THERAPIST‐ AND SELF‐MONITORED DRO CONTINGENCIES AS A TREATMENT FOR THE SELF‐INJURIOUS SKIN PICKING OF A YOUNG MAN WITH ASPERGER SYNDROME

The use of differential reinforcement of other behavior (DRO) has decreased, at least partially due to the development of less effortful alternative behavioral interventions (e.g., noncontingent reinforcement; Vollmer, Iwata, Zarcone, Smith, & Mazaleski, 1993). The effort associated with DRO contingencies may be lessened by incorporating self‐monitoring components in which clients are responsible for the delivery of reinforcers for their own behavior. The current study evaluates the effectiveness of DRO in the treatment of self‐injury when implemented first by the therapist and subsequently by the client.     

Displacement as trauma and trauma as displacement in the experience of refugees

This paper investigates the relations between displacement, home, trauma and the self in the experience of refugees, which has become an issue of unexpected and far-reaching proportions in recent times. It questions to what extent and under what conditions displacement in the world may be traumatic and how trauma may be considered the effect of an inner displacement. Refugees’ lives are marked by forced migration that is related to a certain suffering due to the changes in their family, relational, social and cultural lives. The paper explores the extent to which these changes can represent a break so significant as to be traumatic. It outlines the way in which traumatic experiences can produce an inner displacement and reorganization of one’s mental life that leads to a focus on traumatic complexes. Under the most severe traumatic conditions, this can be understood as a displacement of the central axis of Self, in which the ego complex yields its position to other complexes, with a deep change in the organization and functioning of self. The experience of refugees highlights the way in which we live in a matrix of conscious and unconscious links between inner and outer worlds that need deeper and simultaneous consideration to understand their implications and mutual resonances for the psyche. Clinical cases of refugees will illustrate some aspects of these interconnections.     

Moments That Matter? On the Complexity of Using Triggers Based on Skin Conductance to Sample Arousing Events Within an Experience Sampling Framework

To sample situations that are psychologically arousing in daily life, we implemented an experience sampling strategy in which 82 Dutch young adults (M_age = 20.73) were triggered based on random time intervals and based on physiological skin conductance scores across a period of 5 days. When triggered, participants had to fill in short surveys on affect, situational characteristics and event characteristics on their smartphone. We found theoretically expected relationships between the skin conductance signal on the one hand and self-reported arousal and positive energy (e.g. energetic and enthusiastic) on the other hand, although effect sizes were small. Unexpectedly, none of the negative affective scales (i.e. irritation, anxiety, and negative valence) were predicted by skin conductance levels. Despite the (partial) validity of the signal, a simple algorithm that triggered the survey based on relative increases of skin conductance levels produced counterintuitive results due to a dependence between level and slope. Additional exploratory analyses highlighted other skin conductance signal characteristics (i.e. autocorrelation, number of peaks, and change points) that might be worth examining when designing future algorithms to sample arousing moments. Overall, our experiences highlight not only the promise but also the complexity of real-time measurement of physiological processes in daily life. © 2020 The Authors. European Journal of Personality published by John Wiley & Sons Ltd on behalf of European Association of Personality Psychology     

以中节指动脉弓为蒂逆行指动脉岛状皮瓣修复指端缺损

观察以中节指动脉弓为蒂逆行指动脉岛状皮瓣修复指端缺损的临床效果。对24例指端缺损的患者实行以中节指动脉弓为蒂逆行指动脉岛状皮瓣修复术。结果24例患者皮瓣全部成活,术后随访3个月~6个月,手指功能恢复良好。该手术操作简便,术后功能外观好,是修复指端特别是指腹皮肤软组织缺损的首选手术方法。     

From psychic holes to psychic representations

Abstract

In this essay, I will explore the term “psychic hole,” and compare it to similar terms from the world of astrophysics and terms used in the psychoanalytic literature. I will then present my own conception of the “psychic hole” in cases of Holocaust survivors' offspring. I will explain how this “hole” is created, and describe a particular aspect of the “psychic hole” that is unique to Holocaust survivors' offspring, namely the enactments (termed “concretization” by Bergman) generated by the negated traumatic themes that reside in it. I will illustrate these enactments using clinical material taken from case studies of Holocaust survivors' offspring that I have previously published. The clinical vignettes reveal the transgenerational impact of the memory hole resulting from negation of survivor parents on the lives of their offspring, up to the third generation. They also show the painful journey from enactments to psychic representations, a journey which exposes the traumatic events that have been denied or repressed, and facilitates the work of mourning and the eventual achievement of a better integrated self. Finally, I will offer technical suggestions for analysts to help patients transform psychic holes into psychic representations.     

Hallucinations in the psychotic state: Psychoanalysis and the neurosciences compared

In this contribution, which takes account of important findings in neuroscientific as well as psychoanalytic research, the authors explore the meaning of the deep‐going distortions of psychic functioning occurring in hallucinatory phenomena. Neuroscientific studies have established that hallucinations distort the sense of reality owing to a complex alteration in the balance between top‐down and bottom‐up brain circuits. The present authors postulate that hallucinatory phenomena represent the outcome of a psychotic's distorted use of the mind over an extended period of time. In the hallucinatory state the psychotic part of the personality uses the mind to generate auto‐induced sensations and to achieve a particular sort of regressive pleasure. In these cases, therefore, the mind is not used as an organ of knowledge or as an instrument for fostering relationships with others. The hallucinating psychotic decathects psychic (relational) reality and withdraws into a personal, bodily, and sensory space of his own. The opposing realities are not only external and internal but also psychic and sensory. Visual hallucinations could thus be said to originate from seeing with the ‘eyes’ of the mind, and auditory hallucinations from hearing with the mind's ‘ears’. In these conditions, mental functioning is restricted, cutting out the more mature functions, which are thus no longer able to assign real meaning to the surrounding world and to the subject's psychic experience. The findings of the neurosciences facilitate understanding of how, in the psychotic hallucinatory process, the mind can modify the working of a somatic organ such as the brain.     

Sibling rivalry,separation, and change in Austen's Sense and Sensibility

The paper explores a process of growth represented in the interplay of Jane Austen's characterizations of Marianne and Elinor Dashwood in Sense and Sensibility, approaching the text through the lens of psychoanalytic theories on oedipal sibling rivalry, separation, and processes of change. A close reading of Sense and Sensibility tracks Marianne Dashwood's repudiation of any ‘second attachment’ as the surface of an unconscious fantasy, denying a rival for the mother's love. A psychoanalytic view contrasts Marianne's lack of separation from her mother, her use of denial and projection, and her near death after losing the man she loves, with her older sister Elinor Dashwood's capacities for depression, reflection, and greater acceptance of loss and separation. The narrative portrays Mrs. Dashwood's identification with and idealization of her daughter Marianne, which contribute to her oedipal sibling ‘victory’. In the language and structure of the novel, the projections, identifications, aggressions, and separations (conscious and unconscious) of the sisters in the vicissitudes of their adolescent loves and rivalries constitute a process of growth. Austen's novel brings to life, with the vividness and coherence of great literature, forces and fantasies in oedipal sibling rivalries, inspiring renewed attention to their subtle presence in the transference and countertransference of the psychoanalytic process.     

Experiential self‐understanding

The notion of insight is at one and the same time central to psychoanalysis and to the self‐understanding that is part of everyday life. Through clinical material and critical engagement with contemporary philosophical work on self‐knowledge, this paper clarifies one crucial aspect of this key notion. Self‐understanding of the sort we have in mind, while of course involving cognitive elements, is not sufficiently accounted for by cognition about one's affects, motivations, or other aspects of the psyche, nor by the simple conjunction of such cognition with felt affect, motivational urges, etc. Nor is it best modelled in terms of internal self‐observation. Rather, it is the product of an ongoing process of the unfolding articulation of one's psychic life. The notion of experience is important here in three ways. First, lived experience is that out of which the self‐understanding arises. Second, this self‐understanding is a development and articulation of these aspects of our inner lives; it is a part of that same lived perspective. And third, this understanding in turn shapes one's experience of one's inner world: as it is attained, one's experience of oneself thereby changes. Central here is the emphasis upon a developing process involving the ability to speak from one's subjective perspective while experiencing one's subjective perspective as the perspective that it is.     

The Impact of Face Skin Tone vs. Face Symmetry on Perceived Facial Attractiveness

The purpose of this study was to assess and compare the relative contribution of skin tone and symmetry on judgment of attractiveness regarding female faces. Two hundred and fifteen Mozambican adults were presented with a set of faces, and instructed to rate their degree of attractiveness along a continuous scale. Chi-square, factorial weight analyses and ANOVA were used to analyze the data. Face skin tone had a significant impact on the participants' attractiveness judgment of target faces. However, the target face skin tone contribution to the participants' attractiveness judgment (5% of the total variance) was much weaker than the contribution of the target face symmetry (85% of the total variance). These results imply that skin bleaching, common among Black people across sub-Saharan African countries, is not only dangerous to the health of those who practice it, but it is unlikely to make them appear much more attractive.     

‘Am I a Ceadas child?’: exploring the nature and experience of shame in the psychotherapy of an adolescent boy

Although shame is a central affect running through all phases of psychosexual and social development, it is usually masked by guilt and therefore it is not readily recognised, explored, and understood within the therapeutic situation. Moreover, there is a tendency to treat all shame manifestations as if they operate at the same level. The author proposes the need to distinguish between two qualitatively discrete manifestations of shame states which, albeit intertwined, operate at different levels and require different understanding and technique: a primary, unconscious kind based on psychobiological survival and triggered by a condition of psychic and physical danger, and a secondary, social shame, mainly conscious, based heavily on vision and evoked in social situations. The natural, primary form of shame becomes pathological after catastrophic chronic exposure of the primitive ego to unthinkable anxieties. Such premature rupture of primary skin containment may result in omnipotence-based pathological organisations impeding or precluding acceptance of guilt and need for reparation. Pathological primary shame predisposes the individual to states of pathological secondary shame. When initial traumatic conditions are re-activated and re-experienced in therapy, they may trigger re-enactments and, possibly, a negative therapeutic reaction. Recognising variations and mixed states of primary and secondary shame states, especially when shame is compounded with guilt, can provide guidance in the assessment of the fragility of the ego, and therefore inform our technique and the therapeutic process. This theoretical position is discussed with the help of clinical material from a twice-weekly psychotherapy of a 16-year-old boy imbued with shame compounded with guilt, related to transgenerational objectification and dehumanising experiences.