Selective involvement of the auditory-verbal modality in an acquired communication disorder: Benefit from sign language therapy

A 39-year-old female suffered bitemporal infarctions and exhibited an unusual behavioral syndrome of muteness and impaired auditory comprehension, with milder aphasic deficits in reading and writing. The anatomic basis of this modality-selective communication disorder appeared to involve both peripheral perceptual and motor as well as “central” language mechanisms. The patient's ability to communicate was greatly aided by instruction in Amerind and Ameslan Sign Language, in which she learned more than 100 signs. Patients whose acquired language deficits spare modalities of input or output may be ideal candidates for sign language therapy.     

Rethinking desire: the objet petit a in Lacanian theory

The concept of the objet petit a is central to Lacan's theory of desire, which arguably represents his major contribution to psychoanalysis. It is an expression of the lack inherent in human beings, whose incompleteness and early helplessness produce a quest for fulfillment beyond the satisfaction of biological needs. The objet petit a is a fantasy that functions as the cause of desire; as such, it determines whether desire will be expressed within the limits of the pleasure principle or "beyond," in pursuit of an unlimited jouissance, an impossible and even deadly enjoyment. Parallels between the objet petit a and Winnicott's transitional object are explored and its functions illustrated through analysis of Pedro Almodovar's film Talk to Her. A clinical case is presented in which the question of desire seemed crucial.     

The translational metaphor in psychoanalysis

The translational metaphor in psychoanalysis refers to the traditional method of interpreting or restating the meaning of verbal and behavioral acts of a patient in other, presumably more accurate terms that specify the forces and conflicts underlying symptoms. The analyst translates the clinical phenomenology to explain its true meaning and origin. This model of analytic process has been challenged from different vantage points by authors presenting alternative conceptions of therapeutic action. Although the temptation to find and make interpretations of clinical material is difficult to resist, behaving in this way places the analyst in the position of a teacher or diagnostician, seeking a specific etiology, which has not proven fruitful. Despite its historical appeal, I argue that the translational model is a misleading and anachronistic version of what actually occurs in psychoanalysis. I emphasize instead the capacity of analysis to promote the emergence of new forms of representation, or figuration, from the unconscious, using the work of Lacan, Laplanche, and Modell to exemplify this reformulation, and provide clinical illustrations of how it looks in practice.     

THE SECOND SPHERE AND THE STORY OF NO STORY

The author discusses Roy Schafer's ideas of the second self and second reality, as well as his consistent theme of storyteller and story. The latter theme is also explored in the context of more recent psychoanalytic influences, such as Bionian thought, trauma theory, the French approach, and the interpersonal perspective. To illustrate the idea of the nonstory in today's clinical encounters, the author presents two clinical vignettes.     

Counselor Competency in the Courtroom

This article outlines general courtroom procedures and offers systematic practical advice for the counselor testifying as an expert witness. Major topics include the counselor role in court, preparing for testimony, answering questions, and dealing with the cross-examination.     

Neuropsychological characteristics of young adult chronic psychiatric patients: preliminary observations

Psychological evaluation included tests of brain-behavior functioning and academic level for 110 young adults (16 to 39 yr. of age), each a moderate to heavy user of mental health services. The composite patient manifested borderline, diffuse brain dysfunction with deficiencies in language, visuospatial, motor, concentration, and higher-order problem-solving skills, together with below normal performance on tests of intelligence, reading comprehension, arithmetic calculation, and spelling. Standard mental health services appear inadequate for habilitation or rehabilitation of many such people. The findings suggest that one reason for these patients' lack of response to conventional mental health treatments is that clinicians fail to identify patients' fundamental deficiencies and to incorporate this knowledge in planning treatments and evaluating progress. Suggestions for further studies are offered.