Linking work: from violence to subjectivization

For certain adolescents, the eruption of puberty sometimes carries the risk of a break in their psychic life: a break in their impression of continuity in existence, in the investment of their inner world, and in their relation to external objects. When these adolescents are unable to tolerate the discontinuity that accompanies the experience of adolescence, this can lead to pathologies of compulsive breaking away, depression, violence, or psychosis. Linking work, on the contrary, enables adolescence to become a transforming process on the psychic level and contributes to the dynamic character of the therapeutic process.     

Islamophobia and the therapeutic dialogue: Some reflections

In the atmosphere of fear and controversy that surrounds Muslims at this moment in time it is hardly surprising that they feel unable to voice their fears and concerns openly. Added to this is the fact that Muslims already underutilize mental health services (Patel et al., 2000 Patel, N, Bennett, E, Dennis, M, Dosanjh, N, Matitani, A, Miller, A and Nadirshaw, Z. 2000. Clinical Psychology: ‘Race’ and ‘Culture’: A training manual, Leicester: The British Psychological Society.  [Google Scholar]). In the counselling arena four distinct aspects of the counselling relationship are affected. First, the therapeutic alliance, second, the socio-political context in which counselling occurs, third, the awareness of personal characteristics and competencies that facilitate multicultural counselling and, finally, the training requirements of multicultural counsellors. This paper seeks to consider each of these aspects of the therapeutic encounter with regard to Muslim clients.     

Recognizing the infant as subject in infant-parent psychotherapy

Drawing on Winnicott's view of infants as subjects entitled to an intervention in their own right, infants as the referred patient have been seen in infant-parent psychotherapy for 20 years at the Royal Children's Hospital, Melbourne, Australia. This is a radically different view of infant symptomatology than viewing it as only expressing an aspect of the mother's unconscious. The clinical pathway differentiates the therapy from much parent-infant psychotherapy. The author describes the theoretical model of a twofold approach to understanding the infant's experience through interactive dialogue between therapist and infant, and sharing this understanding with the parents, and illustrates it with cases of failure-to-thrive infants. She discusses two criticisms: first, that infant-parent psychotherapy may undermine the parents and, second, that brief parent-infant psychotherapy does not alter parents' insecure attachment status. Videotaped sessions often show rapid improvement; parents generally feel relieved. This approach potentially shapes not only parents' and infants' representations, but also their implicit knowledge of relationships-partly, it is suggested, through activating the mirror neuron system to bring about implicit memory change. Change may therefore be longer lasting than psychoanalytic theory presently conceives. The approach is relevant in an outpatient setting: gains were maintained long term in 90% of out-patient cases.     

Defining and Measuring Mechanisms of Change in Psychological Therapies: The Path Not Taken

Metcalf and Dimidjian (this issue) have provided an important review of the current evidence base for mindfulness‐based cognitive therapy (MBCT) and presented a helpful summary of the proposed mechanisms of change. It is necessary to engage in a continuous dialogue regarding the evidence base for change mechanisms, and the article by Metcalf and Dimidjian highlights an important barrier of concern to the field of treatment outcome research. The present commentary aims to expand the discussion regarding the definition, measurement, and evaluation of “mechanisms of change.” Using MBCT as an example, this commentary addresses the ambiguity surrounding the definition and operationalisation of these mechanisms in research on psychological therapies and how the method of measurement may impact the results obtained in clinical trials. It is argued that a potentially fruitful avenue of future research would involve investigation of techniques, important client‐therapeutic processes, and mechanisms in a single study in order to comprehensively evaluate how change occurs.     

Wisdom won from illness: The psychoanalytic grasp of human being

From its inception psychoanalysis claimed not merely to be an effective therapy for psychological suffering, but to shed light on the human condition. But what kind of insight does psychoanalysis offer? This paper locates psychoanalysis in the western philosophical tradition, arguing that psychoanalysis provides not only theoretical wisdom about the human, but practical wisdom of a peculiar kind. The human mind, through its self‐conscious understanding can be immediately and directly efficacious in shaping its own structure.     

三阶层多靶点综合集成法指导难治性皮肤病治疗

本文借鉴以往综合治疗难治性疾病的成功经验,运用系统科学的综合集成方法,提炼出“皮肤病三阶层多靶点综合治疗策略”,即治疗层次分为病因阶层、病机阶层及症状阶层,多靶点综合集成是多个作用机理不同的药物进行有机综合。本文列举了各阶层多靶点综合集成治疗皮肤病的成功案例,论证了该策略的指导作用。同时提出应该根据某一种难治性皮肤病的病因、发病机制等的研究新进展,定期更新治疗方案,以便与时俱进,提高疗效。     

Towards an Italian model of therapeutic community

In this paper the author reflects on research undertaken by the Association Myth and Reality in the context of the psychiatric reforms in Italy which resulted in the closure of the asylums and the organisation, over the last 20?years, of a network of services in the community. These include thousands of residential units operating on a rehabilitative model. The focus of this paper is on the concept of the therapeutic community as a dynamic evolutionary path, individually tailored to people with different diagnoses and different ages – e.g. psychosis; borderline; adolescents and children. The therapeutic – and more specifically the environmental – factors are presented here. This includes the aesthetics of living and the sensory/emotional climate in relation to the care of the self and protection, regulation and safety, transitional playful climate, everyday life and the sharing implicit in relationships. The emotional climate is a fundamental component that transverses and intersects all the other factors. Treatment is central to the group with its potential for containment and dynamism in relation to relationships, cohesion, belonging, integration of the self in the community and connections with social networks outside the group aimed at reintegration into society of the resident as a citizen. A system of evaluation through peer reviews between therapeutic communities in Italy is being built in order to continuously improve the quality of service delivery.