Author biographies

This paper describes how an application of psychodynamic principles and techniques in a school setting can open up perspectives and insights into aspects of loss and mourning, which result in the personal and professional growth of individuals. It discusses applied psychoanalytic work in relation to its clinical base in the consulting room, in particular family work, and exemplifies this with a variety of cases.     

A pre-suicide state in an adolescent female 1

Abstract

During a pre-suicide state, the enactment of a suicide fantasy is the motive force. The nature and function of a suicide fantasy is explored in this paper in the context of the impact of puberty on the female body image and against the background of the pre-Oedipal and Oedipal father's relationship with his daughter. Case material from the analysis of an adolescent girl is presented to illustrate the crucial role of the father, in the transference, prior to a suicide attempt.

La force motrice qui sous-tend l'état pré-suicidaire est la mise en acte d'un fantasme suicidaire. Cet article explore la nature et la fonction du fantasme suicidaire dans le contexte de l'impact, chez une adolescente, de la puberté sur son image du corps avec, en toile de fond, la relation que le père, pré?dipien et ?dipien, entretient avec sa fille. Un matériel clinique extrait de l'analyse d'une adolescente est présentée afin d'illustrer le rôle crucial du père au sein du transfert avant la tentative de suicide.

Mots-clés: État pré-suicidaire, fantasme suicidaire, puberté et image du corps chez la fille, père pré?dipien et ?dipien, transfert, contre-transfert

Riassunto: Durante lo stato pre-suicidio, il motivo forza è la messa in atto di una fantasia di suicidio. Nell'articolo viene esplorata la natura e la funzione della fantasia di suicidio considerando l'impatto della pubertà sull'immagine del corpo femminile e sullo sfondo di una relazione pre-edipica ed edipica del padre con sua figlia. Viene presentato il materiale dall'analisi di una adolescente per illustrare il ruolo cruciale del padre, nel transfert, precedente al tentato suicidio.

Parole chiave: stato pre-suicidio, fantasia di suicidio, immagine corporale femminile e della pubertà, padre pre-edipico ed edipico, transfert, contro-transfert

Während eines prä-suiziden Zustands, ist das Ausagieren einer Suizidphantasie die motivierende Kraft. Die Eigenschaft und Funktion einer Suizidphantasie wird in diesem Artikel im Zusammenhang mit dem Einfluss der Pubertät auf das weibliche Körperbild und mit dem Hintergrund der prä-ödiplaen und ödipalen Beziehung des Vaters zu seiner Tochter exploriert. Es wird Fallmaterial aus der Analyse eines adoleszenten Mädchens vorgestellt, um die wichtige Rolle des Vaters in der Übertragung vor einem Suizidversuch zu illustrieren.

Keywords: Prä-suizider Zustand, Suizidphantasie, Pubertät und das weibliche Körperbild, prä-ödiplaer und ödipaler Vater, Übertragung, Gegenübertragung     

Revisiting ‘What works for whom?’: A qualitative framework for evaluating clinical effectiveness in child psychotherapy

This paper describes a framework for evaluating the effectiveness of child psychotherapy used by child psychotherapists in an inner city Child and Adolescent Mental Health Service (CAMHS). The Hopes and Expectations for Treatment Approach (HETA) involves using the assessment for psychotherapy that normally precedes treatment to derive a baseline from which to generate a set of hopes/expectations as regards the effects of the treatment on the part of parents and the psychotherapist, to be revisited one year after the start of the psychotherapy and/or at its completion. The Strength and Difficulties Questionnaire, for parents and schools, was also administered before and after the treatment. The characteristics of the first 30 children referred for psychotherapy over a particular time period are described. Of the first 15 children in this group to complete one year of individual psychotherapy, all showed change or significant change in the areas concerning parents' and therapists' hopes at the end-of-year review, as rated by parents and psychotherapists. A case of a child with conduct disorder is used to describe how the assessment generated a psychoanalytic formulation, how the therapist's understanding was fed back to the parents, and how the parents' and therapist's hopes and expectations were derived and recorded. This case illustrates powerfully the impact of trauma in the parents' backgrounds on the internal world of the child, and how the method provides a useful bridge between parent and child work. Feedback from the psychotherapists, the parents and the referrers using the framework is reviewed, and in conclusion the paper argues for the framework's value in promoting good practice in the treatment and management of complex cases and in enhancing awareness of the nature and scope of the psychotherapy process.     

Effect of the Healthy MOMs Lifestyle Intervention on Reducing Depressive Symptoms Among Pregnant Latinas

Depression during the prenatal and postpartum periods is associated with poor maternal, perinatal and child outcomes. This study examines the effectiveness of a culturally and linguistically tailored, social support-based, healthy lifestyle intervention led by trained community health workers in reducing depressive symptoms among pregnant and early postpartum Latinas. A sample of 275 pregnant Latinas was randomized to the Healthy MOMs Healthy Lifestyle Intervention (MOMs) or the Healthy Pregnancy Education (control) group. More than one-third of participants were at risk for depression at baseline. MOMs participants were less likely than control group participants to be at risk for depression at follow-up. Between baseline and 6 weeks postpartum, MOMs participants experienced a significant decline in depressive symptoms; control participants experienced a marginally significant decline. For MOMs participants, most of this decline occurred during the pregnancy intervention period, a time when no change occurred for control participants. The change in depressive symptoms during this period was greater among MOMs than control participants (“intervention effect”). From baseline to postpartum, there was a significant intervention effect among non-English-speaking women only. These findings provide evidence that a community-planned, culturally tailored healthy lifestyle intervention led by community health workers can reduce depressive symptoms among pregnant, Spanish-speaking Latinas.     

The Relationship Between Trajectories of Family/Cultural Stressors and Depression and Suicidal Ideation Among Substance Using Mexican-American Adults

We used an intersectional minority stress perspective to examine the association between family/cultural stress and mental health among substance-using Mexican-Americans. Employing a unique longitudinal sample of 239 socioeconomically disadvantaged, non-injecting heroin-using Mexican-Americans from San Antonio, Texas, we examined how culturally relevant stressors are related to depression and suicidal ideation. First, we identified depression and suicidal ideation prevalence rates for this disadvantaged sample. Second, we determined how cultural stress is experienced over time using stress trajectories. Third, we evaluated how family/cultural stressors and stress trajectories are related to depression and suicidal ideation outcomes. Results showed high rates of baseline depression (24 %) and suicidal ideation (30 %). We used latent class growth analysis to identify three primary stress trajectories (stable, high but decreasing, and increasing) over three time points during 1 year. We found that the increasing stressors trajectory was associated with higher rates of depression and suicidal ideation, and that stress trajectories had unique relationships with mental illness. We also showed that baseline stressors, sum stressors, and high but decreasing stressors maintained positive associations with mental illness after controlling for baseline depression. Our results highlight the importance of focusing on within-group, culturally specific stressors and addressing both operant and cumulative stressors in the study of mental health for marginalized populations and suggest the importance of early intervention in minimizing stressors.     

Creating a ‘psychological nest’ for vulnerable infants and children: an interview with Annette Mendelsohn

This is an edited version of a recent interview with Annette Mendelsohn, Child and Adolescent Psychotherapist at the Royal Free Hospital, London, UK. It aims to make available in published form Mendelsohn's thinking and approach in relation to her work with traumatised children in a hospital setting. Mendelsohn also discusses her work in a neonatal intensive care setting and the way in which approaches to psychosocial care in the hospital setting have changed over the course of her professional life.     

Improving Classroom Quality with The RULER Approach to Social and Emotional Learning: Proximal and Distal Outcomes

The RULER Approach to Social and Emotional Learning (“RULER”) is designed to improve the quality of classroom interactions through professional development and classroom curricula that infuse emotional literacy instruction into teaching–learning interactions. Its theory of change specifies that RULER first shifts the emotional qualities of classrooms, which are then followed, over time, by improvements in classroom organization and instructional support. A 2-year, cluster randomized controlled trial was conducted to test hypotheses derived from this theory. Sixty-two urban schools either integrated RULER into fifth- and sixth-grade English language arts (ELA) classrooms or served as comparison schools, using their standard ELA curriculum only. Results from multilevel modeling with baseline adjustments and structural equation modeling support RULER’s theory of change. Compared to classrooms in comparison schools, classrooms in RULER schools exhibited greater emotional support, better classroom organization, and more instructional support at the end of the second year of program delivery. Improvements in classroom organization and instructional support at the end of Year 2 were partially explained by RULER’s impacts on classroom emotional support at the end of Year 1. These findings highlight the important contribution of emotional literacy training and development in creating engaging, empowering, and productive learning environments.     

Avoiding unbearable pain

This presentation describes the way in which defence mechanisms and resistance manifested themselves in the analysis of a man with a narcissistic personality disorder. In the course of the analysis, there were changes in the forms taken by the defence and the resistance, signalling important genetic and dynamic conditions in his life. Both represented desperate attempts to avoid the unbearably painful feelings and affects which he had experienced in his childhood, and bore witness to early and primitive defence mechanisms such as denial, splitting and projective identification. The defence can also be seen as an expression of an unconscious fear of being re-traumatised. The idealisation of the analyst in the first years of the analysis can therefore be understood as a precondition for entering into this kind of process. It also represented a defence against aggressive and homosexual feelings in the transference which first became clear during the final phase of the analysis and could then be worked through. At this point, the analyst's reactions to his own unconscious countertransference were of help in understanding what was actually going on. This analysis may also suggest that defects and trauma in the earliest years may be conducive to alexithymia, deficient contact between feelings and words, linked to the risk of developing serious psychosomatic illnesses. This may be a consequence of the fact that the child's feelings and affects were neither accepted, understood nor affirmed in words, or they may even have been met with rejection or ridicule. A connection between narcissistic personality disorders and alexithymia can possibly be seen here.     

Some considerations on the capacity to be alone

This paper considers the lack of coherence of the psychoanalytic theories of the primary and secondary process. As a consequence, the interplay of primary and secondary process modes of thought cannot be conceptualised properly. Firstly, we summarize the results of an elsewhere-made metapsychological re-examination of both principles of mental functioning, and argue that Rapaport's distinction between a drive and a conceptual organization of memory, elaborated on by Siegfried Zepf is an extremely useful means of understanding primary and secondary process activity. As a central thesis, we state that primary process operates by affects, whilst secondary process utilizes concepts. The second part of the paper makes an attempt to show the dialectical relationship of affective and conceptual thought in the functioning of the living psyche. Temporarily dominating mental functioning, primary and secondary process thinking each utilize the other as a means, but never work purely within the psychic apparatus. It is shown that it is the specific interplay of primary and secondary process activity, which produces new adaptive substitutive formations. Some basic assumptions about the concepts of regression and progression are made to elucidate the shift from secondary to primary process dominance and vice versa.