ONE BRAIN,TWO MINDS: AN ESSAY ON PRIMORDIAL AND ADVANCED MENTAL ACTIVITY

The Primordial Mind in Health and Illness: A Cross‐Cultural Perspective. By Michael Robbins. London/New York: Routledge, 2011. 240 pp.     

A child’s loss becomes a young man’s violence

Abstract

This paper describes the contribution of earlier traumatic loss to the later violent eruptions, with fatal consequences, of two young men, one who killed his mother and one who killed an unknown woman. Their developing personalities became disordered during their disturbed childhoods and the link between these developing personality disorders and psychoses is referred to. The need for long-term treatments is emphasised, as well as the importance of communication between therapist and clinical team.     

Reliability of the Halstead-Reitan Battery in individuals displaying acutely psychotic behavior

The purpose of the present study is to examine the test-retest reliability of the Halstead-Reitan Battery (HRB) in an acutely psychotic population. Ten acutely psychotic patients, initially tested upon admission to an inpatient unit of the Austin State Hospital, were selected for retesting on the basis of showing the most complete remission of psychotic symptoms of all patients tested over the 14-month period from June 1978 to August 1979. Only patients showing good remission were selected in order to maximize the potential for changes in test performance to occur and, thus, provide a conservative estimate of test-retest reliability. The average retest interval was 10.4 weeks (SD=6.67), with retest being completed just prior to discharge. Reliability was examined for each HRB subtest across subjects, as well as for each subject across subtest. While the patients generally showed an improved performance at retest, the reliability of the HRB was relatively high.     

A Model to Transform Psychosis Milieu Treatment Using CBT-Informed Interventions

Although CBT for psychosis (CBTp) has been recommended as a best practice since 2002, CBTp’s availability is quite limited in the U.S. Integration of CBTp-informed interventions into the milieu of the treatment settings in which the majority of the 2.4 million Americans with psychosis receive treatment may greatly improve access to those services. This paper presents an evidence-based model for training line staff in CBTp principles, in order that more staff throughout the U.S. might better support the recovery of people with psychosis in this way. Examples are provided to illustrate effective strategies and approaches.     

Group Cognitive-Behavioral Therapy via Telebehavioral Health for Those With Psychotic Spectrum Disorders: A Case Series

Telebehavioral health emerged as an important practice during the coronavirus disease 2019 (COVID-19) pandemic as an opportunity for continued evidence-based mental health intervention, while minimizing exposure to coronavirus contagion. Though preliminary research suggests feasibility and positive outcomes of telebehavioral health practice for people with schizophrenia spectrum and other psychotic disorders, there is limited research about implementation and effectiveness of this practice (Kasckow et al., 2014). This case series highlights the transition from in-person to telebehavioral health practice of a Cognitive Behavioral Social Skills Training for Schizophrenia group due to the COVID-19 pandemic. This article summarizes: (a) the staff procedures needed to transition the group from in-person to telebehavioral health, (b) participant outcome data, (c) session attendance data, and (d) survey results from facilitators and participants about barriers and facilitators of the transition to telebehavioral health, and about how the virtual platform altered the therapeutic relationship and engagement. Participant outcome and engagement data suggest that, not only were two participants able to transition to telehealth and complete the program, but both participants also showed notable improvement in treatment engagement, goal progress, and skill acquisition. Surveys of six facilitators and one participant highlight how the transition to telebehavioral health had treatment advantages (e.g., therapeutic relationship, treatment engagement, group dynamics). Though survey results highlighted several implementation challenges in using the new virtual platform (e.g., technological connectivity, confidential space for engagement), no survey respondents reported that participation in this program resulted in harm to facilitators or participants. All facilitators and one participant agreed that the transition from in-person to virtual services was easy and reduced transportation barriers. Given the limited treatment engagement for this population (Lora et al., 2012) and the importance of early intervention to maximize clinical outcomes (Black et al., 2001; Bottlender et al., 2003), unanimous facilitator and participant report about improved patient attendance and participation in treatment after the transition to telebehavioral health was critically important. Though results of this case study are promising in suggesting telebehavioral health could be a viable modality for providing psychosocial treatment to people with schizophrenia spectrum and other psychotic disorders, more rigorous study is needed.     

The explosion of the present and the encapsulation of time: Transference phenomena in the analysis of a psychotic patient

The paper deals with some basic problems concerning the experience of time and space in the psychoanalytic treatment of psychotic patients. Whereas borderline patients tend to distort the experience of time and space under emotional pressure, the concepts of time and space seem to dissolve in acute psychotic states of mind. Sometimes this manifests itself in an explosion of the present, where the past is ubiquitous and the future is perceived as the end of all times. The case of a 48 year‐old patient with the external diagnosis of ‘paranoid–hallucinatory schizophrenia’ is presented to illustrate that the main task is to recreate a structure to contain the experience of space and time. Such a development may occur if primitive psychotic anxieties can be taken up and metabolized. A near‐psychotic decompensation before the first break and the development of a transference psychosis in the second year of the analysis are depicted in detail. Subsequently some developments became visible which helped the patient to better tolerate catastrophic fears of loss. This included the formation of a structure which the patient called ‘hibernation’ enabling her to psychically survive without falling apart. By retreating into her ‘time capsule’ she managed to overcome breaks and to delay her fears of fragmentation until they could be taken up and worked through in the transference. The creation of a structure like the patient's ‘time capsule’ is considered to be an attempt to construct the experience of time and space. It prevented a collapse of her internal space thereby enabling further steps towards thinking and symbolization. In conclusion, some theoretical and clinical aspects are discussed including the role of the countertransference.