The Skin Picking Impact Scale: Factor structure,validity and development of a short version

In the present study, we examined the psychometric properties of the Skin Picking Impact Scale (SPIS; Keuthen, Deckersbach, Wilhelm et al., 2001), a 10 item self‐report questionnaire designed to assess the psychosocial impact of skin picking disorder (SPD). Participants were 650 individuals who met criteria for SPD in an online survey. Exploratory and confirmatory factor analyses demonstrated a unitary factor structure with high internal consistency (α = 0.94). Consequently, we constructed an abbreviated 4‐item version that retained good internal consistency (α = 0.87) and a robust factor structure. Both the short and the full versions demonstrated discriminant and convergent/concurrent validity. In conclusion, the findings indicate that both versions are psychometrically sound measures of SPD related psychosocial impact; however, some potential limitations of the full scale are discussed.     

Action across emptiness

This paper examines how autism may affect the processing and containing of emotions and sensations. At the beginning of life we can hypothesise that the baby develops two means of processing experience: containment that involves a sensory and mimetic trace of relational experience (proto-containment) and containment which, through the α function and projective and introjective functions translates feelings into meaning (♀/♂). Both these means of processing emotional experience remain active throughout life but oscillate the one with the other. The main hypothesis of this work is that the autistic child is not able to oscillate between real containment (♀/♂) and a primitive form of proto-containment. The author aims to explore, through clinical material, the factors which may promote this oscillation. Autistic children often use non-verbal communication. The author examines how a particular type of action can cross the relational void in the therapeutic relationship through a process that can transform feelings of great distress in the analyst via acts that can be described as an Act of Faith, as described by Bion. This form of action that can cross the void is like an artistic performance.     

‘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.     

Exposed: phallic protections,shame and damaged parental objects 1

Using ideas derived from Dana Birksted-Breen (‘Phallus, penis and mental space’, International Journal of Psycho-Analysis, 77: 649–57, 1996), this article explores the clinical experience with ‘Tommy’, a young boy who suffered multiple traumas and neglect. Birksted-Breen describes a phallic state of mind, which, amongst other things, serves to repudiate the potential for a creative link between internal parental objects and a capacity for thinking. In order to survive psychically, Tommy frequently turned to a phallic state of mind. The deficits in his internal and external objects meant that helpful parental qualities, linked with the development of psychic bisexuality, were not available for introjection and identification. The paper suggests a link between Tommy's employment of phallic (and at times perverse) ways of thinking, related to his intrusive attempts to expose and humiliate his psychotherapist, and to an experience of shame associated with inadequate internal objects. The serious compromise to the development of a creative psychic bisexuality in the patient is reflected in the countertransference strain on the psychotherapist's own internal couple.     

The conceptual distinction between projective identification (Klein) and container-contained (Bion)

This paper describes the use of play in the psychotherapy of a latency child from a severely traumatised background. It considers the meaning of play in relation to the role of the psychotherapist and to psychotherapeutic technique and explores its functions in terms of the child's development. The paper documents the psychotherapist's learning experience about the difficulty of trying to make the ‘right’ interpretations and her consequent realisation of the intrinsic value of play in psychotherapy. In considering these themes, the author explores how, by placing interpretation secondary to play, the therapy enabled the development of the child's creativity and self-agency, facilitating a movement from primarily paranoid–schizoid defences towards the beginnings of a depressive position.     

Out of the body: embodiment and its vicissitudes

Body‐mind dualism and the consequent neglect of the body of the analyst can have important negative effects on the analytical process leading all too often to misinterpretations of the analysand's verbal and non‐verbal communications and to disturbances of analytical temporality. This is intensified when we are dealing with individuals where disembodiment and states of psychic deadness are central features. The paper explores the philosophical roots of the idea of a disembodied mind and the way in which this impacts our relationship with the world. While André Green's concept of the dead mother and disturbances in the sense of self‐agency have been held to play an important role in states of psychic deadness, I suggest that it is rather disturbances in the sense of body ownership and of the body image which are more central. The paper then discusses the particular kinds of countertransference that can be evoked in the analyst when we find ourselves dealing with this type of patient and suggests how we can use our embodied countertransference to become aware of and elaborate our own feelings of deadness in order to overcome the loss of temporality that is characteristic of such states. This is illustrated with reference to my work with a young man with a masochistic perversion and a severe disturbance of the body image with an accompanying profound sense of psychic deadness.     

The impact of emotions on recall: An empirical study on social ads

Emotions are a complex phenomenon that entails a tricky problem regarding the measurement. To partially overcome this question, we assess emotions both using self‐report and measures commonly used in neuromarketing. This study assesses the accuracy of the recall after 4 months regarding two social advertising videos about female genital mutilation. Forty female participants were recruited. The skin conductance trend of the participants is different when viewing the two videos. The majority of participants (94.9%) reported that the two videos elicited different emotions (sadness for the first video and anger for the second one). Furthermore, according to arousal and valence model, these data are consistent with the literature that underlines the importance of psychophysiological indexes in measuring emotions and their associations with memory performances.     

The effects of brief cognitive-behaviour therapy for pathological skin picking: A randomized comparison to wait-list control

Thirty-four college students suffering from pathological skin picking were randomly assigned to a four-session cognitive-behavioural treatment (n = 17) or a waiting-list condition (n = 17). Severity of skin picking, psycho-social impact of skin picking, strength of skin-picking-related dysfunctional cognitions, and severity of skin injury were measured at pre-, post-, and two-months follow-up assessment. Participants in the treatment condition showed a significantly larger reduction on all measured variables in comparison to the waiting-list condition. The obtained effect sizes for the outcome measures were large, ranging from .90 to 1.89. Treatment effects were maintained at follow-up. In conclusion, cognitive-behavioural therapy, even in brief form, constitutes an adequate treatment option for pathological skin-picking behaviour.     

The 'secret cocoon': fantasies about the private self in the absence of consensual reality

Clinical material is presented from an analysand whose defense of withdrawal to 'a private internal space' was mobilized when she became confused, within her relationships and within the transference, about whose understanding of a shared event was 'real.' Analysis of the defense as resistance revealed a disrupted sense of connection to others and to the analyst in the face of the difficulty in determining a consensual reality. This was accompanied by emotional withdrawal, with a complex fantasy of retreat to a protective inner hiding place, or cocoon. The phenomenology and functions of such withdrawals, the fantasies accompanying them, and the ways in which they changed during the analysis are discussed in this paper. For the patient described, the analysis of her shifting 'cocoon' states and of the fantasies connected with them eventually enabled her to access her creative 'private self' more freely and with less conflict.