Dance movement psychotherapy with an adult with autistic spectrum disorder: An observational single-case study

Dance movement psychotherapy (DMP) is considered to be a relevant and appropriate intervention for people with autistic spectrum disorder (ASD). A number of studies have reported DMP techniques and approaches in therapeutic work with children. Wider therapeutic practice in special education and other settings for children with ASD includes the use of structured narrative approaches in treatment. To date there is limited literature reporting DMP practice with adults with ASD. The aim of the study was to introduce a structured narrative approach in the form of the six-part story within DMP with an adult with ASD. A practice-based research approach was used to generate therapist observations and collect in-therapy responses from one patient. The study results indicate that DMP practice can incorporate structured narrative approaches in work with adults with ASD.     

Cognitive analytic therapy: developing its theory and practice via attachment theory

Cognitive Analytic Therapy (CAT) makes scant reference to Attachment Theory, despite many similarities. It is argued that the theoretical basis of CAT is not yet fully integrated, and that current attachment theory can contribute to CAT's thinking about motivation, the origin of procedures, the therapeutic relationship and abusive relationships. Attachment theory should influence CAT theory regarding developmental issues and reactions to loss; some suggestions are made for improved CAT practice. The ambiguous concept of ‘core’ in CAT is also clarified in terms of unassuaged attachment needs, with a distinction being made between ‘core pain’ and ‘core states’. Finally, consideration is given to a developmental research tool, the Adult Attachment Interview, as a means of determining different types of ‘defensive exclusion’ of information in psychopathology. There are preliminary indications that patients with predominantly dismissing or preoccupied attachment strategies might require somewhat different therapeutic processes in CAT. Copyright © 1999 John Wiley & Sons, Ltd.     

Cognitive therapy and serious mental illness. An interacting cognitive subsystems approach

The increasing application of Cognitive Therapy to the more enduring forms of psychopathology represented by the DSM‐IV ‘Axis II Disorders’ has led to the piecemeal development of the discipline, and the incorporation of approaches from other therapeutic modalities, and from wider sources, such as Buddhist meditation. The present paper proposed the development of the Cognitive rationale, using as a foundation the research‐based insights provided by Teasdale's ‘Interacting Cognitive Subsystem’ model (Teasdale and Barnard, 1993). By emphasizing the close relationship between the emotional (implicational) subsystem and states of bodily arousal, this restores aversive arousal states to a central place in the understanding of psychopathology, and clinical practice. The role of threatening information about the self received through early relationships in leading to chronic aversive arousal states, whether high arousal as in anxiety, or low, as in depression, in Axis II disorders, is considered. The implications of the tension between this aversive information and the basic human endeavour of constructing the self are discussed, and a clinical example is used to illustrate the therapeutic approaches suggested by this perspective. Copyright © 1999 John Wiley & Sons, Ltd.     

Rare embryonal and sarcomatous central nervous system tumours: State-of-the art and future directions

The introduction of molecular methods into the diagnostics of central nervous system (CNS) tumours and the subsequent deciphering of their molecular heterogeneity has resulted in a significant impact on paediatric neurooncology. Particularly in the field of rare embryonal and sarcomatous CNS tumours, novel tumour types have been delineated and introduced in the recent 5th edition of the WHO classification of CNS tumours. The rarity and novelty of these tumour types result in diagnostic and therapeutic challenges. Apart from distinct histopathological and molecular features, these tumour types exhibit characteristic clinical properties and require different therapeutic approaches for optimal patient management. However, based on the limited availability of clinical data, current therapeutic recommendations have to be based on data from small, predominantly retrospective patient cohorts. Within this article, we provide guidance for diagnostic work-up and clinical management of rare CNS embryonal tumours (‘embryonal tumour with multi-layered rosettes’, ETMR; ‘CNS neuroblastoma, FOXR2-activated’, CNS NB-FOXR2; ‘CNS tumour with BCOR-ITD, CNS BCOR-ITD) and rare CNS sarcomatous tumours (‘primary intracranial sarcoma, DICER1-mutant’, CNS DICER1; ‘CIC-rearranged sarcoma’, CNS CIC). By emphasizing the significant consequences on patient management in paediatric CNS tumours, we want to encourage wide implementation of comprehensive molecular diagnostics and stress the importance for joint international efforts to further collect and study these rare tumour types.     

Can we switch microglia's phenotype to foster neuroprotection? Focus on multiple sclerosis

Microglia cells, the resident innate immune cells in the brain, are highly active, extending and retracting highly motile processes through which they continuously survey their microenvironment for ‘danger signals’ and interact dynamically with surrounding cells. Upon sensing changes in their central nervous system microenvironment, microglia become activated, undergoing morphological and functional changes. Microglia activation is not an ‘all‐or‐none’ process, but rather a continuum depending on encountered stimuli, which is expressed through a spectrum of molecular and functional phenotypes ranging from so‐called ‘classically activated’, with a highly pro‐inflammatory profile, to ‘alternatively activated’ associated with a beneficial, less inflammatory, neuroprotective profile. Microglia activation has been demonstrated in most neurological diseases of diverse aetiology and has been implicated as a contributor to neurodegeneration. The possibility to promote microglia’s neuroprotective phenotype has therefore become a therapeutic goal. We have focused our discussion on the role of microglia in multiple sclerosis, a prototype of inflammatory, demyelinating, neurodegenerative disease, and on the effect of currently approved or on‐trial anti‐inflammatory therapeutic strategies that might mediate neuroprotection at least in part through their effect on microglia by modifying their behaviour via a switch of their functional phenotype from a detrimental to a protective one. In addition to pharmaceutical approaches, such as treatment with glatiramer acetate, interferon‐β, fingolimod or dimethyl fumarate, we address the alternative therapeutic approach of treatment with mesenchymal stem cells and their potential role in neuroprotection through their ‘calming’ effect on microglia.     

DONNEL STERN AND RELATIONAL PYSCHOANALYSIS

Relational Psychoanalysis as a paradigm is presented through an exposition of the work of Donnel Stern. Stern's ideas centre around four aspects of clinical theory: the therapeutic conversation; dissociation; enactment; the emergence of new meanings. The impact on Stern of the German philosopher Gadamer's ideas is discussed. Key clinical concepts arising in Stern's work include: ‘true conversation’ as a ‘fusion of horizons’; ‘not‐me’– the repudiated parts of the self which are then enacted in the therapeutic relationship; and the emergence of new meanings when conflict, through mentalizing, is moved from the interpersonal to the intrapsychic sphere. Contrasts and comparisons with traditional psychoanalytic thinking are examined. The key defining feature of Relational Psychoanalysis is its radical interpersonal stance, insisting that there is no such thing as a mind on its own, only a mind‐in‐relationship.     

Interpersonal skills in behavioural psychotherapy: Clinical psychology trainees' attitudes

During a behaviour therapy training workshop, 15 postgraduate clinical psychology trainees were asked to assign 27 interpersonal therapeutic skills either to themselves and/or to the ‘typical behaviour therapist’. The behaviour therapist's low ratings in therapeutic relationship skills is discussed, and the need for more research into the specific behavioural therapeutic relationship is emphasized.     

The Role of Culture in Eating Disorders

A comprehensive understanding of eating disorders should include engagement with the role of contemporary cultural trends. Feminists and critical social theorists have made significant contributions in this regard. Using two clinical cases, this paper contemplates the relationship between culture and psyche in eating disorder, proposing a psychoanalytic conceptualization underpinned by John Steiner's (1982, 1987, 1993, 2011) theory of pathological organizations and psychic retreats. Two conceptual terms will be introduced, namely ‘the normalized body order’ and ‘the abject body object’ to develop the argument. One of the clinical cases will be used to explore a particular kind of therapeutic impasse that can occur when therapist and patient are both female. In this particular case, the normalized body order emerged temporarily obstructing therapeutic progress; the impasse was understood to be an example of the so‐called anti‐analytic third (Straker, 2006 ).     

Ripley's Game: Projective identification,emotional engagement,and the counselling psychologist

Counselling psychology's dual emphasis on the use of the self as both vehicle of therapeutic change and legitimate focus of inquiry and research is one of the features by which the profession may be distinguished from related fields such as clinical psychology or psychotherapy. This paper discusses the relevance of the psychoanalytic concept of projective identification in understanding the extent, nature and subtlety of the ways in which the therapist's ‘self’ and emotions may be deployed within the therapeutic relationship. Illustrated with reference to the film ‘Ripley's Game’ and a clinical case vignette, Searles's (1978) advocacy of ‘a richness of emotional participation’ within clinical work is discussed in relation to the pluralist philosophy of counselling psychology; implications for the training and personal development of counselling psychologists are also briefly explored.     

WHAT IS THE DIFFERENCE BETWEEN A ‘PSYCHOANALYTIC’ AND A SO-CALLED ‘NORMAL’, EVERYDAY RELATIONSHIP? THE CONTROVERSY BETWEEN FREUD AND FERENCZI

Is the form Freud gave to the analytic relationship definitive? This question will be answered by analysing the argumentation in the Freud-Ferenczi controversy concerning the design of the therapeutic relationship. The current albeit superficial mode of interpretation of this controversy is mainly in terms of a supposed ‘warm’ emotional involvement of the analyst, as opposed to his ‘cold’ aloofness. Fundamentally however, the controversy concerns the way one should delineate the psychoanalytic relationship, as a method of treatment, from our everyday relationships. Freud and Ferenczi are the historical figures exemplifying what can be considered an ongoing debate. …My recommendations on technique given at the time were essentially negative. I considered it most important to underline what should not be done and to show the temptations opposing analysis. Almost everything to be done positively I left to the ‘tact’ introduced by you. But I aimed not at the obedients who were not aware of the elasticity of my remarks and subjected themselves to my recommendations as if they were taboo-regulations. This should be revised one day, without, however, doing away with the obligations. Freud in a letter to Ferenczi, 4.1.1928 (Ferenczi 1928a, p. 99)     

Sexuality in dance movement psychotherapy: Shyness or avoidance?

ABSTRACT

Dance movement psychotherapy (DMP) has contributed relatively little to literature and research on the topic of sexuality. Starting with a critical and thematic literature review from 1976 to the present day, attention is drawn to absences in theory, biases in practice, and an overall neglect of approaches to sexuality that employ fluid perspectives. This theoretical paper integrates perspectives from psychodynamic, person-centred, feminist and queer theories to engage with the history of DMP as a clinical discipline. Seven specific reasons are offered as to why the fullness of sexuality has tended to be avoided or ignored in DMP, and suggestions are made concerning how the profession can move forward.     

Sniffing animals as a diagnostic tool in infectious diseases

BackgroundScents and odours characterize some microbes when grown in the laboratory, and experienced clinicians can diagnose patients with some infectious diseases based on their smell. Animal sniffing is an innate behaviour, and animals' olfactory acuity is used for detecting people, weapons, bombs, narcotics and food.ObjectivesWe briefly summarized current knowledge regarding the use of sniffing animals to diagnose some infectious diseases and the potential use of scent-based diagnostic instruments in microbiology.SourcesInformation was sought through PubMed and extracted from peer-reviewed literature published between January 2000 and September 2019 and from reliable online news. The search terms ‘odour’, ‘scent’, ‘bacteria’, ‘diagnostics’, ‘tuberculosis’, ‘malaria’ and ‘volatile compounds’ were used.ContentFour major areas of using sniffing animals are summarized. Dogs have been used to reliably detect stool associated with toxigenic Clostridioides difficile and for surveillance. Dogs showed high sensitivity and moderate specificity for detecting urinary tract infections in comparison to culture, especially for Escherichia coli. African giant pouched rats showed superiority for diagnosing tuberculosis over microscopy, but inferiority to culture/molecular methods. Several approaches for detecting malaria by analysing host skin odour or exhaled breath have been explored successfully. Some microbial infections produce specific volatile organic compounds (VOCs), which can be analysed by spectrometry, metabolomics or other analytical approaches to replace animal sniffing.ImplicationsThe results of sniffing animal studies are fascinating, and animal sniffing can provide intermediate diagnostic solutions for some infectious diseases. Lack of reproducibility, and cost of animal training and housing are major drawbacks for wider implementation of sniffing animals. The ultimate goal is to understand the biological background of this animal ability and to characterize the specific VOCs that animals are recognizing. VOC identification, improvement of odour sampling methods and development of point-of-care instruments could allow implementation of scent-based tests for major human pathogens.     

Optimizing Therapeutic Antibody Function

Since the establishment of monoclonal antibody production using hybridoma technology in the mid-1970s, there has been expanding progress and continuous technological improvement in the development of therapeutic antibodies. The initial technological breakthroughs involved reduction of immunogenicity and thus enabled repeated administration. The establishment of chimeric, humanized, and fully human antibodies has led to the great success of several ‘second-generation’ therapeutic antibodies, such as rituximab, trastuzumab, cetuximab, and bevacizumab. However, there still exists an urgent demand for improvement in the efficacy of the current antibody therapeutics, which is not yet fully satisfactory for patients. Based on the current understanding of the clinical mechanisms of several therapeutic antibodies, many now believe that Fc-mediated functions (e.g. antibody-dependent cellular cytotoxicity, complement-dependent cytotoxicity, and neonatal Fc receptor [FcRn]-mediated storage) will improve the clinical outcomes of therapeutic antibodies. The present review focuses on the recent progress in the development of ‘Fc engineering,’ which dramatically improves (and sometimes silences) Fc-mediated functions. These achievements can be classified into two technological approaches: (i) introducing amino acid mutations and (ii) modifying Fc-linked oligosaccharide structures. The effectiveness of multiple third-generation therapeutic antibodies armed with various engineered Fcs is now ready to be tested in clinical trials.     

THE DAWN OF A NEW IDENTITY: ASPECTS OF A RELATIONAL APPROACH TO PSYCHOTHERAPY WITH A TRANSSEXUAL CLIENT

The importance of developing a certain consciousness in which one is present and autonomous while being intimately interconnected with larger meaning is an important dimension of a relational approach to psychotherapy. Based on the premise that both client and therapist bring something of themselves and of their respective past emotional experience to the therapeutic relationship, a relational approach to therapy is very attentive to the dynamics in the therapy room. It stresses the co‐creation of the therapeutic relationship at conscious, explicit verbal levels and unconscious, implicit levels of functioning, and establishes the therapist's emotional behaviour as a significant factor in fostering change ( Aron, 1996 ). Therapist responsiveness to client's affective impact is discussed with emphasis on its centrality to clinical practice and its relationship to countertransference. A case study of the psychotherapeutic journey with ‘Dawn’ (previously ‘David’), a 53 year‐old client who was awaiting sex‐reassignment surgery, is presented which illustrates how the therapist's struggle in the countertransference represents part of a complex relational body/mind system of parallel processes, re‐enactment and potential for therapeutic change.     

THE LAST FARTHING

ABSTRACT Forgiveness is powerfully enjoined within the Christian tradition, but how feasible is forgiveness and what are the consequences of non‐forgiveness? This paper explores these questions by considering the therapeutic experiences of three people for whom forgiveness was an issue. Their struggles suggest that part of the process of forgiveness may be working towards a ‘third position’, within ourselves, which transcends the instinct to portray our relationship with the person who has hurt us in terms of absolute goodness or badness, innocence or guilt. The significance of the ‘third position’ is that it provides a way of ‘seeing’ ourselves as we were at the time of the outrage, and the person who hurt us as they were at that time, and of continuing to live with both, while not being controlled by either. This understanding of forgiveness is then set alongside the experiences of two people who showed a remarkable capacity to use this ‘third position’; and also the author's experience, as priest and therapist, of hearing confessions which have arisen out of therapeutic work.     

The Use of Benign Authority with Severe Borderline Patients: A Psychoanalytic Paradigm

Kernberg has suggested that work with severe borderline psychopathology requires limit‐setting interventions to mitigate the possibility of life‐threatening enactments. These actions constitute a deviation from the classical analytic stance of technical neutrality. Taking up these modifications, I argue for a re‐calibration of the analytic task with severe borderline patients predicated on the use of benign authority. Abandoning therapeutic equidistance, I propose a model based on interventions organized around ‘maternal’ and ‘paternal’ functions and the dialectical and generative intercourse between these two poles. Such engagement requires close attention to the countertransference, as enactments are inevitable. In this context I reflect on the way ‘action’ in psychoanalysis is considered pathological, as a countertransference enactment. Clinical vignettes are presented arguing for ‘actions’ based on limit setting and active emotional engagement as therapeutic in their own right, which is consistent with psychoanalytic practice. This realignment of the psychoanalytic project embodies the ideas that Gabbard and Westen introduced in ‘Rethinking therapeutic action’. They suggest that it is now more accurate to speak of therapeutic actions in psychoanalytic treatment, rather than the ‘single‐mechanism theories of therapeutic action’, which may have implications for psychoanalytic practice beyond the treatment of the personality disordered patient.     

Interpretive Community,Intersubjective Experiences,and Supervisees’ Paradoxes

Contemporary theorists believe that each expert's discourse has meaning only in the context of an interpretive community. For therapists, the analytic community serves this purpose, helping them to construct their patients’ experiences and to hold inherent intersubjective paradoxes; the community provides them with a vantage point from which they learn to acknowledge, tolerate, and accept these paradoxes. I will examine the role of this vantage point in holding one of the central paradoxes for therapists: the uniqueness of each therapeutic relationship which urges them to ‘reinvent psychoanalysis’ with each patient, and its similarity to other therapeutic relationships which urges them to draw on the analytic community's theoretical schemas. I will suggest that supervisors help their supervisees in this internal struggle by representing the analytic community's vantage point and by holding a parallel paradox: the uniqueness of each supervisory relationship, which urges them to ‘reinvent’ the theory of supervision for each supervisee, and its similarity to other supervisory relationships, which urges them to draw on the analytic community's theoretical supervisory schemas. Reasonably, the supervisors’ capacity to hold these paradoxes is gradually internalized by their supervisees, facilitating their growth as therapists.     

THE THERAPEUTIC USE OF PETS IN PRIVATE PRACTICE

abstract The therapeutic use of pets has usually involved institutional visitation. Noting Freud's comments on the discovery of the profound connection between himself and his dogs, and recent research on the regulatory functioning sustained by a libidinal pair‐bond, this paper reports the therapeutic uses of the clinician's companion animal, a Labrador retriever, in a psychoanalytically oriented private practice. Patients were sitting up and seen once or twice a week. I argue that the containment of the treatment setting, attachment theory and a number of Winnicott's concepts – the good enough mother, the True and False Self, and the development of concern – are pertinent to an understanding of this approach to treatment, and that the right companion animal may contribute to the emergence of a True Self. The companion animal has the qualities of ‘devotion’, offers expressions of love and acceptance, tactile opportunity and responsiveness. I make a distinction between a ‘corrective object relationship’ and a ‘corrective emotional experience’, and take into account analytic debates about the ‘corrective emotional experience’. Through clinical vignettes I demonstrate the value of a trained companion animal as a psychotherapeutic addition in a private practice.