Working with Remembered Childhood Nightmares in Adult Psychotherapy

This essay explores work with adult clients who have a particular attachment to their childhood nightmares. The essay argues that in the remembered nightmares, we have access to particularly well preserved dynamics and memories that can aid work and understanding. It is interesting that in cases where so much may have been forgotten, particularly in cases that involve trauma, memories of these dreams have endured. There is the somewhat tragic sense that some of the problems that have gone on to trouble the client's life were visible in the nightmares, and there to be addressed all those years ago. How different a life might have been if the issues in the childhood nightmares had been addressed at the time when they were first dreamt. The essay pursues the idea that remembered childhood nightmares can supply us with, firstly, important information that can support understanding of clinical work; and secondly, the possibility of assisting someone in carrying out work that has been long neglected.     

Direktausbildung: Der Psychotherapeut als Scientist-Practitioner Bologna,Staatsexamen, Approbation und sozialrechtliche Zulassung

To reform the German law of psychotherapy, new academic training programs under the label ‘Direktausbildung’ are currently discussed in the field. Our study concept combines under-/postgraduate study program, license to practice and permission to run a practice.     

L’attachement du client au thérapeute en psychothérapie : une revue systématique des études empiriques

Attachment theory describes characteristic patterns of relating to close others and has important implications for psychotherapy. Consistent with Bowlby's (1988) secure base conception of attachment in psychotherapy, several instruments have been developed to measure client attachment to therapist. Despite a large number of studies, no review takes into account all published work. The purpose of this systematic review was to compare different measures of client's attachment to therapist, with different groups of client and in different therapeutic contexts. Medline, Embase, Pubmed, PsycInfo, and Web Of Science were searched to identify studies published between 1995 and 2019 reporting on help-seeking client's attachment to therapist. Twenty-five empirical papers met the inclusion criteria. Meta-analyses were conducted for studies that examined client attachment to therapist subscales (Secure, Avoidant–Fearful, Preoccupied–Merger) as correlates of client-rated working alliance (K = 11, 892 clients), and general adult attachment (K = 11, 752 clients). The results show that the client's secure attachment to therapist is strongly correlated with the therapeutic alliance (mean weighted R = 0,71 [95% CI = 0.62–0.79]), moderately correlated with the results, and negatively correlated with the avoidance (mean weighted r = − 0,12 [IC 95% = − 0.06–− 0.21]) and anxiety dimensions (mean weighted R = − 0,11 [IC 95% = − 0.03–− 0.17]) of adult attachment. With the Avoidant–Fearful style, results go in the opposite direction, negatively correlated with the therapeutic alliance (mean weighted R = − 0.55 [IC 95% = − 0.59–− 0.50]), negatively correlated with the results, and correlated with the avoidance dimension of adult attachment (mean weighted R = 0,16 [IC 95% = 0.09–0.23]). The Preoccupied–Merger style shows weak (positive or negative) to zero correlations. In addition, nine studies looked at some dimensions of the psychotherapy process (e.g., resistance, transference, emotions, self-disclosure, and attitude toward psychotherapy), showing that insecurity of attachment to the therapist (both Avoidant–Fearful style and Preoccupied–Merger style) seem to interfere in one way or another with the development of a productive psychotherapy process. Overall, these results are in line with what was expected. They are consistent with Bowlby's conception of a secure base of attachment in psychotherapy. They showed that dysfunction and maladaptive developmental experience interfere with adult's ability needed to establish secure attachments and that psychotherapy may play the role of what has been previously defined as corrective emotional–or intersubjective–experience. In addition, these results do not seem to vary according to the instruments used. Together, the high correlation with therapeutic alliance and the weak correlation with pretherapy adult attachment confirm the relevance of the client's attachment to therapist as a specific variable related to the process of change in psychotherapy.     

L’expérience d’une équipe de liaison en addictologie pour adolescents en établissement soin/étude

“La clinique Dupré” is a psychiatric inpatient clinic associating long-term hospitalization and ambulatory treatment with upper secondary schooling for adolescents and young adults (care and studies program). In this article, we first describe how the recent opening of a consultation liaison in addictology was established as a response to the substance use disorder among the hospitalized adolescents. Then we show how the emotional dysregulation associated with substance use disorder drove us to develop an integrative psychotherapeutic intervention that reduces or halts the use and abuse of substances and helps to regulate emotions.     

Consenting to constraint: BDSM therapy after the DSM-5

ObjectiveBDSM is a overlapping acronym that refers to the practices of bondage and discipline, dominance and submission, sadism and masochism. The American Psychiatric Association “depathologized” kinky sex – including cross-dressing, fetishism, and BDSM –, despite retaining a clinical justification, in the fifth edition of its Diagnostic and Statistical Manuel of Mental Disorders (DSM-5). Henceforth, the paraphilias are considered “other sexual interests.”MethodWe analyze several psycho-sexological studies that treat sadomasochistic practices as psychic case studies. BDSM practices are no longer considered deviant behaviors, but, on the contrary, “common” behaviors that have been adopted by a large number of individuals. These individuals use contractualization in a specific context.ResultRather than considering BDSM practice to be a perversion by assimilating it to homosexuality, current research in gender and psychiatry and in the psychology of subsexualities has moved beyond the analysis of “deviance,” preferring a scientific study of the effects of BDSM practice, particularly of their positive effects on mood, stress, or depression.DiscussionThe BDSM and Therapy Project is concerned with articulating the possible risks of BDSM play and with clarifying situations where BDSM play is neither safe nor helpful. Members of the BDSM community have expressed the following points: the development of barriers between community members; the risks of alienation and isolation through stigmatization; having one's limits violated during a scene; the potential risk of dehumanization and destruction.ConclusionBDSM therapy, in a therapeutic setting as well as within the community, is based on consent. BDSM can be a form of psychotherapy for the subject. BDSM therapy would consist in the modification of the meaning of physical suffering by transforming it into voluntary pain, through consensual constraint. A functional BDSM therapeutic practice requires at least three conditions: (1) the SM relationship involves a willing dominant and a willing submissive; (2) this erotic duo exists in a codified setting; (3) the dominant is a “therapizer” in her/his display of empathy for the submissive; (4) a two-way flow of reciprocal benefits in terms of post-session well-being.