与未成年人相关的心理咨询与治疗的保密原则

保密原则对心理咨询/治疗有重大的影响,在未成年人心理咨询或治疗时这一伦理议题尤为突出。本文将从法律层面、未成年来访者自主权、父母或监护人的权利等方面了解青少年(未成年人)心理咨询与治疗中的保密原则,深入探讨其限制及与成人咨询保密原则的差别。从事青少年心理咨询的咨询师或治疗师可能会面对保密相关的伦理困境,本文为他们提供相关的伦理信息和职业信息,并有助于尽早制定出适用于未成年来访者的伦理守则。     

Manoeuvres of Transference in Psychosis: A Case Study of Melancholia from a Lacanian Perspective

According to French psychoanalyst Jacques Lacan, psychosis is marked by a non‐separation of the object a. Consequently, transference in psychosis remains at the level of duality and appears to have an inverted form, where it is the Other that looks for something in the patient and not vice versa. This makes the handling of transference challenging since there is no triangular structure that can mediate between the patient and the Other. The patient cannot rely on the Other to deal with difficult experiences of jouissance (marked by excess and senselessness). In this paper, we discuss our work with a patient following the logic of melancholic psychosis. Specifically, we discuss three types of interventions that aim to provide a space where the clinician can ‘manoeuvre’ within the transference, thus avoiding a relation that becomes persecutory or erotomaniacal in nature and providing the possibility of finding solutions in dealing with psychic suffering. First, we describe interventions aimed at incarnating a limited other. Second, interpreting the mad Other is discussed. Finally, we outline how the clinical work involves having an interest in the patient's affinities.     

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.     

Psychoanalytic Psychotherapy in Contemporary Mental Health Services: Current Evidence,Future Role and Challenges

Three interacting challenges are facing all aspects of health care in the United Kingdom: financial restraint in the context of a global economic downturn; a move to services being commissioned and decommissioned by primary care Clinical Commissioning Groups; and a need to provide evidence based practice through ‘payment by results’. Psychoanalytic psychotherapy faces more difficulty than most services in mental health, with long and frequent criticisms of it being expensive and under‐researched; and it is not as well understood by GPs as cognitive behavioural therapy, with which it is frequently unfavourably compared. This review provides an overview of the existing evidence for psychoanalytic psychotherapy, identifying strengths and areas that are under explored. We also argue that psychoanalytic psychotherapy has a unique clinical role but this will need to be clearly stated in the future, and promoted by clinicians to encourage future commissioning in the UK.     

Significant Factors in The Development of Elective Mutism: A Single Case Study of a 5 Year‐Old Girl

A constellation of processes found to be characteristic in the aetiology of elective mutism is explored through clinical material from the psychotherapy of a 5 year‐old girl. The major factors significant in this process are excessive ties to the mother that hinder the child's social–emotional development; difficulties in discharging aggression in a situation when it is not possible to feel separate from mother; primitive ways of dealing with aggressive feelings based on phantasy and omnipotence; and – in my own experience – the symbolic equation of anus and mouth, at the developmental phase of mastery of both speech and sphincter control, as a cause of withholding words.     

The Eye and the ‘I’: The Construction and Use of the Observer in Cognitive–Analytic Psychotherapy and Mindfulness‐Based Therapy

This paper explores issues in the integration of cognitive–analytic therapy and mindfulness‐based therapy. Differences in the conceptualization of the observer part of the self in both approaches – as centralized and independent as opposed to decentralized and fluid – are associated with different therapeutic emphases – on task and structure versus process. The tensions between these clinical and theoretical stances are explored, both in an individual and organizational (NHS) context.     

The Role of Interpersonal Connection,Personal Narrative,and Metacognition in Integrative Psychotherapy for Schizophrenia: A Case Report

The recovery movement has not only challenged traditional pessimism regarding schizophrenia but also presented opportunities for the possibilities for psychotherapy for people with the disorder. Though in the past psychotherapy models were often pitted against one another, recently there have been emergent reports of a range of integrative models sharing an emphasis on recovery and a number of conceptual elements. These shared elements include attention to the importance of interpersonal processes, personal narrative, and metacognition, with interest in their role in not only the disorder but also the processes by which people pursue recovery. This article explores one application of this framework in the psychotherapy of a woman with prolonged experience of schizophrenia and significant functional impairments.