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PubMed1984

Representation of the internal world in catatonic schizophrenia.

Catatonia, which until 1874 was called atonic melancholia, has remained a relative mystery despite many advances in the understanding of schizophrenia. Its typical symptoms are certainly distinctive: a motionless stupor, bizarre posturing, waxen flexibility, religious delusions, stereotyped movements, negativism, loss of will, confusion, and recurrent frenzy (Kahlbaum 1874). The processes which motivate this particular derailment of self and body have been sought in various organic etiologies, with little success. Arieti (1974) proposes several reasons for the paucity of case studies of the treatment of catatonic schizophrenia. First, catatonic schizophrenia has been declining in occurrence. Second, the symptoms themselves, such as mutism and excitement, make verbal therapy extremely difficult. Finally, catatonics often have no memory of their psychotic experiences. Psychotherapists have therefore had to rely on highly personal intuitions of their patients' crisis-in-being. Despite therapists' attention to nonverbal behavior, mutism and stupor are particularly effective hindrances to communication in psychotherapy. Psychotherapy is often not begun until the patient's symptoms ameliorate through chemotherapy and milieu support. The centrality of the verbal medium of communication in psychotherapy suggests that other approaches, using nonverbal media, may be indicated in the study of catatonia. This paper describes a treatment of a catatonic schizophrenic man which utilized movement and drama therapy. These methods were successful in evoking representations of the patient's inner life.

Adolescent↗
PubMed1985

Therapists with disabilities: theoretical and clinical issues.

Disability as a characteristic of the therapist needs to be addressed for several reasons. First, substantial evidence indicates that people without visible disabilities or physical differences regard persons who diverge from ideals of physical perfection and norms of physical acceptability with a variety of emotions which--at the very least--alter ordinary social interaction. Second, the psychoanalytic literature on therapy with disabled patients and the developmental literature about people with disabilities reinforce the generally negative or ambivalent attitudes about the mental well-being and potential for productivity and intimacy of people with disabilities. As a consequence of both general acculturation and professional training in psychology and psychoanalysis, professionals in charge of admissions have frequently denied competent disabled people the graduate education which is prerequisite to psychoanalytic training and professional employment. Mental health practitioners who make up the training committees of analytic institutes have frequently been reluctant to accept a disabled candidate for psychotherapy or psychoanalytic training. Once trained, many disabled clinicians have faced hurdles in obtaining employment, in advancing within their profession, in being selected as faculty members or supervisors, and even in obtaining referrals from nondisabled colleagues. After briefly describing the literature on attitudes of the nondisabled toward people with physical impairments, we will present the reasons for the reluctance to train disabled people as therapists. We will include material on how disabled people work with their disabilities in the analytic process and will bring in analogies to practitioners who are members of racial or cultural minority groups.

Attitude↗
PubMed1988

Contemporary psychiatric interviewing: new directions for training.

THERE has been an unheralded evolution in psychiatric interviewing, an evolution that is, nonetheless, of a critical nature. Over the past three decades the basic psychiatric interview has evolved into a collection of different psychiatric interviews. Each style of interview is determined by the immediate patient care tasks facing the clinician, whether in an emergency room or a private practice office. The acquisition of new skills, such as structuring techniques and diagnostic examinations using the DSM-III, has become a vital and challenging aspect of the education of contemporary psychiatrists. In this paper the influences that have created these new developments in psychiatric interviewing will be outlined and their implications for training discussed. We will describe a specific training approach that has evolved as a method of helping psychiatric residents develop the skills and confidence needed to handle any one of the numerous types of psychiatric interviews required of a contemporary clinician, ranging from a traditional psychodynamic assessment to a standard diagnostic interview.

Countertransference↗
PubMed1989

Brief dynamic psychotherapy: characterologic intervention and the physical position of the patient.

BRIEF dynamic psychotherapy has achieved widespread acceptance in the past 20 years but as yet has formed no satisfactory approach to effecting character change. The most frequently chosen path has been to select for treatment only those who readily demonstrate the capacity to investigate focal conflict, thus bypassing character armor. The strategy here flows in the opposite direction. Within brief dynamic treatment, what technical alterations might more effectively engage characterologic difficulty? I report on one such innovation. When patients are asked to sit close to but turned at 180 degrees from the therapist, those with character disorders--particularly patients suffering from mid-level disorders--can often suspend their defenses sufficiently to permit specific types of new material into the treatment. This alteration in process appears, in turn, to abet outcome.

Adult↗
PubMed1992

The mental health treatment team as a work group: team dynamics and the role of the leader.

Although treatment teams have been examined often in the mental health literature, this literature seldom addresses the crucial property of "teamness"--the key set of intangible phenomena that allow a team to function synergistically as more than the sum of its parts, and with a sense of team identity. In this paper, the concept of the work group is used to develop a framework for understanding the factors contributing to effective team functioning and identity, an their implications for the tasks of team leadership and sociotherapy: "the art of maintaining a social system in which the treatment of an individual patient can best occur" (Edelson 1970). Leadership activities that promote team cohesiveness and boundary maintenance are discussed, and suggestions are provided for ways in which the subjective experiences and emotional reactions of the leader and team members can be used to promote improved task performance and clinical care.

Countertransference↗
PubMed1998

Short-term treatment of a Central American torture survivor.

The short-term treatment of a Honduran torture survivor is recounted. Torture--the "counter-therapy of the State" (Ritterman 1987, p. 43)--involves intentional physical and psychological destruction of human beings. The socio-political context in which the traumatic events occurred is described, as are the theoretical and ethical assumptions underlying the work. Treatment of victims of organized violence is a formidable challenge. Obstacles and advantages of short-term psychotherapy and use of the therapist's emotional reactions to understand survivors' experiences are emphasized.

Adult↗
PubMed1989

Therapeutic processes. A longitudinal view.

1. Psychic equilibrium serves work, love, and play. 2. When such equilibrium is disrupted, symptoms occur. 3. Psychotherapy is effective when the equilibrium is restored. The restoration of such equilibrium may be a unifying feature of many psychotherapies. 4. The actions undertaken to restore the equilibrium may be viewed within an operational framework or an intrapsychic one. 5. The operational framework is more readily inferred from observable features. It describes the relationship the patient and doctor make with one another in pursuit of their avowed aims. It highlights technical features. 6. The intrapsychic framework attempts to describe and explain what goes on in the mind of the patient as the treatment proceeds, and what goes on is often very different from the avowed aims of either participant. It highlights individual structure, organization, and meanings. 7. There may be a class of patients who very easily restore their psychic equilibrium within a therapeutic setting, independent of the theoretical assumptions of the therapist or the avowed goals of the treatment. They are people with compelling synthesizing, integrative, and organizing capacities used in the service of development, mastery, and control. There may also be a class of therapists with similar capacities who apply them in conjunction with their authority in order to facilitate such a restoration. The restoration of stability is a valuable treatment goal for many children and adults. 8. Attention to these capacities may be useful for furthering clinical work and for appraising various theories of therapeutic action, especially those theories that rely heavily on positive clinical results for evidence. It may also be one of the starting points to distinguish the treatment process in analysis from the treatment process in other therapies.

Adolescent↗
PubMed1989

The analyst's visual images and the child analyst's trap.

The analyst's experience is different with an adult and a child. One element that constitutes the difference is that the analyst while listening to the adult can become aware of visual images which are created as a continuous commentary to the analysand's material, while the corresponding phenomenon in the child analyst is an emotional commentary. The child can break through the analyst's defenses and catch him in a trap consisting of his own unintegrated, phase-specific emotions and at the same time inhibited ability to introspect. Case material from adult and child analysis is presented to describe these phenomena and to demonstrate how the analyst's visual images in adult analysis and emotional states in child analysis can constitute a central element in the analyst's concept of the analysand.

Child↗
PubMed1993

The temporal framework and Lacan's concept of the unfixed psychoanalytic hour.

Lacan's controversial clinical innovation of the unfixed analytic hour is evaluated within the context of Lacan's own theoretical and metaclinical views and against the classic, developmentally oriented concept of the fixed temporal analytic framework. Two clinical illustrations featuring disturbed reactions to the temporal framework of the analytic hour elucidate Lacan's proposed master/slave analogy for the treatment relationship, bringing to the fore, ironically, the basic contradictoriness of Lacan's clinical recommendation.

Adult↗
PubMed1996

The psychoanalyst of the adolescent.

The adolescent who comes for psychoanalytic treatment has probably experienced a developmental breakdown-a rejection of his or her body and a distorted image of himself or herself as being male or female. A critical requisite for work with such adolescents is an understanding of one's own adolescent development. The internal freedom of the psychoanalyst is an essential ingredient in the treatment of the adolescent. This means that the psychoanalyst of the adolescent can separate his own sexual life and thoughts from what is lived out in the analytic sessions and thus can ensure that the treatment will confront whatever is essential and that he will avoid deriving gratification from the treatment process through taking over the adolescent's body or feeling that he is secretly sharing the intimacies of the patient.

Adolescent↗
PubMed2004

Counter-responses as organizers in adolescent analysis and therapy.

The author introduces Counter-response as a phenomological term to replace theory-burdened terms like counter-transference, counter-identification, and counter-resistance. He discusses the analyst's use of self (drawing on the comparison with Winnicott's use of the object) in processing the expectable destabilizing counter-reactions that occur in working therapeutically with disturbed adolescents and their parents. Further; he discusses the counter-reaction to the patient's narrative, acting-out, and how re-enactments can serve as an organizer for understanding the patient's inner life when the analyst formulates his/her counter-response. Emphasis is placed on the therapist forming his or her own narrative with the adolescent that takes into account the evoked counter-reaction. For this purpose, the author recommends the use of a combined counter-response and metaphor-orienting perspective to acknowledge and work with the denial, illusions, reversal of perspective, and catastrophic anxieties experienced with these adolescents. The counter-response perspective permits the emergence of the disturbed adolescent's novel narrative; however, since these experiences can be destabilizing or disruptive, the author also recommends the use of a personal metaphor to anticipate the reluctance to examining, processing, and formulating the analyst's dysphoric counter-reaction. With the use of the counter-response, the analyst's therapeutic ideal is to achieve a more optimal balance between using accepted narrative theories and exploring novel enactment experiences. His swimming metaphor stratagem is designed to keep the analyst in these difficult encounters.

Adolescent↗
PubMed2005

"In a black hole": the (negative) space between longing and dread: Home-based psychotherapy with a traumatized mother and her infant son.

This paper offers fragments from the first year of a home-based mother-baby psychotherapy, in which I attempted to help a traumatized and dissociated mother to emotionally engage with her infant son. The treatment was organized in part around certain developmental objectives common to both attachment and psychoanalytic theory. These include: The ability to name and metabolize feelings, to evoke a soothing maternal introject, and to relate to the partner's mind as a separate, understandable center of initiative and intention. In addition, attachment theory, with its emphasis on the critical psychobiological role of containing fear and distress in infancy, was a useful guide in formulating the treatment. The paper reviews research findings on mother-infant pairs described as frightened-disorganized, discusses some of the challenges encountered in home-based mother-infant psychotherapy and then discusses the case of Mary and John. The case illustrates how mother-infant psychotherapy may interrupt the intergenerational transmission of disorganized attachment by working within the couple to name, metabolize and flexibly respond to painful, dissociated or frightening experiences.

Adult↗
PubMed2005

Psychoanalytic reconstruction and reintegration.

Psychoanalytic reconstruction has declined in theoretical and clinical interest as greater attention has been directed to the here and now of the transference-counter-transference field and inter-subjectivity. Transference, however, is based upon childhood fantasy, and is a new edition of unconscious intra-psychic representation and relationships. In this paper transference is viewed as a guide to reconstruction, but transference itself is also an object of reconstruction. Reconstruction is a complementary agent of change, which integrates genetic interpretations and restores the continuity of the self The patient's childish traits, features, fixations, and irrational childish fantasies and behavior point to the necessity for reconstruction. Reconstruction organizes dissociated, fragmented memories, potentiating the further retrieval of repressed memories. Reconstruction is essential to the working through and attenuation of early traumatic experience. Recapture of the past is necessary to demonstrate and diminish the persistent influence of the past in the present, and to meaningfully connect past and present. A case is presented in which reconstruction had a central, vital role in the analytic process.

Adaptation, Psychological↗
PubMed1986

Severe regressive reactions in sex therapy.

In this paper we describe five cases of severe regressive reaction during the initial evaluation of treatment for sex therapy. We focus on three dimensions useful for assessment in guarding against such regressions: the nature of the patient's defensive posture; the nature of the couple's interaction and dynamics regarding the sexual symptom; the context of the referral for brief sex therapy treatment. The particular constellation of these factors appear to make regressive reactions quite likely. Guidelines for evaluation and handling decompensation are briefly noted.

Adult↗
PubMed1995

HIV-positive people, HIV-negative partners.

More relationships exist today between HIV-positive and HIV-negative partners. This article explores the underlying dynamics that might account for this phenomenon. Codependency theories may explain these relationships for some couples. For other couples, it is suggested that positive-negative homosexual relationships may be influenced by both unhealthy and healthy gay developmental experiences as well as by a sense of compassion. The article addresses both HIV-positive people choosing HIV-negative partners and vice versa. Treatment issues for the various theories are discussed and recommendations are made.

Choice Behavior↗