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The exit line: heightened transference-countertransference manifestations at the end of the hour.

Final comments in many contexts have privileged positions among the many communications we make to one another as human beings. Deathbed pronouncements are treasured for their alleged profundities. "Famous last words" are catalogued. As we listen to political debates, we are particularly attentive to the closing statements of the candidates in the belief that something of superordinate importance will be revealed in these final words. Patients who come to us for psychotherapy and psychoanalysis also convey special messages in their parting comments. Final words are heavily invested because they bear the feelings deriving from earlier separations, complete with the longings to fuse with the earliest objects. Moreover, the cathexis belonging to the object may indeed be displaced onto words. In this paper I have sought to delineate and to describe certain patterns of exit lines which may provide useful information for the clinician. These "last words" are saved for the hour's end to keep them out of the therapeutic process and to render the therapist impotent and unable to respond. However, the therapist need not despair because he can bring these comments into the following hour as the focus of much productive work. After all, as Scarlet O'Hara would say, "Tomorrow is another day."

Adult↗

Thoughts about early pathology.

In this paper, I have presented the assumption that some symptom pictures such as attachment to pain, the masochistic character, the negative therapeutic reaction, a basic depressive response, and anhedonia are rooted in a prevalence of organismic distress during the symbiotic phase. Neuroscientists taught us that early experiences are associated with the neuronal structuring of the developing brain, which then affects concurrent or subsequent reactions. In particular I followed Ginsburg's (1982) assumption of a neuronally, genetically given aggressive drive potential which influences and is influenced by early experiences, and which can interact with other gene potentials. In some patients aggressive drive components contributed to a less than harmonious basic core associated with failure of the early infant/mother interaction. Unpleasure prevailed during the symbiotic phase; aggressive energies predominated and enmeshed with the neuronal encoding, the early structuralization in both the neurophysiological and psychological meaning. Thus, the structuring of the function of internalization and the emerging self-object experience were disturbed from early on. This then continued to foster a proclivity for unstable (fusion and) diminished neutralization tendencies. As biological discharge phenomena evolve into vague psychological awareness, such an infant does not attain a sense of well-being, but rather attains a sense of "not-well-being" (Joffe and Sandler, 1965) which remains continuous or can be triggered--kindled--by any reactivating constellation, and the object is experienced as a source of unpleasure. This is in line with Mahler's bad mother and bad self-introjects. Primary narcissism has not evolved well or, said differently, is invested more with aggressive than with libidinal cathexis and is in an unfortunate association or balance with primary masochism. Aggressive drive components subsequently color fantasies, readiness for and severity of conflicts. The aggressivization of self-feelings and of the function of internalization with its influence on--and exacerbation of--the rapprochement crisis is traced into later symptomatology. The basic pathology as described in this paper then compounds the oedipally derived problems.

Adult↗

Discriminant analysis of personality and body-image factors of females differing in percent body fat.

The purpose of the study was to determine whether individuals with high percent body fat can be distinguished on the basis of personality and body-image from those possessing lower levels of body fat. 65 female college students were administered the 16 Personality Factor Questionnaire and the Secord and Jourard Body-cathexis Scale. Measurement of height, weight, and skin folds at the triceps and illiac crest were also taken. On the basis of percent body fat two groups of 20 females each (high and low percent body fat) were identified. From discriminant analyses one personality factor and six body-image items were identified which distinguished between groups. Reclassification of the subjects, based upon derived discriminant functions, resulted in 60.0% of the subjects being correctly reclassified from personality data and 100% of the subjects correctly reclassified from body-image data. Body-image appears to be an important factor that can distinguish between individuals possessing high and low levels of body fat.

Body Height↗

Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women.

Developed by Robert Connell, the theory of gender and power is a social structural theory based on existing philosophical writings of sexual inequality and gender and power imbalance. According to the theory of gender and power, there are three major social structures that characterize the gendered relationships between men and women: the sexual division of labor, the sexual division of power, and the structure of cathexis. The aim of this article is to apply an extended version of the theory of gender and power to examine the exposures, social/behavioral risk factors, and biological properties that increase women's vulnerability for acquiring HIV. Subsequently, the authors review several public health level HIV interventions aimed at reducing women's HIV risk. Employing the theory of gender and power among women marshals new kinds of data, asks new and broader questions with regard to women and their risk of HIV, and, most important, creates new options for prevention.

Communicable Disease Control↗

The Color-A-Person Body Dissatisfaction Test: stability, internal consistency, validity, and factor structure.

Stability, internal consistency, validity, and factor structure of the Color-A-Person Body Dissatisfaction Test (CAPT) were assessed. Two- and 4-week test-retest correlations for college students and alpha coefficients for students and eating-disorder patients ranged from .70 to .89. Factor structure was unaffected by gender and clinical status. Correlations were mostly between -.40 and -.60 with Rosenberg's (1965) Self-Esteem Scale and Secord and Jourard's (1953) Body Cathexis Scale (BCS). Men higher on Body Mass Index (BMI) liked upper body parts; women higher on BMI disliked lower body parts. Treatment for bulimia affected both body image tests comparably.

Adult↗

Relationships between body image and depressive symptoms during postpartum in ethnically diverse, low income women.

The aim of this study was to examine body image, depressive symptoms, and their interrelationship at post-delivery and at 6 weeks postpartum in a triethnic sample of low income new mothers. Data for this study were drawn from the Austin New Mothers Study. Participants were 76 Anglo/White, 72 African American, and 135 Hispanic new mothers who were participating in Medicaid, at least 18 years old, free of medical risk factors, and delivered at term. Body image was measured by the Body Cathexis Scale (BCS) and depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D). The leading areas of body dissatisfaction in postpartum were similar across ethnic groups. At 6 weeks postpartum Anglo women had the highest number of body image components perceived negatively, whereas African-American women had the least. In the overall sample, body image attitudes were significantly related to depressive symptoms in correlational (r's .19 to .34) and regression analyses. In addition, African American ethnicity was associated in regression analyses with higher depressive symptoms. Neither African American nor Hispanic ethnicity significantly moderated the relationship between body image attitudes and depressive symptoms in tests of interactions. Marital/partnered status and income level were related to depressive symptoms at both time points. In addition, being a woman with a parity of II was associated with higher depressive symptoms at 6 weeks postpartum. Although addition of these personal variables increased the percent of variance accounted for, body image attitudes continued to be significant predictors of depressive symptoms.

Adult↗

Quality of life in female lung transplant candidates and recipients.

OBJECTIVE: Quality of life (QOL) studies of lung transplant recipients indicate that there are improvements following transplantation. More recently, there has been some suggestion that certain QOL issues are different for men and women. The purpose of the present study was to examine changes in QOL, body satisfaction, and sexual functioning in women lung transplant recipients. STUDY POPULATION: Seven prelung transplant (PRE) and 34 postlung transplant (POST) women. MAIN OUTCOME MEASURES: The RAND-36 Health Survey, Body Cathexis Scale, Derogatis Sexual Functioning Inventory, Hospital Depression and Anxiety Scale, Rosenberg Self-Esteem Scale, and an open-ended questionnaire. RESULTS: Higher scores were found in the POST group with respect to general health and role limitations due to physical health. We were unable to detect significant differences between the groups with respect to emotional well-being, role limitations due to emotional health, and social functioning. There were significant differences between the PRE and the POST body satisfaction scores. Although there was no significant difference in overall sexual functioning, recipients in the PRE group reported higher sex drive. Eleven of the POST recipients (52%) scored below the 10th percentile in overall sexual functioning. CONCLUSIONS: Overall QOL improves following lung transplantation; however, the lack of differences in many domains of QOL raises the concern that women lung transplant recipients may continue to have significant impairments, including those regarding sexuality and body satisfaction.

Adult↗

Psychological functioning and quality of life in lung transplant candidates and recipients.

OBJECTIVE: The purpose of this study was to examine the psychological functioning and quality of life (QOL) of lung transplant candidates and recipients. METHODS: The following measures were completed by 36 lung transplant candidates (the pretransplant group [PRE]) and 73 recipients (the posttransplant group [POST]): the Rand-36 Item Health Survey 1.0 (RAND-36), visual analog scale of overall QOL (OQOL), Brief Symptoms Inventory (BSI), Derogatis Sexual Functioning Inventory (DSFI), Hospital Anxiety and Depression Scale (HAD), Rosenberg Self-Esteem Scale (RSES), and Body Cathexis Scale (BC). RESULTS: Compared to the PRE, POST patients had significantly better scores on the following measures: RAND-36 total, physical health, role limitations due to physical health, general health, vitality, and social functioning subscales (all p < 0.0001); visual analog scale of OQOL (p < 0.0001); BSI (p < 0.05); BC (p < 0.05); HAD anxiety (p < 0.05) and depression (p < 0.0001); and RSES (p < 0.05). Despite better scores, some areas did not differ between the PRE and the POST, and many patients continued to experience impairments in psychological functioning. Specifically, the RAND-36 emotional health and role limitations due to emotional health subscale scores did not differ between the PRE and the POST and they remained lower than published norms. A significant proportion of patients in both groups (44% of PRE patients and 28% of POST patients) had borderline or clinical levels of anxiety (ie, the HAD). Finally, PRE and POST mean scores were significantly lower than published norms on the RSES (p < 0.05) and the body image scale of the DSFI (p < 0.05). CONCLUSIONS: Although lung transplant recipients have better general, physical, and psychological health than their pretransplant counterparts, the present research suggests that both groups experience impairment in several areas of psychological functioning. Future research into the QOL of the lung transplant population should be aimed at recognizing, intervening, and improving patients' psychological and emotional well-being.

Adaptation, Psychological↗

Affect in psychoanalytic theory: discussion of André Green's 'on discriminating and not discriminating between affect and representation'.

André Green's 1999 programmatic essay on affect and representation, an attempt to extend Freud's model of the neuroses (where affect and representation have different vicissitudes) to non-neurotic cases is submitted to critical reading. Green wishes to restore the importance of representation; to use the second topographical theory, where id, psychical impulse and object-cathexis replace the unconscious and the ideational representation in order to conceptualize borderline disturbance, and to show how ultimately the 'non-discrimination' affect-representation obtains in non-neurotic cases as well. The author, interested in the question posed in Green's essay as to what we have to sell our borderline patients, addresses the various reasons why this project fails. Among the problematic points are the paradox of Green's model of unconscious affect, that does not allow the analyst to generate meaning with borderline patients, the view of 'representation' as replacing presence and perception of the object that does not allow the analyst to be a non-absent object, and the inability to conceptualize affect-representatives and to work out the definition of affect as 'the anticipation of a meeting with the other's body' which does not allow the analyst to function as an 'anticipatory object' or 'an object of affect'.

Affect↗

Considerations on depressive conflict and its different levels of intensity: implications for technique.

This article considers the problem of depressive conflict (DC) and the difficulties that arise in integrating aggression towards the object of libidinal cathexis. This conflict results, in particular, from the destructive omnipotence that infantile fantasies attribute to the aggression. In order to better clarify Klein's very broad concept of the depressive position, three levels of severity of depressive conflict are proposed, depending on the type of fantasies concerning the loss of the object that predominate in the individual. These are: fantasies of catastrophic and irreparable destruction of the object ("parapsychotic" DC); fantasies of death and serious damage of the object ("para-depressive" DC); and fantasies of rejection and loss of the love of the object ("para-neurotic" DC). Having looked at these theoretical hypotheses, their implications for technique will then be considered, particularly the importance of focusing the interpretation on guilt feelings rather than on drives in the transferential relationship. A clinical example drawn from the work of Klein and a clinical vignette of a particularly difficult analysis illustrate this technical hypothesis.

Adult↗

On discriminating and not discriminating between affect and representation.

The topic involves two issues. They can be related either to different clinical pictures or to divergent opinions about the same clinical facts. But the above mentioned opposition can be found in Freud's work. Listening in analysis differentiates between situations where the distinction of affect and representation is blurred within the general frame of communication and others where this distinction imposes itself because of the critical or chronic character of the predominance of affect. Problems about the discrimination between affect and representation in the unconscious are elucidated in the light of their structural differences. The notion of the psychical representative of the drive announces the reference to the further notion of instinctual impulse. Later on, in Freud's theory, the notion of instinctual impulse has encompassed the distinction between affects and representation. Contemporary authors have, in their vast majority, chosen to refer preferably to object relationships. Nevertheless, the problems raised by Freud remain unanswered. It is with the clinical picture of borderline personality disorders that the lack of discrimination between affect and representation becomes evident. A detailed description is presented of the forms of transference where the irrepresentable prevails, accompanied by feelings of being overwhelmed, repetition compulsion, acting out and somatic reactions. In the countertransference, the affects of helplessness, despair and even the impossibility of grasping the meaning of the patient's communication are frequently met in the analyst. In these clinical pictures, intermediary formations, i.e. psychic organisations where primary processes structures the unconscious, are impaired. One is struck by the limitation of the capacities of representation and by the importance of phenomena related to negative hallucinations specially focused on thought processes, The communication is frequently self-contradictory, the transference oscillating between disembodiment and primitive fusion. The object has a paradoxical status; it is at the same time everything and nothing, the transference being incomprehensible and unanalysable. Different hypotheses are presented to explain the importance of destruction. Finally, the author presents a hypothesis for the deficiency of these intermediary formations because of the absence of continuing cathexis from the primary object at certain important moments of the relationship. It is the establishment of theses intermediary formations that will permit the acceptance of the separation from the object, the child now being able to rely on his own internal creations. However important the influences of the relationship to the other in the genesis of affects, the internal orientation towards the body of the psychic processes is what constitutes the core of the primordial psychic world.

Affect↗

Psychoanalytic principles in psychosocial rehabilitation.

Major mental symptomology in schizophrenic patients is alleviated when isolation and withdrawal are replaced by improved object relationships. This can best be accomplished through the enhancement of social, emotional, and environmental support systems. Psychosocial rehabilitation, that is, the establishment of a corrective living situation for emotionally isolated individuals, is a dynamic process. Staff in psychosocial centers are presented with unusual challenges and opportunities for helping people. Freudian psychoanalytic theory helps explain the causation of major mental symptomatology in schizophrenics as well as the mechanisms for the alleviation of those symptoms. It is postulated that the basic defect is exaggerated narcissistic libido and deficient cathexis of libido onto objects, which is accompanied by dammed-up libido. Like a festering boil, the dammed-up libido continues to exert noxious and deleterious effects, ultimately by way of chemical and neuronal pathways presently not well understood. The release of the dammed-up libido through improved object relationships is accompanied by lessening symptomatology and improved functioning. Indiscriminate and prolonged utilization of psychotropic medication is antitherapeutic in that it prevents delabeling, interferes with the resocialization process, and inhibits ego growth and development.

Freudian Theory↗

Effects of body image on tactile sensitivity to a tickle:: a study of pregnancy.

A group of 20 middle-class women between 20 and 40 yr. of age and in the third trimester of pregnancy was compared with a control group of 20 non-pregnant women for cutaneous sensitivity (to a tickle) and for modifications of body schema which were hypothesized to occur during pregnancy. Latency and actual duration were considered in the perception of the tickle. Body schema were studied using two of Fisher's tests, Body Prominence and Body Cathexis. Pregnancy leads to modifications in sensitivity to tickle, specifically with regard to the right half of the body and to some extent in body schema.

Adult↗

An appraisal of body image among Nigerian university students.

This study was designed to provide baseline data on the attitudes of Nigerian university students toward their own bodies. 286 students completed the 25-item version of the Body Cathexis Scale of Berscheid, et al. These students were more satisfied than they were dissatisfied with their body parts. The body weight and general muscle development were aspects with which they were most dissatisfied. Compared to men, women were significantly more satisfied with their ears, body weight, general muscle development, chest/breast, size of sex organs, and appearance of sex organs. These baseline data may help screen Nigerian university students with negative body ideation.

Adolescent↗

College students with tattoos and piercings: motives, family experiences, personality factors, and perception by others.

The motives, family experiences, and personality characteristics of 341 college students with and without tattoos or piercings were studied. Participants completed Lippa's 1991 measures of the Big Five personality factors, a shortened version of the Body Cathexis Scale, a series of questions about their childhood experiences, and questions about risk-taking behaviors. In addition, reasons to have or not have body modifications and the perceptions of people with body modifications were investigated. Of the 116 men and 186 women, 25% and 33%, respectively, had at least one tattoo or body piercing. There were very few differences in the childhood experiences or personality characteristics of people with or without body modifications. Although people with body modifications did not differ from people without modifications on the Big Five personality measures, people without modifications perceived people with modifications as much different from themselves on these measures. These results indicate that tattoos and piercings in college students are associated with significantly more risk-taking behavior, greater use of alcohol and marijuana, and less social conformity. However, the traditional stereotype that body modifications are indicators of social or personal pathology does not describe contemporary college students.

Adolescent↗

Catharsis reconsidered.

Mainstream psychiatry and psychotherapy have held for many years that cathartic psychotherapies involving powerful emotional expression have limited value. The conventional wisdom is that they are either dangerous, or ineffective, or that their effectiveness is short-lived. This paper reviews the origins of this conventional wisdom and makes two findings. Firstly, that there is remarkably little serious research into cathartic psychotherapies, but what there is tends to support catharsis. Secondly, that the periods in the last 200 years when cathartic methods have fallen into disrepute have often coincided with threatened or actual scandals involving prominent practitioners of cathartic psychotherapy. Four models of catharsis are described; the "Hydraulic", the "Pavlovian", the "Cathexis", and the "Holographic". The discussion suggests situations in which catharsis would be likely to prove useful, and indicates potential risks.

Adaptation, Psychological↗

Body image in secondary amenorrhea.

Body image and personality traits are described in women suffering from secondary amenorrhea. Data gathered, in 21 consecutive female patients, from the Minnesota Multiphasic Personality Inventory (MMPI), Body Cathexis Scale, Image Marking Method and Distorting Television Image Method, were examined and compared with those collected in a control group. No significant differences were found in terms of body perception and body dissatisfaction. The evaluation of MMPI profiles, on the contrary, suggested differences between amenorrheic subjects and controls for what concerned personality traits, these last being significantly, but differently, related to body dissatisfaction and wish for thinness in both groups.

Adolescent↗

[Influencing factors on problem behaviors among adolescents: focused on middle school students in Seoul].

PURPOSE: This study was to investigate the factors influencing problem behaviors among adolescents. METHOD: The subjects for this study were 596 students in middle school in Seoul. The data was collected during the period from May to November, 2001 by use of questionnaires. The instruments used were the Child Problem Behavior list by Hong (1986), the Body Cathexis Scale by Secord and Jourard(1953), and the Beck Depression Inventory by Beck(1978). The data was analyzed by using the SPSS-Win program. RESULT: Problem behaviors showed a significant negative correlation with body image (r= -.310. p=.000) and positive correlation with depression (r=.674, p=.000). There were significant differences in the problem behavior scores of subjects according to sex, family status, economic status, and school scores. Female students were found to have a high degree of internalized problem behaviors. In addition, depression, body image, and sex were significant predictors to explain problem behaviors(47.3%). Depression, sex, grade, and school scores were significant predictors to explain externalized problem behaviors(21.9%) and depression and body image, internalized problem behaviors(51.4%). CONCLUSION: Since predicting factors of problem behaviors among middle school students by problem behavior type and sex were different, then practitioners should consider these differences when developing programs for them.

Adolescent↗