Intensive Behavior Therapy for Tics and Co-Occurring ADHD: A Case Report

Tic disorders (TDs) can substantially impact daily child functioning across social, familial, and academic domains, leading to a significant public health impact. Additionally, an overwhelming majority of children with a TD have at least one co-occurring disorder. In particular, over 60% of children with a TD also meet criteria for attention-deficit/hyperactivity disorder (ADHD). Comprehensive Behavioral Intervention for Tics (CBIT) is a first-line treatment for youth with TDs and has been shown to be effective in reducing the frequency, duration, and severity of tics in children and adolescents. Nonetheless, access to trained CBIT providers remains limited, and common comorbid conditions are not addressed in standard CBIT. Thus, there is a need for CBIT interventions that can incorporate treatment strategies for TDs and common comorbidities. To address the critical need to address TD and common comorbidities simultaneously, the current case study presents and evaluates a 2-week intensive approach to address tic and ADHD symptoms concurrently in a peripubertal male. The child’s parents reported significant improvements in tic and ADHD symptoms following the end of treatment, which were maintained throughout three follow-up booster sessions. Clinical implications and future directions to modify and improve the proposed treatment are discussed.     

Enhancing the Responsiveness of Family-Based CBT Through Culturally Informed Case Conceptualization and Treatment Planning

Family-based CBT has been shown to be effective in controlled settings for an array of youth mental health difficulties, yet disparities in treatment engagement and outcomes across culturally diverse groups remain. In practice, cultural minority families are less likely to reap the demonstrated benefits of supported programs. Although there have been tremendous advances in case conceptualization, leading models have largely ignored cultural factors, contributing to observed disparities. The present paper reviews recent advances in science-informed case conceptualization and highlights how such advances nonetheless have failed to provide guidance on systematically incorporating cultural formulation into assessment and treatment planning. We then build upon Christon et al. (2015) useful 5-stage model of science-based case conceptualization in an effort to move the field toward culturally informed case conceptualization. We highlight how leveraging cultural assessment—such as with the use of the Cultural Formulation Interview (CFI)—can facilitate the incorporation of cultural factors into each of the five stages of science-based case conceptualization. A case example is utilized to illustrate key opportunities for strategically incorporating relevant information gleaned from the CFI into culturally responsive care with youth and families.     

Treating Symptoms of Borderline Personality Disorder Through Narrative Therapy and Naltrexone

Abstract

Borderline Personality Disorder (BPD) is characterized by instability in interpersonal relationships, volatile perceptions of self-image and affects, and marked impulsivity, presenting in various contexts. Current BPD treatments are individual-centered, coping skills based, with a reduced emphasis on identifying etiology and systemic components. Narrative therapy focuses on deconstructing and reauthoring personal stories. A clinical case study shows narrative therapy to be efficacious, however, sometimes psychotherapeutic interventions alone are inadequate in managing these symptoms. Medication can serve as a useful adjunct in addressing self-injurious behaviors, suicidal ideation, and dissociation. Researchers further discuss the integration of naltrexone into treatment of BPD symptoms.     

The patient,the nurse,his life and her mother: Psychodynamic influences in nurse education and practice

Using the film The Cook, the Thief His Wife and her Lover (from which this paper's title is borrowed) as a powerful illustration, the paper examines some of the unconscious processes which form part of everyday life for nurses working in the community, particularly on the wards of our hospitals. It is an attempt to describe some of these processes and to understand the conditions that promote them. With acknowledgements to the pioneers in this sort of work, such as Main, Menzies-Lyth, Trist, Bamforth and Jaques, the paper looks at the ethology of institutions and at activity that takes place on the boundaries between self and other, between the inner world and external reality, and between various levels in the hierarchy.

The paper identifies some of the ‘routines’ which grew up in nursing (and those which have replaced them), the unconscious purpose of which is to safeguard the emotional and psychological integrity of the nurse, through creating a distance between herself and her patients. The paper argues against removing these necessary defences until more helpful alternatives are in place. To fulfil this aim, it recommends that clinical supervision and support seminars should become a regular part of all nurse-training programmes, and should continue throughout the professional life of the nurse.     

The social unconscious in persons,groups and societies,Vol 1: mainly theory; and Trauma and organizations

This paper considers the emotional life of the infant in the incubator and develops a new psychological theory which is called the ‘incubator psyche’. Theory building is advanced from three main discourses: (1) psychoanalysis, (2) neo-natal nursing and (3) psychology. A case study of Corey, a 7-year-old boy, who had been delivered prematurely, with a hole in his heart, and spent the first 6 weeks of post-natal life in an incubator, is presented to illustrate how aspects of an incubator psyche might be clinically manifest. The concept of an incubator psyche is advanced with reference to a particular kind of second-skin formation (Bick, 1968, The experience of the skin in early object relations, The International Journal of Psychoanalysis, 49, 484–486). It is proposed that the incubator psyche characterises a client's mental functioning exercised as an environmental sensibility that could be understood in terms of the total transference situation (Klein, 1952, The origins of transference, International Journal of Psychoanalysis, 33, 433–438; Joseph, 1985, Transference: The total situation, International Journal of Psychoanalysis, 66, 447–454). Implications for practice are considered advocating particular attention to the setting.     

Child Abuse and Divorce

Summary

This article addresses the problem of divorce situations in which there are also allegations of abuse. Its goal is to provide guidance for professionals evaluating these cases. It describes the challenges peculiar to cases where divorce and abuse allegations coexist, relevant research findings, and potential sources of bias. The article suggests a multidisciplinary approach may be the optimal strategy for evaluating these cases. Specific guidelines for evaluation and decision-making are provided.     

The role of Christian commitment in predicting drug use amongst church affiliated young people

This research set out to establish which of four statements reflecting Christian commitment ('usually go to church on Sunday', 'have given my life to Jesus', 'read the Bible every week' and 'pray most days') were the most important predictors of never having smoked, drunk alcohol or tried drugs amongst a group of church affiliated young people. A self-report questionnaire was completed by 7661 participants aged 12-30. Agreement with the Christian commitment statements was generally associated with a lesser likelihood of having smoked, drunk alcohol or tried drugs, though different factors were found to be important in predicting lifetime substance use in the two age groups surveyed (12-16 years and age 17-30). Church attendance was the only factor which predicted each behaviour for the younger age group (12-16 years), but for older participants (age 17-30), statements suggesting a greater level of commitment were most important ('have given my life to Jesus', 'read the Bible every week'). The findings suggest that for church affiliated young people it is initially the socialization of religion that acts as a prohibitor against substance use, though, as age increases, a greater internalization of Christian commitment becomes more important.     

Children in psychodynamic psychotherapy: changes in global functioning

This study was part of the Erica Process and Outcome Study. The aim was to investigate if children's global functioning improves after psychodynamic psychotherapy. Variables that may predict changes in global functioning were examined both statistically and qualitatively, for example, the child's age and gender; diagnosis and comorbidity; treatment variables. The sample consisted of 33 children (five to 10 years of age) who participated in psychodynamic psychotherapy with parallel work with parents. Twenty-nine children had at least one DSM-IV diagnosis, and 15 children had comorbid conditions. At the start of psychotherapy, the most frequent diagnoses were attention disorder and disruptive behaviour. Child psychotherapists rated the children's global functioning using CGAS and HCAM. Large effect sizes were obtained (d = 1.80 and d = 1.98). However, no statistical correlations were found between global functioning and the selected variables. In order to illuminate the complex connection between process and outcome the study was complemented with in-depth case studies where data were taken from questionnaires, completed by the child therapists every third month. Two child therapies were selected: one in which the therapist rated a large change and one in which a small change was rated (CGAS). The analysis showed that important individual change, for example, attainment of formulated goals, was not always reflected in the change rated using the CGAS. Findings suggest that psychodynamic child psychotherapy can be beneficial. However, further research is needed to identify factors that contribute to change in children's global functioning.     

The Dawning of a Thought and the Role of Play and Trauma

A critical scrutiny of Freud's case the Rat Man elucidates the implications of the built-in contradictions that Freud made while evolving the psychoanalytic method. By comparing the published case of the Rat Man with Freud's private notes we get access to two different perspectives. Wishing to mould a clinical situation that would confirm his theories and uphold the image of the psychoanalyst as an authority figure, Freud was partly blind to some irrational distortions in how he perceived the interaction between the patient and himself. Contradictory explicit and unconscious “theories” and the emergence of a more modern understanding of transference, which includes inter-subjective dimensions, are expounded.     

Cognitive Behavioural Therapy and Applied Relaxation for Generalized Anxiety Disorder: A Time Series Analysis of Change in Worry and Somatic Anxiety

The present study examined symptom change profiles in patients with generalized anxiety disorder (GAD) receiving either cognitive behavioural therapy (CBT) or applied relaxation (AR). It was hypothesized that (a) changes in worry would uniquely predict changes in somatic anxiety for most participants receiving CBT and (b) changes in somatic anxiety would uniquely predict changes in worry for most participants in the AR condition. Twenty participants (CBT n = 10; AR n = 10) completed daily ratings of worry and somatic anxiety during therapy, and multivariate time series analysis was used to assess the causal impact of each variable on the other. The hypotheses were not supported because we found no evidence of a match between individual symptom change profiles and treatment condition. Rather, a bidirectional relationship between worry and somatic anxiety was observed in 80% of participants receiving CBT and 70% of participants receiving AR. When only treatment responders were considered, 83% of participants receiving CBT and 86% of those receiving AR had such a bidirectional effect. The findings are discussed in terms of models of psychopathology that posit dynamic interactions between symptom clusters and in terms of the value of examining treatment mechanisms at the individual level.