Biomedical subjects

G A Awad

Publications and source records attributed to G A Awad.

At least 19 recordsLinked to original sources

PubMed2001

The effects of medication on the psychoanalytic process. The case of selective serotonin reuptake inhibitors.

This paper deals with two analysands who developed serious symptoms of anxiety and depression during the middle phase of their analysis. The symptoms were severe enough to disrupt the previously established analytic process. After a consultation, both patients were put on a selective serotonin reuptake inhibitor (SSRI). Both responded well to the medication, not only in terms of symptom reduction but also in re-establishing the analytic process. Both patients made very little reference to medication after an initially negative reaction to the suggestion of a psychopharmacology consultation. The process of seeking a consultation, the prescription and monitoring of the medication, the concept of medications as parameters, and the possible reasons for the virtual absence of references to medication are discussed.

Adult↗

PubMed2000

The development and consequences of an aggressive symbiotic fantasy.

Chronic anxiety in a female patient was understood to have multiple meanings in relating to the mother through the fantasy of a symbiotic union. The origins of the fantasy are traced to the patient's poor relationship with a preoccupied and unavailable mother. The fantasy underwent several transformations under the influence of subsequent developmental phases and the special role of aggression in its elaboration. This paper illustrates the reciprocal interactions between separation-individuation and psychosexual development and their influence on the development of the self and gender identity, defenses against aggression, development of a sadomasochistic style, and transference-countertransference interactions. The symbiotic fantasy is seen as carrying the imprints of all developmental phases and as having multiple functions.

Adult↗

PubMed1996

The use of selective serotonin reuptake inhibitors in young children with pervasive developmental disorders: some clinical observations.

OBJECTIVE: To study the effects of a new group of psychotropic medications, the selective serotonin reuptake inhibitors (SSRIs), on some symptoms of young children (under 7 years old) with pervasive developmental disorders (PDD). METHOD: Open clinical trial. RESULTS: Medications produced positive results in half the children, particularly those with obsessional, repetitive, and anxiety symptoms. The medication was discontinued in half the children: one-quarter for worsening of symptoms and the other quarter for doubtful side effects. CONCLUSIONS: SSRIs may have a role to play in ameliorating some symptoms of PDD. Further studies with standardized measurements, however, are needed to elucidate which children and what symptoms could benefit from which medication.

Child↗

PubMed1995

An outpatient treatment program for young children with pervasive developmental disorder.

Clinical experiences with some fourteen young children (under 3 1/2 years) suffering from pervasive developmental disorder led to the design of an outpatient treatment program. The conceptual basis for the program was facilitated by two important changes in theory. The first was a shift in our understanding of infancy, based on observations rather than reconstruction from adult and child analysis; the second was the gradual evolvement in our understanding of this disorder. The treatment program has three components: (1) a prolonged period of parent-child or adult-child interactions aimed at attracting the attention of the child and helping him or her develop imitations, interaction, and communication; (2) intense instruction, with the help of an occupational therapist, designed to teach the child basic life skills such as eating, dressing and undressing, and toilet training; and (3) exposure to normal social interactions with other children within a day-care or preschool facility to encourage joining in the usual childhood activities. The success of the program depends heavily on coordination among all the people involved: ideally they should include the parents, speech therapist, occupational therapist, teachers, child-care worker, and clinician.

Activities of Daily Living↗

PubMed1992

A fantasy penis: its development, multiple meanings and resolution.

A 30-year-old single woman came to analysis because of anxiety, guilt and a sense of being bad. After two years of analysis that focused primarily on her relationship with her family members, an unconscious fantasy of having a penis was uncovered. The origin of the fantasy was traced to the narcissistic crisis and the birth of her brother, and as an attempt to regain the loss of mother's love. However, other meanings were added during subsequent developmental stages; namely, the fantasy penis was an umbilical cord that connected her with her mother, it bestowed power and licence to do whatever one wants and was a shield against father's subtle breach of the oedipal fantasies. The resolution of the fantasy passed through a stage of losing the penis and ending up with 'nothing' before a vagina could be experienced as a natural way to be.

Adult↗

PubMed1991

Male adolescent sexual offenders: exhibitionism and obscene phone calls.

Clinical assessment of 19 male adolescent sexual offenders who had committed exhibitionism or telephone scatologia showed that the majority were maladjusted, had committed numerous sexual offenses and came from multi-problem families. Several of them appeared to be sexually deviant, although they did not meet DSM-III-R criteria for a diagnosis of paraphilia. Anti-social traits, sexual deviance in the family, homosexual conflicts, repressed sexuality and sexual deviance were considered to be contributory factors.

Adolescent↗

PubMed1991

Therapeutic management of sexual abuse allegations in custody and visitation disputes.

Our experience is that in many cases, trying to assess the "truthfulness" or "falseness" of sexual abuse allegations that occur in the midst of custody and access disputes may not be possible. Instead therapeutic management of such cases is advocated. A case is presented in which sexual abuse was suspected because the recanting child displayed sexualized symptoms. Following a thorough assessment, which indicated that the child was abused, but could not confirm who the offender was, both the child and the mother were seen in psychotherapy on a regular basis. The father used counselling to achieve rights for visitations. The building of a therapeutic relationship allowed us to experiment with the situation to where we felt we could identify the potential offender who had to be kept away from the child. In addition, the therapeutic relationship enables this family to come to us to resolve their disputes rather than use the judicial system.

Adult↗

PubMed1991

Adolescent female firesetters.

A retrospective study of the charts of 13 female adolescent firesetters revealed severe family and individual pathology. The parents had a history of separation, violence, alcohol and/or drug abuse, and inability to take care of the children. The girls had a long history of serious behavioural problems. Four girls had set one fire, six had set several fires within a period of a few days, three had a long-standing history of setting fires. The girls showed a lack of remorse or concern for their behaviours.

Adolescent↗

PubMed1991

Unconscious fantasies: from the couch to the court.

No single unifying theory exists that explains the plethora of behaviors that bring individuals before the courts on a daily basis. No biological, social, or familial model for criminal behavior is without limitations, or exempt from controversy and criticism. We suggest, however, that it is appropriate, and often necessary, for the psychiatric expert to advance lucid, intelligible, and simplified psychodynamic formulation, either alone or in conjunction with another explanatory model of criminal behavior, to assist the court in its understanding and disposition of a given case. In some cases, apparent criminal behaviors result when unconscious motivating factors, particularly unconscious fantasies, find expression in conscious life. In this article, we consider the etiologic role of unconscious fantasy in certain seemingly inexplicable criminal behaviors. The concept of unconscious fantasy is explained and a detailed case description and formulation are provided in order to illustrate the central role of unconscious fantasy in some of these behaviors. Recommendations are offered for the manner in which psychodynamic formulation should be presented in reports and in courtroom testimony through reference to the author's experience.

Adult↗

PubMed1989

Adolescent child molesters: clinical observations.

Clinical assessments of 29 male adolescent child molesters referred to the Toronto Family Court Clinic showed that many were socially isolated, had chronic learning problems and had been maladjusted prior to committing their sexual offenses. The roles of drug and alcohol abuse, past sexual victimization, antisocial traits, disinhibition, peer-group influence, psychopathology and sexual deviance, alone or in various combinations, as causal factors for these boys' sexual offenses are discussed in view of previous studies and illustrated by case vignettes.

Adolescent↗

PubMed1988

Assessment, management, and treatment planning for male adolescent sexual offenders.

Adolescent sexual offenders are considered as a part of the larger group of emotionally disturbed youngsters. For purposes of clinical management, areas of overlap between the two groups are identified and issues specific to sexual offenders are delineated. Ethical issues, preventive interventions, the risk of recidivism, and the special problems presented by incestuous offenders are discussed.

Adolescent↗

PubMed1988

The court as a catalyst in the treatment process.

The role of the Court in the treatment process varies. In some cases it can work as a catalyst. We present the treatment of a family with a mother whose involving psychosis kept her daughter from attending school, and show how the power of the Court can be useful.

Adult↗

PubMed1987

A critique of the principles of the Young Offenders Act.

A unique feature of the Young Offenders Act is a section on the Principles of the Act. The principles clearly focus on the responsibility of young offenders, their legal rights, and the protection of society. The focus on the due process of the law is a welcome addition to the Juvenile Justice system. However, these principles do not recognize any other rights for adolescents, downgrade the importance of their needs, and do not take into account the cognitive, psychological and social functioning of adolescents. In addition, the principles implicitly reverse those important principles that have guided our society and the clinical process for more than a century; namely, a shift from a "therapeutic state" to a "legalistic state", the roles of institutions in our society, and the adultomorphization of adolescence.

Adolescent↗

PubMed1987

The assessment of custody and access disputes in cases of sexual abuse allegations.

Sexual abuse allegations directed at one parent can arise in the context of custody and access disputes. The role of the clinician, when such allegations occur, is to provide an assessment of the total situation, taking the allegations into account. To assess the probability that sexual abuse has occurred involves a thorough assessment of the accuser, the accused, the accusation, the child, and different family subsystems. Particular attention should be paid to interviewing the young child with detailed focus on the interviewing process, how the interviews are reported and what conclusions may be drawn from them. Following a thorough assessment, the clinician may reach one of three conclusions: that the sexual abuse has probably occurred, has probably not occurred, or is unsure. A strong caution is given against becoming entangled in an endless process of trying to find out whether the allegations are true or false. Whatever conclusions are reached are but one factor in the recommendation regarding custody and/or access. Ultimately the recommendation will be made according to the best interests of the child, taking into account the child's relationships and attachments, as well as the sexual abuse allegations.

Canada↗

PubMed1986

Male adolescent sexual offenders: the offender and the offense.

A group of male adolescent sexual offenders were divided into three groups: Courtship Disorders (Exhibitionism, Toucherism and Obscene Phone Calls), Sexual Assaults, and Pedophilic Offenses. Group I offenders tended to come from a less disorganized family background, were better adjusted to school and in the community and were seen by clinicians as less seriously disturbed than the adolescents in the other two groups. In addition, these adolescents did not experience the offense as a sexual act. Group II offenders (Sexual Assaulters) came from a more disturbed family background characterized by a high rate of long-term parent-child separations, committed more violent offenses and had a higher frequency of intellectual functioning in the Borderline Range of Intelligence. Group III offenders (Pedophilic Offenses) were Canadian born, had witnessed physical violence between their parents, were described as having been infants who did not enjoy being cuddled and had siblings who were truant. This study suggests that classifying adolescent sexual offenders along the line suggested in adult literature seems to be justified.

Adolescent↗

PubMed1985

Responsiveness in psychotherapy with antisocial adolescents.

Creating a "therapeutic situation" is a necessary condition for any type of psychotherapy. Antisocial adolescents often come from disturbed and chaotic backgrounds and present as behaviorally disturbed and deprived. One of the necessary ingredients in creating a therapeutic situation with them includes being responsive to them. The meaning of responsiveness, within a psychodynamic frame, is defined and its applications and limitations are explored.

Adolescent↗

PubMed1984

Beyond the best interest of the child: ten years later.

The book "Beyond the Best Interest of the Child" advocated major changes in understanding and implementing child placements, through general principles and guidelines and through specific recommendations. After ten years of clinical experience with child placements, a reassessment of the book is attempted. It is felt that the main principles and guidelines espoused are useful and are an improvement over the previous guidelines. However, the specific recommendations were felt to be less useful and are not necessarily the logical consequences of the principles and guidelines.

Adoption↗

PubMed1983

The middle phase of psychotherapy with antisocial adolescents.

Through a long series of trials and errors psychotherapeutic techniques for treating antisocial adolescents were developed based on the adolescents' dynamics and functioning. Basic psychoanalytic concepts were used as organizing principles, but not as an ideal to try and reach. This paper focuses on the middle phase of psychotherapy. Some characteristics of this phase, which include more regular attendance, more ability to introspect, and a sense of continuity between sessions, are described. The vehicle for change is the establishment and maintenance of a therapeutic situation that would allow regression and transference on one hand, while dealing with reality and problem-solving on the other. Several issues that affect the therapeutic situation are discussed. These include the level of the therapist's activity, the source of material brought up in the sessions, the therapist's use of the self and the handling of unreported antisocial acts. Finally, specific therapeutic interventions, namely listening, clarifications, confrontations, suggestions and interpretations are defined and discussed.

Adolescent↗