Psychoanalytic Psychotherapy with Deaf Patients: A Qualitative Study of Characteristics and Technical Adaptations in Clinical Practice

How do deaf patients treat their psychological conflicts? Is psychoanalytic psychotherapy possible for this population? Should adaptations be made in the psychotherapeutic setting? Many deaf people have come to psychotherapists’ offices in search of care for their emotional suffering only to encounter professionals who are unprepared, at least technically, to work with these patients and their differences. Due to the scarcity of publications or because very few professionals work with this population, many psychoanalysts are obliged to develop treatment in a basically intuitive way. The main objective of this study is to describe characteristics and technical adaptations carried out when treating this group through psychoanalytic psychotherapy as exercised by professionals who are familiar with the area. This article is the result of qualitative research backed up by very diverse reading. Content analysis was carried out according to Bardin's widely accepted method, and resulted in three final categories that are discussed. The categories are: (1) professional experience in the field of deafness: preparation and initial difficulties; (2) contextualization and subjectivity of deaf patients; (3) a psychoanalytic approach with deaf patients: characteristics and technical adaptations of clinical practice.     

How Much Time Do We Need? Time and Psychoanalytic Psychotherapy in CAMHS

The author considers what seem to be norms and values concerning session frequency and length of treatment in ‘traditional’ and current child and adolescent psychotherapy practice, and the impact of training expectations and models of training on identity and status as a child and adolescent psychotherapist. In the UK National Health Service, there is pressure to do more in less time: the norm is once-weekly work. Such an expectation does not sit comfortably with psychoanalytic theory and training, which remains rooted in higher frequency, longer-term cases. For trainees, this can lead to feelings of fraudulence and questioning whether less frequent therapies imply that the work is not psychoanalysis. The author explores, through a literature review, a case study and research material, how one might acknowledge the tension between these conflicting values about time; how psychoanalytic work in all its forms might be valued and be valuable for patients; and urges the need to feedback clinical experience into training structures and ongoing learning.     

Maintaining the Tension Between the Classic Seduction Theory and the Role of Unconscious Fantasies: A Contemporary Reconsideration

This article describes the long-term psychoanalytic psychotherapy of a young woman who had experienced trauma during her childhood. The details of the trauma were unknown, as all memory of the trauma had been repressed. Past trauma is analysable through a prism of transference, dreaming and dreams, mental states and thinking processes that offer an opportunity to explore and analyse the influence of both reality and fantasy on the patient. The presented case describes a therapeutic process that strives to discover hidden meanings through the unconscious system and illustrates the movement from unconscious to conscious during exploration of the patient's personal trauma in treatment. The author discusses the importance of classical and contemporary psychoanalytic models of childhood sexual trauma through the discovery of manifest and latent content, unconscious fantasies and actual events of trauma. It is suggested that the complexity of trauma is clarified by the tension between these models and by the inclusion of aspects of both of them for a complete understanding.     

Taking Your Own Side in the Argument

This contribution is written in response to Helen Morgan's paper ‘Whiteness: A problem for our times’. A distinctive feature of her writing and thinking in this essay, and her new book, is how she moves easily and freely between psychoanalytic, sociological, political and psychological frameworks of understanding. In doing so her work exemplifies something that the psychoanalytic community has mostly been poor at achieving – a recognition of both its distinctive and unique potential to illuminate social and political processes, and a parallel acknowledgement of its need to enter into equilateral dialogue with other intellectual paradigms. Social and political life is historical, specific, local and complex, and not amenable to reductionist or universalizing modes of analysis and engagement. Through some examples I aim to add to Helen's very thoughtful and well researched paper, to show how psychoanalysis needs to respect other languages and methodologies for engaging with the world, render its own more accessible to non-specialists, and relinquish its tendency to assume the status of a ‘master discourse’.     

The Wish to Never End: Grappling with the Termination of an Infant observation And its Relevance to Clinical Work

This paper uses a psychoanalytic infant observation to highlight the significance of grappling with endings. It describes the termination of a two-year relationship with a child and his mother, who were observed weekly by the author. The content of the ending process is extrapolated to apply to infant observations in general, with implications for termination of psychoanalytic psychotherapy treatments with patients of any age as well as personal relationships. Transference and countertransference reactions and enactments evoked during the prelude to termination are considered. Vignettes from the infant observations illuminate important crossroads during the termination process. The paper also illustrates the resilient capacity that a child (and by extension the child part of an adult) can have to experience, process and bear the ending of a relationship, as well as to continue to hold that relationship internally. This glimpse into one child's, one mother's and one observer's experience of separating from each other demonstrates the ways primitive aspects of the psyche may be activated during a termination. Finally, Donald Meltzer's concept of three-dimensional interior space and Bion's idea of open-ended reality are applied, indicating how relationships that have ended may be contained within one's psyche, enduring beyond their ending.     

Gay Men and Suicidality: The Development and Nature of the Critical Superego

National research studies report elevated suicide rates amongst gay men, particularly those under the age of 26. Much of the current health and psychiatric literature on suicide tends to focus on the external world impacting on the suicidal individual. Although valuable, it is not enough to understand the specific circumstances that could contribute to gay men's suicidality. This paper focuses on the relationship between the external and internal dynamics at play in the suicidality of gay men, with particular emphasis on the development, influences, and nature of a cruel and punishing superego. The author provides some contemporary psychoanalytic theories on same-sex desire as a useful framework to understand minority sexuality. Some influential classic and contemporary psychoanalytic theories regarding suicidality and the development and character of a cruel and punishing superego are presented. The concept of internalized homophobia and the impact of heteronormative masculinity on the gay man's psyche are explored as drivers for suicidality. A composite case study from clinical experience with suicidal gay men in an NHS setting is presented to illuminate the discussion. This paper could add new perspectives and important dialogue for psychoanalytic psychotherapists working with this patient population.     

Therapists' Experience of Working with Interpreters in NHS settings: Drawing Upon a Psychoanalytic Theoretical Framework to Contextualize the Findings of an IPA Study

NHS therapists are required to work with interpreters. Therapy with an interpreter may take longer and aspects of the work may be challenging. Surveys of NHS mental health staff, particularly those working in Improving Access to Psychological Therapies (IAPT) services, indicate that they are experiencing burn-out, low morale, and increasing stress and depression as a result of ever-increasing targets and workload demands. This study aimed to gain an understanding of the impact of the context of therapy on the experiences of therapists in the NHS of working with interpreters. Semi-structured interviews were conducted with 10 qualified therapists working within an IAPT or secondary care psychology service from one NHS Trust. The verbal data were analysed using interpretative phenomenological analysis (IPA) methodology. The key finding of the study was that participants’ experience of their organizational context (whether supportive or pressured and demanding) appeared to drive how they related to the interpreter. Previous literature has applied a psychoanalytic framework to understanding organizational, group and individual responses to stress in healthcare settings, including IAPT. Following the initial analysis, aspects of psychoanalytic theory were used to contextualize the findings. Epistemological and ethical tensions in making links to theoretical frameworks within an IPA study are acknowledged and discussed.     

From a Pictogram to a Symbol: Working with a Transgender Patient in an NHS Gender Clinic Using Piera Aulagnier's Theory of Identity Formation

This article presents clinical work with a transgender patient who was attending a regional NHS gender clinic in England. It aims to link aspects of the patient's identity formation with the theoretical framework offered by the French psychiatrist and psychoanalyst Piera Aulagnier. Emphasizing the complexity of (gender) identity and its process of development, the concept of the ‘birth of the body’ is used to situate the development of gender identity as a process of the creation of an individual narrative, with the experience of embodiment based on unconscious fantasy as specifically troubling for transgender individuals. This struggle may be seen in the clinical material presented. Recommendations are made for working with transgender clients who suffer from a disturbance in creating and navigating relationships. By using the concept of the ‘word-bearer’, an exploration may be opened up of the unconscious dynamics between the clinic as an object that offers understanding, and the service user who is seeking meaning and a remedy for subjective suffering.     

从精神分析理论的角度探讨嫉妒产生原因

目的 本文欲从精神分析的角度去探讨嫉妒产生的根源。方法 根据弗洛伊德的精神分析理论原理,作者寻找嫉妒产生的可能原因。结果 作者发现,很多迹象表明嫉妒的产生与人们潜意识中的恋母情结(男性)或者恋父情结(女性)有关。结论 从精神分析理论的角度来讲,嫉妒产生的根源正是人们潜意识中存在的恋母(恋父)情结。     

认识领悟疗法治疗强迫性表象

目的　探讨认识领悟疗法对强迫性表象的治疗作用。方法　按照钟友彬教授认识领悟疗法的原理、方法和步骤 ,对患者实施认识领悟治疗 ,不用任何药物。结果　患者的强迫性表象得以治愈 ,症状完全消失。结论　使用认识领悟疗法治疗强迫性表象有效     

Attachment Theory in Clinical Practice: A Personal Account

Attachment theory was built by Bowlby as an attempt to link psychoanalysis with the wider world of ethology, cybernetics and evolutionary theory. Initially rejected by the psychoanalytic establishment there has been a gradual rapprochement. This paper attempts to accelerate this process by laying out the points of overlap and distinction between the attachment and psychoanalytic perspectives on clinical treatment. It summarizes the main tenets of attachment theory and then looks in detail at the therapeutic alliance, classification, transference/countertransference, and interpretation and mentalizing from an attachment perspective. A clinical example illustrates how insecure and secure attachment play out in the consulting room, and the paper ends by suggesting that attachment provides a suitable evidence base for the relational/Independent psychoanalytic approach.     

我国临床心理学工作现状调查与展望

对３０个省市和所属地市中有心理学系、心理学教研室的高等院校和精神病医院和儿保等机构共１，４３４个寄发了调查表，回收４５７份，回收率为３２％，调查心理测验、心理咨询与治疗和从业人员情况。结果表明常用心理测验共２２种，其中用得最广的前五种为ＷＩＳＣ，ＥＰＱ，ＷＡＩＳ－ＲＣ，ＭＭＰＩ和ＷＰＰＳＩ，各测验应用最多的是医院（占全体的７０．６％），用途最多的为医疗方面（５０％），其次为教育和科研（各占２３．７％）。常用心理治疗方法有行为、认知、支持、精神分析和森田疗法等９种，常治的心理障碍有强迫症、恐怖症、焦虑症等２２种。在调查４５７个单位中有３３５个开展了心理咨询服务，近一年的求助者计８８，１９０人。求助的问题计１８种，依次为个人健康问题（２１．８％），一般人际关系（１５．３％），爱情问题（１０．５％）等。现在从业人员从测验、心理治疗至咨询三项工作来看，专业原为心理学的少（分别为８．３％，２．３％和７．２％），为临床医学的占最大多数（分别为７６．３％，８７．３％和７９．４％）。接受了临床心理系统训练的人数在１０％以内，接受短期专业训练占最大多数（９０％左右）。根据调查结果对这些工作作了展望。     

Listening to the Voices of the Poor and Disrupting the Silence About Class Issues in Psychotherapy

By its very nature, a life of poverty is harmful to the emotional well‐being of poor and working‐class women and men. Psychology, for the most part, has unwittingly played a part in this oppression by pathologizing the poor and maintaining barriers to mental health care. This article presents findings from qualitative studies that illustrate lived experiences and insights from poor and working‐class people in the community at large and in the therapeutic settings in particular. Drawing from these narratives, recommendations are made to psychologists who seek to subvert the normative silence around class issues and take on the work of providing class‐aware services to men and women in poverty.     

‘Chaos,Through a Veil of Order’: The Dialectic of Theory and Spontaneity in Psychoananalytic Work

The theme of the paper is the quotidian debate about the role of theory in analytic practice. Based on examples from recent psychoanalytic publications, I argue that psychoanalytic theory may influence therapists as ideology, heuristics, or empiricism, or combinations thereof. Bion's eschewing of theory, and advocacy of an analytic stance ‘beyond memory and desire’ as a precondition for psychoanalytic creativity is questioned. Buber's advocacy of I–Thou relatedness is compared with the concept of mentalizing, and related to recent findings in developmental psychopathology. Parallels are drawn between the therapeutic relationship – bringing together theory and spontaneity in a hermeneutic enterprise – and the infant's use of security‐promoting care‐givers.     

Effectiveness Trial of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Symptoms in a Naturalistic Treatment Setting

Background The aim of the study was to look at symptom changes in naturalistic outpatient psychoanalytic child and adolescent psychotherapy for anxiety disorders in Germany. Methods (1) The first treatment period of the psychodynamic intervention group (<25 sessions) was compared with a minimal supportive treatment (waiting list) control group, and (2) the effects of long‐term psychoanalytical treatment (>25 sessions) were analysed using a longitudinal observational design. A total of 86 children and adolescents (4–21 years) were in the treatment group and 35 in the minimal supportive treatment control group. Questionnaires were administered at the beginning and end of treatment, as well as at 6‐ and 12‐month follow‐up (FU). Results When comparing the first treatment period with the minimal supportive treatment control group, both groups improved significantly with small effect sizes and no significant group differences. Both parents and patients reported moderate symptom improvements at the end of therapy (parent: d=0.58; patient: d=0.57), which were stable at FU and increased from the patient perspective (parent: d=0.37; patient: d=0.80). Conclusions The results suggest that anxiety symptoms significantly decreased during the treatment period and remained stable at FU. Due to the study design we could not rule out alternative explanations like regression to the mean.     

军医大学航空航天医学及临床医学本科生学习倦怠与学习投入的现状调查

目的:调查军医大学航空航天医学及临床医学本科生的学习倦怠与学习投入现状。方法:抽取某军医大学航空航天医学本科生139名,临床医学本科生129名,采用学生学习倦怠量表与学习投入量表进行调查。结果:军医大学航空航天医学本科生的学习投入得分高于中间值(t=3.463,P0.01),临床医学本科生的学习投入得分同样高于中间值(t=5.638,P0.01),临床医学本科生学业疏离维度得分低于航空航天医学本科生(t=-2.342,P0.05),专注维度得分高于航空航天医学本科生(t=2.321,P0.05)。结论:军医大学临床医学本科生的学习倦怠程度比航空航天医学本科生低,学习投入程度比航空航天医学本科生高。     

Understanding and Using Enactments to Further Clinical Work: A Case Study of a Man Unable to Experience Intimacy

This article examines the value of working within enactments–affectively charged, unconscious remnants of painful, past experiences played out in the novel context of the therapeutic relationship–to further the work of psychodynamically oriented therapy in the treatment of a HIV‐positive Hispanic gay male in his early 30s with a history of relational trauma. Through clinical vignettes, I highlight how relational uncertainty and its vicissitudes–vulnerability, doubt, safety, and trust–have triggered mutual dissociation in the context of enactment. At times, this has disrupted our ability to communicate honestly and relate intersubjectively. By working within affectively charged enactments, we have expanded our capacities to accommodate to relational uncertainty and used the tension of ambiguity within our relationship to permit the emergence of a shared space for recognition and self‐discovery.     

个体大脑枕叶GABA+分布差异性及原因探究

抑制性神经递质γ-氨基丁酸(GABA)是脑神经领域重点关注的代谢物,但其在大脑中含量很低,与其他代谢物在化学位移上重叠而不易检测。磁共振波谱序列(MEGA-PRESS)实现了对大脑中单体素感兴趣区域(VOI)GABA的检测,促进了对GABA的相关研究。对一组被试进行多次扫描,同一区域相同大小的VOI内(约20～30 mm³)所包含的灰质(GM)比例很难保持完全一致。而GM是皮层主要成分,有解剖、切片染色等实验发现大脑皮层中GABA含量更高,然而多数基于单体素VOI的研究并未进一步考虑VOI中GM占比对结果分析的影响。通过扫描14名健康被试(7男7女),在高分辨率T1加权结构像上重现VOI对应区域,并计算其内GM等占比。个体重复实验结果表明,枕叶VOI内GABA+均值与GM占比均值呈正相关(r=0.74, P<0.01),且二者的波动具有一致性。该结果表明,在进行GABA相关的病理或功能研究时,需要考虑单体素内GM占比的影响,以进一步提升实验结果的分析准确度。