Too close for comfort: the challenges of engaging with sexuality in work with adolescents

This paper explores some of the ways in which sexuality can intrude into the psychotherapeutic relationship and present both opportunities and risks to our work with adolescents. It highlights some of the complexities of this area of the clinical encounter, exploring the particular difficulties encountered by both patient and therapist when sexuality emerges in the transference and countertransference. While we are well aware of the centrality of sexual development during adolescence, far less has been written about the way in which sexuality and the erotic transference emerges and impacts on both patient and therapist. Given the profoundly unsettling nature of this area of work and its capacity to disrupt our thinking and psychic equilibrium, it is easy to underestimate how much we are drawn to avoid, negate and defend ourselves against registering such experiences. Through the discussion of clinical material with two adolescent patients, this paper explores some of these dynamics, addressing some of the technical dilemmas that frequently challenge us in this area of work. These include questions about whether and when it is therapeutically important and effective to take up and interpret the emergence of sexuality more directly in the transference and some of the risks to our patients when we ‘play safe’ and fail to do so. Most importantly, this paper aims to facilitate further thinking and discussion about an important but uncomfortable and easily neglected area of our work.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

“You Just Know It’s the Only Thing You Can Think”: A Conversation with Chodorow

ABSTRACT

Nancy Julia Chodorow (1944–) is a pioneer feminist theorist who brought together academic fields of sociology, anthropology, and psychoanalysis in her work related to feminist theories and psychoanalysis. Her first book, The Reproduction of Mothering: Psychoanalysis and the Sociology of Gender (1978 Chodorow, N. J. (1978; second ed. 1999). The reproduction of mothering: Psychoanalysis and the sociology of gender. Berkeley: University of California Press. [Google Scholar]), gave primacy to a more generalized account of the developmental and familial origins of prevalent psychological differences between femininity and masculinity from a psychoanalytic sociological viewpoint. Her later books, Femininities, Masculinities, Sexualities: Freud and Beyond (1994 Chodorow, N. J. (1994). Femininities, masculinities, sexualities: Freud and beyond. Lexington, KY: University Press of Kentucky. [Google Scholar]), The Power of Feelings: Personal Meaning in Psychoanalysis, Gender, and Culture (1999 Chodorow, N. J. (1999). The power of feelings: Personal meaning in psychoanalysis, gender, and culture. New Haven, CT: Yale University Press. [Google Scholar]), and Individualizing Gender and Sexuality: Theory and Practice (2012 Chodorow, N. J. (2012). Individualizing gender and sexuality: Theory and practice. New York and London: Routledge.[Crossref] , [Google Scholar]), bring in a rich interplay among socio-structural influences (i.e., culture) as well as intra- and inter-psychic dynamic processes, emphasizing more the importance of individuality and subjectivity. Based on an interview I had with Chodorow on the development of her thought, this paper gives Chodorow’s account of her personal history and academic background, current manifestations in feminist social science research and feminist psychoanalysis based on her contribution and legacy, and reflective narratives on the unfolding of feminist and psychoanalytic theories from the 1970s onward. Chodorow’s note to the next generation of feminist psychotherapists is also included.     

Iraqi refugee men’s experiences of psychotherapy: clinical implications and the proposal of a pluralistic model

The psychotherapy experiences of a sample of Iraqi refugee men, in later stages of exile, were explored with the aim of shedding some light on how this client group can experience therapy. Ten adult male Iraqi refugees – who had lived in Sweden for at least five years and had been psychotherapy clients at some point during that time – were recruited for this study. Using individual semi-structured interviews (in Arabic), three main areas were explored with each participant: (1) reasons for seeking psychotherapy; (2) perceptions of the psychotherapy professional; and (3) experiences of the psychotherapy process and outcome. The interviews were then translated into English, transcribed, and then analysed using Interpretative Phenomenological Analysis (IPA). Most participants/clients described exile-related stressors as their main reason for seeking psychotherapy, but some described distress due to a combination of pre-migration trauma and post-migration stress. They also found some aspects of therapy to be positive (mainly verbalising ones thoughts and feelings, and feeling less marginalised) and some negative (mainly experiencing racist or culturally insensitive treatment by therapists, and experiencing a lack of competence and transparency in therapists). The findings were explored in terms of clinical implications and a pluralistic model was proposed to address the identified needs.     

艺术治疗的概念、发展及教育

综述了国内外近10年来关于艺术治疗的文献资料,回顾了艺术治疗的概念、学科范围界定、应用、发展,比较了中西方艺术文化差异,同时对于艺术治疗与健康和疾病的关系,及其机理等进行了探讨.也对国外艺术治疗在高等院校中的课程设置、讲解内容等进行了阐述.根据作者多年的研究和教育实践,试图探索出中国艺术治疗学科体系的构建框架.     

唯心主义与癔症

从唯心主义角度分析癔症病因,为揭示癔症形成提供新的思路.说明唯心主义认知观在癔症的形成中有不可忽视的作用.因此,改变癔症患者的唯心主义认知现对治疗癔症患者有重要的作用.     

Are psychodynamic and psychoanalytic therapies effective?: A review of empirical data

There is a need for empirical outcome research in psychodynamic and psychoanalytic therapy. However, both the approach of empirically supported therapies (EST) and the procedures of evidence‐based medicine (EBM) have severe limitations making randomised controlled trials (RCTs) an absolute standard. After a critical discussion of this approach, the author reviews the empirical evidence for the efficacy of psychodynamic psychotherapy in specific psychiatric disorders. The review aims to identify for which psychiatric disorders RCTs of specific models of psychodynamic psychotherapy are available and for which they are lacking, thus providing a basis for planning further research. In addition, results of process research of psychodynamic psychotherapy are presented. As the methodology of RCTs is not appropriate for psychoanalytic therapy, effectiveness studies of psychoanalytic therapy are reviewed as well. Studies of psychodynamic psychotherapy published between 1960 and 2004 were identifed by a computerised search using Medline, PsycINFO and Current Contents. In addition, textbooks and journal articles were used. Twenty‐two RCTs were identifed of which 64% had not been included in the 1998 report by Chambless and Hollon. According to the results, for the following psychiatric disorders at least one RCT providing evidence for the efficacy of psychodynamic psychotherapy was identifed: depressive disorders (4 RCTs), anxiety disorders (1 RCT), post‐traumatic stress disorder (1 RCT), somatoform disorder (4 RCTs), bulimia nervosa (3 RCTs), anorexia nervosa (2 RCTs), borderline personality disorder (2 RCTs), Cluster C personality disorder (1 RCT), and substance‐related disorders (4 RCTs). According to results of process research, outcome in psychodynamic psychotherapy is related to the competent delivery of therapeutic techniques and to the development of a therapeutic alliance. With regard to psychoanalytic therapy, controlled quasi‐experimental effectiveness studies provide evidence that psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy. Conclusions are drawn for future research.     

Psychoanalytic application and psychoanalytic integrity

In this article, the author offers an analysis of psychoanalytic application, defined as the breaking of new conceptual ground in some field of knowledge whereby the new idea is conceived, and later articulated, with the aid of reference to analogous phenomena in psychoanalysis. It requires apt analogy based on competent understanding of the applied field and of psychoanalysis. Only when the relevant differences between the applied and psychoanalytic fields are grasped can the extent of certain parallels emerge. The thinking by analogy that comprises psychoanalytic application may be intuitive and implicit, but should be susceptible of explicit theoretical elaboration that specifies, precisely, the point(s) of correspondence between psychoanalysis and the applied field in relation to a precise specification of their relevant differences. Applied psychotherapy at the interface of the internal and external worlds (historically rooted in casework) is employed as a model. By analogy with Donnet's concept of the analytic site, the author proposes the concept of the psychodynamic (case)work site, and elaborates it for that applied field in order to elucidate the proposed principles of psychoanalytic application.     

On psychoanalytic writing

Analytic writing constitutes a literary genre of its own. It involves the linking of an analytic idea (developed in a scholarly manner) with an analytic experience created in the medium of language. What makes this literary genre so demanding is that experience-including analytic experience-does not come to us in words. This fact generates a paradox that lies at the core of analytic writing: analytic experience (which cannot be said or written) must be transformed into 'fi ction' (an imaginative rendering of experience in words) in order to convey to the reader something of what is true to the emotional experience that the analyst had with the patient. The author discusses a clinical passage from one of his recently published papers in an effort to demonstrate some of the conscious and unconscious thinking that goes into his writing. He then looks closely at the way the language works in a successful piece of theoretical analytic writing. The paper concludes with a discussion of a number of facets of the author's experience with analytic writing including the psychological 'state of writing', which is at once a meditation and a wrestling match with language; experimenting with the form (structure) of an analytic essay; and the question of originality in analytic writing.     

A successful trial utilizing the Leuzinger-Bohleber methodology for evaluation of psychoanalytic treatment: Preliminary report

Utilizing audio-recorded psychoanalytic interviews of both patients and their analysts, group discussions of these interviews, and the application of questionnaires commonly used in psychotherapy research, the authors investigate the potential use of the Leuzinger-Bohleber methodology as an objective evaluative instrument to assess the quality of psychoanalytic treatment. Preliminary study results were obtained through interviews conducted with seven analysts and their respective patients, three of whom were treated with psychoanalysis (three or more sessions per week, for a duration of no less than one year) and four with psychotherapy (one or two sessions per week, for a duration of no less than one year). Patients were found to be eager to participate, and no adverse experiences were reported by analysts, patients or the research team. In addition to the interviews, further data were obtained through review of mailed-in questionnaires completed by 21 patients. The authors present both preliminary observations regarding the methodology as a whole, as well as the detailed results of one specifi c case subject treated with psychotherapy. Review of study fi ndings supports the utilization of this methodology as an evaluative instrument which may ultimately advance current knowledge of the process and outcome of psychoanalytic treatment.