyadic effects of alcohol use on sleep cycle duration in dating and married military couples (N = 149 dyads), using data from the National Longitudinal Study of Adolescent Health. Person-level results from a series of multilevel path models showed partial support for our focal hypothesis implicating high alcohol use in shortened average sleep duration for the service members and their romantic partners. Specifically, partners of service members who drank more regularly had shorter average sleep durations, as did female service members who drank more alcohol per drinking occasion. At the couple-level, a partner effect indicated that service members’ lower depressive symptoms were associated with their partner’s shorter average sleep durations. In addition, when service members reported relatively high alcohol-related problems, their partner tended to have a shorter average sleep duration. In contrast, when service members’ partners reported relatively high alcohol-related problems, they had a longer average sleep duration. This suggests the consequences of problematic alcohol use for service members’ partners depended on each dyad member’s drinking patterns. Taken together, these findings underscore the importance of viewing military couples as a dyadic unit in research studies and clinical interventions.     

The relation between emotion regulation choice and posttraumatic growth

ABSTRACT

Previous research has examined emotion regulation (ER) and trauma in the context of psychopathology, yet little research has examined ER in posttraumatic growth (PTG), the experience of positive psychological change following a traumatic event. ER typically involves decreasing negative affect by engaging (e.g. reappraisal) or disengaging (e.g. distraction) with emotional content. To investigate how ER may support PTG, participants who experienced a traumatic event in the past 6 months completed a PTG questionnaire and an ER choice task in which they down regulated their negative emotion in response to negative pictures of varying intensity by choosing to distract or reappraise. Latent growth curve analyses revealed that an increase in reappraisal choice from low to high subjective stimulus intensity predicted higher PTG, suggesting that individuals who chose reappraisal more as intensity increased reported higher PTG. Findings suggest that reappraisal of negative stimuli following a traumatic event may be a key component of PTG.     

Perspectives of a Pastoral Counselor

No abstract available for this article.     

Feminist Therapy as a Path to Friendship with Women

While many feminist therapists have found that their personal experiences of friendship have given them an experiential base from which to develop their work, some feminist therapists have had alternative journeys through connections with women. This article explores how the author transformed her childhood and adolescent experiences of relational aggression into a deepened understanding of the value and importance of relationships between women. The contributions of misogyny and sexism to relational aggression among girls and women, and their enduring effects on all women's relationships to other women is explored. Finally, the author describes her intimate e-epistolary friendship with two other women, and considers how the medium of email and other forms of electronic communication may facilitate emotional intimacy for women who have experienced relational aggression with other women.     

Sexist Treatment in the Mental Health System

No abstract available for this article.     

Women and Physical Distinction:

With few exceptions, the special concerns and status of women with physical distinctions (physical disability and facial disfigurement) have been largely ignored in the disability literature. Women with physical distinctions are perceived negatively and are devalued and marginalized in our culture. They face a double discrimination due to their gender and their disability. The situation is even more acute for ethnic minority women with physical distinctions. This paper will review the literature on women with physical distinctions and explore some of the issues for ethnic minority women with physical distinctins. Recommendations are offered for feminist therapists who work with this population.