The role of a parent's illness in the emotional experience of a child evidence from Klein's Narrative of a child analysis

Abstract

The analysis of Richard, described by Melanie Klein in Narrative of a Child Analysis, gives us some insight into the effect on a child of threats to the health of his parents. His mother was involved in a road accident when Richard was 2; his father collapsed during the time of the analysis when he was 10. This paper links these events with disturbances in Richard's relation to his father and to his mother, as well as with threats to his own integrity, as demonstrated in the analysis. Richard's reversal of roles with his father and mother is discussed, as are Klein's reaction to Richard's report of finding his father ‘ill and nearly fainting’ and Richard's response to her behaviour. The paper draws attention to the way in which a child's reaction to the ill health of one parent can affect relations with both parents, as well as disturbing his sense of himself.     

The Failure to Contain: How Persecutory Anxieties Contribute to Noncompliance in Adult Patients with Congenital Chronic Pain Conditions

ABSTRACT

Patients with sickle-cell disease suffer from lifelong pain. Many prefer to receive emergent rather than managed health care, which results in these people being termed “noncompliant.” This paper explores the contributing factors of such noncompliance in the adult patient with painful chronic illness. In the earliest stages of development, internal pain is attributed to external origins, and the effects of this on the psyche are analogous to those of physical abuse. When the infant's pain cannot be contained, projective identification and persecutory anxieties become deeply ingrained. Interventions that focus on healing from trauma and building trust are preferable to those which most value immediate compliance, as the patterns of behavior are so firmly entrenched.     

Cognitive Factors in the Maintenance of PTSD

Abstract

Cognitive behavioural therapies have the strongest empirical support as the treatments of choice for Post-traumatic Stress Disorder (PTSD). Despite the relative efficacy of these treatments compared to other psychological treatments, and no treatment, a large proportion of PTSD patients retain their diagnosis after treatment. In this article, a review of cognitive factors that are suggested to be responsible for the maintenance of PTSD in unimproved patients is presented. Among these factors are: anger and rage, guilt and shame, attentional bias and memory bias, negative attributional style, low self-efficacy, cognitive avoidance, dysfunctional schemas, catastrophic interpretations of intrusive recollections and pathological trauma memory structures. In the discussion section, suggestions about how therapy programmes might be modified in order to maximize cognitive change are provided.     

Health Anxiety in Children: Development and Psychometric Properties of the Childhood Illness Attitude Scales

The course of severe anxiety surrounding health issues is unknown. The available literature suggests that adults who are overly anxious about health issues often interpret or misinterpret their bodily signs and symptoms to be indicative of a serious illness. The construct of health anxiety has not been examined in children and, to date, there has not been an instrument developed for this purpose. The Illness Attitude Scales is one of the most commonly used instruments for evaluating fears, beliefs, and attitudes that are associated with hypochondriasis and abnormal illness behaviour in adults. We sought to adapt the Illness Attitude Scales for use with children ages 8–15 years. The adapted Illness Attitude Scales was renamed the Childhood Illness Attitude Scales. Revisions to the adult version consisted of simplification of language, revision of Likert scale (i.e. 5-point to 3-point scale), and the addition of 7 questions to evaluate the role parents/guardians play in facilitating medical attention or treatment. Correlations between Childhood Illness Attitude Scales total scores and other self-report measures were supportive of the construct-related validity of the Childhood Illness Attitude Scales and suggested that it is a useful measure of health anxiety in school-age children. Practical and theoretical implications of the present results are discussed.     

A Study of the Multiple and Complex Needs of Australian Young Adult Offenders

Youth offending is an important issue; it has significant social, psychological, interpersonal, and financial impacts on the society. International research has shown that young offenders generally have multiple and complex needs across a wide range of domains; however, research examining the depth and breadth of difficulties faced by young offenders in Australia is lacking. Arguably, such information is critical to help guide the development of valid preventative and treatment initiatives. This article describes a study examining the prevalence of mental illness, low intelligence, psychopathy, risk for reoffending, and criminogenic needs in 75 youth and young adult offenders in Victoria, Australia. Results suggest that the prevalence of mental illness and low intelligence is high in this population. Most (86%) of the sample had likely Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I disorders (including mood, anxiety, substance use, eating, and psychotic disorders); 15% had a Full Scale Intellectual Quotient (FSIQ) below 70; and an additional 25.7% had an FSIQ in the borderline range. The majority (80%) of the sample was considered to be at a high or very high risk of reoffending. The high prevalence of mental health issues found in this population highlights the need for comprehensive and multifaceted assessment, and for psychosocial treatment and management to be comprehensive, addressing clinical, criminogenic, and social domains.     

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.     

Characteristics of Traumatic Experience and Survivor Perceptions of Mental Health Services: The 2004–2005 Erie County Community Trauma Survey

Trauma is associated with severe mental illness and substance abuse problems, yet it typically is not addressed sufficiently in treatment. This article reports on an assessment of mental health service recipients and their experience of traumatic events and perceptions of service providers' sensitivity, helpfulness, and knowledge regarding their trauma and service needs using a community-based participatory research model. Demographic characteristics and status of co-occurring disorders were measured. Participants perceived that individual therapists and peer service providers were sensitive to and knowledgeable about their trauma. Group treatment and peer programs were seen as being most helpful. Psychiatric services were seen as being the least sensitive to trauma issues. Implications for practice and research are discussed.     

A Single-Arm Meta-Analysis of Cognitive Processing Therapy in Addressing Trauma-Related Negative Cognitions

Cognitive Processing Therapy (CPT) is a first-line treatment for posttraumatic stress disorder designed to address cognitive “stuck points” connected to a patient’s trauma-related negative cognitions (NCs). Although CPT has well-established efficacy, the ability of CPT to address NCs remains understudied. The purpose of this study was to conduct a single-arm meta-analysis to determine the overall effect of CPT in attenuating NCs pre- to posttreatment across multiple clinical trials. A review of the existing literature was performed with only peer-reviewed clinical trials included in the meta-analysis. Nine studies with data from 583 participants were entered into the meta-analysis. CPT was found to have a large effect size in reducing NCs from pre- to posttreatment. Findings are limited by the single-arm nature of analyses and heterogeneity in included trial methodology (e.g., gender, trauma type, civilian versus veteran).     

The diagnostic and statistical manual: sacred text for a secular community?

The Diagnostic and Statistical Manual of Mental Disorders is the most widely used diagnostic system by mental health professionals in North America. It provides a shared language and paradigm by which practitioners view clients. Can it be argued that the DSM represents a sacred text and defines a worldview for an identifiable community of mental health professionals? In what ways is the relationship between this community and document similar to and different from the relationships that explicitly religious communities maintain with their sacred texts?