Showing papers in "American Journal of Psychotherapy in 1999"

Assessing Psychological Trauma and PTSD

Abstract: JOHN P. WILSON AND TERENCE M. KEANE, EDS.: Assessing Psychological Trauma and PTSD. Guilford Press, New York, 1997, 575 pp, $55.00, ISBN 1-57230162-7. The recent impressive expansion of our clinical knowledge about PTSD and psychological trauma has been paralleled by a progressive introduction of a variety of self-report measures, each one with its own emphasis and relative specificity. The array of assessment instruments related to various psychological traumas and posttrauma disorders has become overwhelming if not confusing. The need for a reference book in this area was acute and crucial not only for clinicians but also for researchers. The editors have thoughtfully addressed this issue by bringing together a group of experts who have covered all the important aspects of psychological assessment in this field. The book is divided into three main areas of assessment, each addressing a particular area of psychological trauma. The first area covers standardized measures and physiological techniques related to PTSD and child-abuse effects in adults supported by a chapter on physiological assessments and another one on psychometric theory explanatory of the degree of validity of the tests. It will be unrealistic to discuss the strength and weakness of each one of the 20 standardized tests already evaluated by the contributing authors. However, an issue affecting all these tests seems to be the questionable validity of attempting by the testdevelopers to objectify the subjective answers of the clients-patients. Like in all self-report measures, there is a subjective bias which may falsify the responses, though it may measure the degree of severity of clinical symptoms, if the specific trauma is documented independently of the client. (Trauma symptom checklist -40) Another problem with these tests is that, while they have been developed based on relatively small samples, they have not been validated against the general population. As noticed by the authors, the validation of these tests is not quite documented in terms of the discriminative validity of the PTSD measures versus other measure constructs. The second group of articles reviews the standardized assessment of the traumatic reaction among victims and survivor populations. The articles included here assess a wide variety of psychological trauma from life-threatening medical illness to bereavement, marital strife with physical aggression, child abuse or combat-related stress trauma. They empirically evaluate the impact of a particular natural or human-induced stressor on people subjected to it, without telling us why some are affected more than others or not at all. …

Attachment Theory and Close Relationships

Abstract: JEFFREY A. SIMPSON AND W STEVEN RHOLES, EDS.: Attachment Theory and Close Relationships. The Guilford Press, New York, 1998, 438 pp., $50.00, ISBN 1-57230-102-3. Attachment theory, as first espoused by John Bowlby, became a pervasive theoretical influence on clinicans and researchers working with children, parents, and families. The work of Mary Ainsworth introducing the methodology of the Strange Situation made it possible to observe parent-child dyads and assess the type of relationship. The categories of secure, insecure-avoidant, and insecure-anxious attachment, later extended to include disorganized attachment, were ways of describing different attachment patterns. According to Bowlby, attachment paradigms are encoded in internal working models, the theorized basis for developing attachment systems. Both Bowlby and Ainsworth assumed internal working models formed in early childhood persisted throughout life and continued to be vital into maturity, and beyond maturity into old age. The concept of internal working models was used to account for continuity in relationships and transmission of trauma between generations. Can the attachment model be extended meaningfully to adult relationships and development throughout a lifetime? The purpose of this intriguing and informative synthetic volume edited by Jeffrey Simpson and Steven Rholes is to orient us to important theoretical and empirical advances that have taken place in the area of adult attachment during the last decade. They distinguish two components within attachment theory. The first component is normative and attempts to explain stages of development through which nearly all human beings pass. A second component is focused on individual differences and attempts to explain stable deviations from modal behavioral patterns. Simpson and Rholes note the study of individual differences has dominated research for adults as well as children. The authors distinguish two traditions emanating from the study of individual differences. The first tradition, the nuclear family tradition, is exemplified by the work of Mary Main and her colleagues. They developed the Adult Attachment Interview to predict the Strange Situation behavior of respondents' children. The peer/romantic partner tradition, on the other hand, focuses on contemporary views and perceptions of current life partners. These studies utilize self-report questionnaires, accessing a more conscious domain of feelings. In this book, Simpson and Rholes focus almost exclusively on research and clinical work utilizing self-report measures. They recognize that the two traditions of research diverge not only in methodology, but also in generalizability of results. …

Intergenerational transmission of trauma: recent contributions from the literature of family systems approaches to treatment.

Abstract: A young woman in her thirties commits suicide by choking herself on an aerosol can. Her mother, a Holocaust survivor, tells of having survived the camps by singing for the guards. The mother's current symptom is a feeling of choking so severe that she cannot talk although she can sing. In another case, a nine-year-old girl is referred for treatment for depression after her mother abandons the family. Later, it is determined that the mother at the age of nine was abandoned by her own mother. When the patient's mother is able to reconnect with the grandmother, she is also able to connect with her daughter. In a third case, a man in his forties is hospitalized with chronic suicidal ideation. Neither he nor his two intelligent siblings are able to function adequately. It is determined that their father, a high-functioning professional, had two brothers who had committed suicide. All these vignettes, drawn from cases seen either in a hospital setting or in private practice, are examples of trauma experienced through the generations. In each case, a "secret" trauma, not verbally expressed, was nevertheless passed on, in one way or another, from parent to child, or from grandparent to parent to child. Trauma has long been recognized as having an impact on mental health and is a component of many classic cases, such as Freud's case of Schreber, who was physically mistreated by his doctrinaire, disciplinarian father. The long-range generational effects of trauma have been widely reported in the literature, especially regarding the Holocaust. It has been almost two decades since the publication of the classic work, Generations of the Holocaust (1), edited by Martin S. Bergmann and Milton E. Jucovy. This book powerfully illustrates the impact of wartime experiences on the children of Holocaust survivors. However, it is clear that intergenerational trauma is not confined to war experiences, but is quite widespread. In work with residents and other trainees in urban and public-sector settings, we have found that a majority of individuals and families requiring help for emotional problems have undergone some form of trauma from within the family or created and fostered by the social systems with which they interact. Recent attention has been focused on the importance of recognizing trauma to arrive at a valid diagnosis and treatment of emotional disorders. Hospitals are forming trauma committees to consider inclusion of the role of physical and sexual abuse in psychiatric assessment. Schools are forming crisis teams to deal with suicide, homicide, death, and other crises. National attention is riveted on disasters and community trauma teams are organized to deal with catastrophic events immediately at the scene. In short, both the field of mental health and society at large are beginning to acknowledge the influence of trauma. This creates new challenges for mental health professionals. A central clinical feature is the silence that occurs in families surrounding traumatic experiences. The process of psychotherapy sometimes replicates that means of coping by not encouraging open discussion. Many patients and families have had experiences that are intolerable to our sense of ordering and managing the world. Families often cope by denial, repression, or by consciously omitting important family information. Clinicians may participate in the denial, thus reinforcing the silence. Among the reasons cited is a fear of inflicting more pain on people already suffering or suggesting a problem that has not been defined by the patient. Countertransference reactions include an intolerance for the therapist's own pain and a stirring up of issues from the therapist's own life. It is important to be conscious of this tendency and to mitigate against repeating the process of denial and silence in the treatment. Rather than sensing that something has happened, and waiting for the material to emerge, some professionals are becoming more active in helping patients to confront these experiences. …

An overview of the psychotherapy of dissociative identity disorder.

Abstract: Dissociative Identity Disorder (DID) is identified and studied with increasing frequency. However, the controversy that often surrounds DID can make it difficult to approach its treatment in a circumspect manner. This paper will provide an overview of DID treatment as it is practiced by those experienced and skilled in the treatment of this group of patients. The treatment of DID resembles the treatment of other traumatized populations in that it is stage-oriented, beginning with supportive and strengthening work. Various stances toward the treatment of DID are reviewed, and specific issues that arise in the psychotherapy of DID are addressed, such as pragmatic arrangements, informed consent, work with alters, and the use of specific techniques, such as hypnosis. The employment of therapeutic modalities and ancillary therapies is discussed. The heterogeneity of DID patients is reviewed, and the characteristics of three general groups of DID patients, high, intermediate, and low in both function and prognosis, are explored. Considerations in the matching of DID patients to either exploratory or supportive treatments are discussed, and observations are made about both trauma work and the supportive psychotherapy of DID.

The Correspondence of Sigmund Freud and Sándor Ferenczi

Abstract: ERNST FALZEDER AND EVA BRABANT WITH THE COLLABORATION OF PATRIZIA GIAMPIERI-DEUTSCH (EDS): The Correspondence of Sigmund Freud and Sandor Ferenczi Volume 2, pp 1914-1919 The Belknap Press of Harvard University Press, Cambridge, MA, 1996, 395 pp, $4695, ISBN 0-674-17419-4 This sad, poignant, and gripping collection of the correspondence of Sigmund Freud and Sandor Ferenczi during World War I is as fascinating and revealing a publication as one can imagine Freud is often criticized for having blundered badly into a boundary crossing, demanding that Ferenczi choose between the two women he "loved" (a mother and her daughter, both of whom were his analysands!) by marrying the mother, who was eight years older than Ferenczi This occurred at the same time Ferenczi was putatively an analysand of Freud's, having experienced some short periods on the couch representing this "psychoanalysis" that Freud considered "finished, not terminated, but rather broken off because of unfavorable circumstances" (p 153) The personalities of the two correspondents emerge dramatically in their letters Ferenczi is mercurial, unstable, passionate and neurotic He addresses Freud as "Dear Professor"; Freud in turn writes to him as "Dear Friend" Freud is solid, stable and somewhat gloomy, as well as consistent, mature, and dedicated His intense internal struggle to maintain a certain analytic distance from Ferenczi is quite manifest, while at the same time his need for the friendship and his appreciation for Ferenczi's warmth and devotion to him is apparent All this occurs against the background of being on the losing side in World War I, with the miseries and frustrations that obviously entailed Freud at one point had three sons in uniform and was very much worried about each of them; Ferenczi's career was continually disrupted by calls to serve as a military physician, a disruption that made it almost impossible for him to dedicate himself to psychoanalysis He was so determined to continue this dedication that he even attempted to analyze his commanding officer while they were both on horseback, the first instance, as he puts it, of "hippic" psychoanalysis (p 50) Given the background of this terrible war it is easier to empathize with the struggles of both Freud and Ferenczi to maintain some kind of stability and to continue a very human relationship that was sometimes one of an analyst and patient and sometimes one of an older with a younger friend Freud has been much criticized for this vacillation, but without it I am certain that both parties would have suffered greatly, and Ferenczi, the patient, most of all Probably Freud's most glaring mistake was to write directly to Ferenczi's intended betrothed, conveying an offer of marriage at Ferenczi's request In the outstanding introduction to this book by Axel Hoffer, it is suggested that Freud had, at least, an unconscious attraction to Ferenczi's betrothed himself, which might account for Freud's continual pressure on Ferenczi to marry her This may or may not be so, but it does raise the issue of the status of Martha, Freud's wife She is rarely referred to in this almost 400 page volume of correspondence, and when she is mentioned, it is in a rather disparaging manner by Freud, characterizing her as essentially a fuss-budget who has little tolerance of discomfort For example, Freud writes, "I don't dare bring my wife to an unknown second- or third-rate Hungarian spa …

Love and Its Place in Nature

Abstract: JONATHAN LEAR: Love and Its Place in Nature. Yale University Press, New Haven, CT, 1998,243 pp., $12.50 (paper), ISBN 0-300-07467-0. Early in his career, Freud claimed that he had no interest in philosophy. Yet, later, in his works on culture and society, he admitted that at heart he had always been a philosopher and explorer, not a physician, or even an able scientist. Freud's latent love affair with philosophy has not been lost on humanities scholars. They have joined the analytic ranks as theorists and practitioners. Jonathan Lear, the author of Love and Its Place in Nature, trained in philosophy, is a member of the Committee on Social Thought at the University of Chicago and a practicing analyst, trained at the Western New England Institute for Psychoanalysis. The subject of Lear's provocative essays is the philosophical implication of Freudian Psychoanalysis. He starts with the thesis that a delineation of the vicissitudes of human individuation is the major contribution of psychoanalysis to knowledge; and dependent on the success of this pursuit, it will survive or not. Lear promotes his thesis by examining several of Freud's texts in more or less chronical order to show that psychoanalysis developed in large part as attempts by Freud to address discrepancies that arose as he sought to explain his clinical data in light of his previous theoretical assumptions. Central to these efforts, according to Lear, were Freud's continual attempts to demonstrate that the human mind unceasingly strives for self-understanding. Inappropriate behavior, as such, is due not to inappropriate emotions, but because the individual's difficulties in selfawareness have led to directing his emotions to inappropriate people. Emotions were conceived by Freud as "a framework through which the world is viewed" (p. 47), "packaged with its own justification" (p. 49). Consequently, Freud's therapeutic methods, according to Lear, are efforts to enable the patient to change the type of responsibility he characterologically assumes for his emotions. The problem with Lear's examination is that he fails to notice the unfortunate counterpoint to psychoanalysis' concern with individuation-social irrelevance and a lack of attention to moral responsibility. In other words, psychoanalysis' most serious error is the notion that the psyche is located within the encapsulated self, removed from a deteriorating social world-which leads to a lack of responsiveness to social and community responsibilities of analytic patients. Of no less concern to this reviewer are a number of Lear's contentions that characterize analytic inquiry as an act of generosity and compassion (he regards Interpretation as "an act of Love," p. …

Dialectical behavior therapy: a new treatment approach for suicidal adolescents.

Abstract: Suicide accounts for more adolescent deaths in the United States than all natural causes combined and ranks as the third leading cause of death among 15- to 19-year-olds (1). It is estimated that in 1990, almost 300,000 high school students in the United States made suicide attempts that required medical attention (2). Follow-up studies find that about 10-50% of adolescents who attempt suicide make future attempts (3), and up to 11 % of adolescent attempters eventually die by suicide (4). Nearly all adolescents who engage in suicidal behavior have a diagnosable psychiatric disorder (5), such as affective disorder, substance use disorder, conduct disorder (6, 7) or borderline personality disorder (BPD) (8, 9), with high rates of comorbid Axis I and Axis II disorders being the rule rather than the exception (10). Many of these teens are at high risk for dropping out of school, substance abuse, violence, and high-risk sexual behaviors, which contribute to teenage pregnancy and HIV transmission (11-14). Unfortunately, up to 77% of adolescent suicide attempters will not attend or will drop out of outpatient treatment (15) before learning how to better tolerate distress and regulate their emotions with skills that would serve to reduce suicidal and other extreme behaviors. These alarming statistics beg the question: what is being done to effectively treat these suicidal multi-problem adolescents? Many different therapeutic interventions (e.g., psychodynamic, cognitive-behavioral, group, family, pharmacologic) have been applied to this difficult-to-treat population; yet, to date, there is not a single empirically supported psychotherapy developed specifically for suicidal multi-problem adolescents (16). DIALECTICAL BEHAVIOR THERAPY Dialectical behavior therapy (DBT) (17, 18) was developed by Linehan for chronically parasuicidal women who were diagnosed with borderline personality disorder (BPD). Parasuicide is defined as any acute, intentionally self-injurious behavior resulting in physical harm, with or without intent to die (17). DBT is currently the only empirically supported treatment for suicidal multi-problem patients who commonly exhibit severe behavioral dyscontrol. In a one-year randomized clinical trial compared to Treatment-As-Usual, DBT not only significantly reduced suicidal behavior (including frequency and medical severity of parasuicidal acts), the number of inpatient psychiatric days, drop-out rate, and anger, it also improved social adjustment and treatment compliance (19, 20). Miller and colleagues (16) adapted DBT for suicidal adolescents with borderline personality traits because of its specific focus on reducing suicidal and quality-of-life-interfering behaviors, as well as keeping adolescents engaged in treatment. DBT is based on Linehan's (17) biosocial theory in which BPD is thought to be caused by pervasive emotional dysregulation. Emotional dysregulation is viewed as the result of the transaction between an individual who is biologically predisposed to have difficulty regulating emotion and an environment that intensifies this vulnerability. The theory suggests that BPD behavior results when a child who has difficulty regulating emotion is placed in an invalidating environment, i.e., one that pervasively and chronically communicates that the child's responses are inappropriate, faulty, inaccurate, or otherwise invalid (17, 21). Thus, DBT conceptualizes parasuicidal behaviors as having several potential functions, including affect-regulating and help-eliciting behavior from an otherwise invalidating environment. From this perspective, parasuicidal behaviors are considered maladaptive solutions to overwhelming, intensely painful negative emotions. DBT with adolescents consists of 12 concomitant weekly individual and group therapy sessions. A primary focus and dialectic of the treatment is the emphasis on balancing change and acceptance. Hence, the therapist selectively applies problem-oriented change strategies (i. …

Ideology, Conflict, and Leadership in Groups and Organizations

Abstract: languages. Understandably, there is de tailed and important description of the practical aspects of the use of interpreters during interviews, a subject that is often taken even more for granted than transla tion of psychiatric measures. The section on depression and culture is an excellent and comprehensive account of the subject and covers the perplexing findings that depres sion, once thought to be rare in Africa, is now found to be more common than in the West. Other topics well covered include the methods and processes of biomédicaland traditional diagnoses of mental disorders and the variety of health practitioners who are accessed for mental health problems in southern Africa. The two great qualities of this book are its style of writing, and its balanced presentation of arguments and facts. The style is intensely personal, reflecting at each corner the intimate experience in teaching, research and service provision of the author's long and committed involvement

Open Minded: Working Out the Logic of the Soul

Abstract: JONATHAN LEAR: Open Minded: Working Out the Logic of the Soul. Harvard University Press, Cambridge, MA, 1998,345 pp., $35.00, ISBN 0-674-45533-9. The rationale for bringing this book to the attention of psychotherapists is definitely the presence of chapter two, which was first published in The New Republic, December 1995, under the horrendous tide of "The Shrink Is In." In the book it is titled "On Killing Freud (Again)." I first saw this article in The New Republic and was so impressed by it that I requested permission to reprint it when I was the editor of the Bulletin of the American Society of Psychoanalytic Physicians, but the magazine wanted so much money for permission to reprint that our little Bulletin could not afford it. All psychotherapists will gain by reading Lear's outstanding, erudite, and beautifully written defense of Freud and of psychoanalysis and his discussion of its place as we go into the 21 st century. Lear's is the best short response to the numerous mindless fanatic Freud-bashers that clutter up the popular literature today. The rest of the book presents professional philosophical discussions enlightened by some of Freud's psychoanalytic concepts, such as internalization, externalization, sublimation, and so forth. It is scholarly, and unless the reader has some background in Plato, Aristotle, and Wittgenstein, it can be difficult to appreciate the subtlety of the author's arguments. As he writes, his book is "an attempt to bring some life into two activities which lie at the heart of our humanity" (p. 3), that is, psychoanalysis and philosophy. Most of the chapters contain clever and sophisticated readings of rather well-known classical Greek texts, which Lear no doubt has been teaching about for years in his position as a member of the Committee on Social Thought at the University of Chicago where he is a John U. Nef Distinguished Service Professor. He has previously published on Aristotle and on philosophical approaches to Freud's psychoanalysis. He has interesting things to say about the Oedipus Rex of Sophocles, Plato's Republic and Symposium, the writings of Aristotle, Kant, Wittgenstein, and others. Most of the chapters in this book have been published elsewhere in a variety of journals, ranging from the International Journal of Psychoanalysis to the Proceedings of the Aristotelian Society. At times his writing becomes rather dense, especially in chapter five, that has the enticing title "Restlessness, Phantasy and the Concept of Mind," an attempt to blend psychoanalytic with philosophical notions in quite an original way. There is in chapter seven an interesting and unusual interpretation of Plato's Symposium, which Lear considers to be both a tragedy and a comedy. Readers unfamiliar with that dialogue will have trouble following Lear's clever interpretation of it. This chapter was apparently not reprinted from another publication, and I found it to be the most original part of the book. …

Understanding empathy and related phenomena.

Abstract: Over a period of time, the author arrived at a few tentative postulates concerning empathy and related processes based on some of his experiences and observations. The central theme of these postulates is, firstly, that interpersonal interaction is an interaction of the personal-space fields. Secondly, empathy, therapeutic benefit, and the professional stress are all related to the same process of interpersonal interaction. This interaction takes place as an enmeshment of personal spaces of the interacting individuals, and involves transfer of a wide range of information in the affective, cognitive, and other areas. This is because the personal spaces have fieldlike qualities analogous to what Kurt Lewin described. Thus, such phenomena as empathy, therapeutic benefit, professional stress are all consequences of the same process. It is possible to substantiate these postulates by diverse evidences in the published literature. The natural consequences of such an interpersonal interaction are empathic understanding, transfer of mood states (like hope, distress or expectancy), affective states (like anxiety, sadness, anger or hostility), ideas, images and even attitudes and values, etc. This phenomenon of transfer can explain such processes as therapeutic benefit in individual and group settings, professional stress, shared delusions, and even experimenter bias. Whether one becomes aware of such transferred information or not depends upon the intent and sensitivity of the participants.

The Widening Scope of Shame

Abstract: Where you can find the the widening scope of shame easily? Is it in the book store? On-line book store? are you sure? Keep in mind that you will find the book in this site. This book is very referred for you because it gives not only the experience but also lesson. The lessons are very valuable to serve for you, that's not about who are reading this the widening scope of shame book. It is about this book that will give wellness for all people from many societies.

Rent Two Films and Let’s Talk in the Morning. Using Popular Movies in Psychotherapy

Abstract: JOHN W. HESLEY AND JAN G. HESLEY: Rent Two Films and Let's Talk in the Morning. Using Popular Movies in Psychotherapy. John Wiley and Sons, New York, 1998, 305 pp., ISBN 0-471-17043-7, $34.90. John W Hesley, Ph.D., is a psychologist with a consulting and psychotherapy practice, and his wife Jan G. Hesley, M.S.S.W, is an advanced clinical practitioner who specializes in marriage and family therapy. In this book, they describe their technique of assigning movies to be viewed by their patients (clients) that are then discussed in the course of the therapy. Depending upon the reader's psychotherapy orientation, they will either be outraged or delighted by the authors' strategy. I actually presented this to two of my colleagues. The dynamically oriented therapist, though willing to admit that the idea was interesting, thought that talking about movies in the course of therapy was possibly a form of countertransference that allowed the therapist to avoid doing any real productive work and that any insights derived would be short-lived. The cognitive behaviorally oriented therapist thought that using films was an intriguing idea that could definitely help certain patients. My reaction was mixed. Though I regularly use commercial films as adjunctive aids to enhance my teaching of psychopathology, diagnosis, and psychotherapy to medical students, residents, training directors, and mental health professionals, the idea of assigning patients the viewing of films as part of their treatment seemed a bit unconventional. I guess that I was concerned, as was my dynamically oriented colleague, that the sessions would deteriorate into discussions about the films that, though pleasant, would serve little useful therapeutic purpose. This was my preconceived notion before I progressed beyond the first chapter or two. I am pleased to report that my perspective changed as I read the book. The authors have clearly done their homework in presenting the strategy to what they almost certainly realized would be a varied professional reception. In the first part of the book, they introduce their concept of Video Work and discuss Theory and Applications. They trace its roots to bibliotherapy, i.e., giving reading assignments to patients, and discuss why Video Work is superior to the value that patients would get on their own in terms of self-improvement of using films (or books) without therapy. They supply ample clinical vignettes, from their own clinical practices, of how certain films generated therapeutic change in their patients. They present a rationale for how, and why, Video Work works including: reframing problems (p. 18), providing role models (p. 20), offering hope and encouragement (p. 18), potentiating emotion (p. 22), improving communications (p. 23) and prioritizing values (p. …

Sign-language interpretation in psychotherapy with deaf patients.

Abstract: Sporadic encounters with deaf patients seeking psychotherapy present a challenge to general clinicians outside of specialized services for the deaf. Skills for working with people who do not share one's own language mode and culture are not routinely taught in most training programs, so clinicians may be unprepared when they first encounter a deaf patient. While it would be ideal to be able to match deaf patients with therapists fluent in their preferred language mode, this is often not feasible in smaller centers. Working with a trained professional sign-language interpreter can be a productive alternative, as long as patient, therapist, and interpreter understand and are comfortable with the process. Peer-reviewed literature on sign language interpretation in psychotherapy is sparse, but some practical guidelines can be gleaned from it and supplemented by information provided by the deaf community through the Internet. This paper arose from one psychiatric resident's first experience of psychotherapy working with a sign-language interpreter, and summarizes the literature search that resulted from a quest for understanding of deaf culture and experience, of the unique characteristics of sign language, and of the effects on the therapeutic relationship of the presence of the interpreter.

Lay Analysis: Life Inside the Controversy

Abstract: ROBERT S. WALLERSTEIN: Lay Analysis: Life Inside the Controversy. Hillsdale, NJ: The Analytic Press, 1998, xv+511 pp., $40.00, ISBN 1-56821-363-8. This is a very interesting and unusual book. It contains 455 pages of a chronicle in detail of the evolution of lay analysis in the United States. Wallerstein was at the center of the tremendous controversy and acquaints us with every nuance of the legal and political battles that were involved in finally forcing the American Psychoanalytic Association to accept nonphysicians as complete equals in training and membership. He infuses into the book a good deal of his own personal history, which is not objectionable, because clearly his identity is involved with this controversy, as it should be. There is a special emphasis on his autobiographical material in chapters 4 and 7; it is rather abruptly introduced in chapter 4 without much of an explanation, and this may confuse the reader. The centerpiece of the book revolves around the question of whether the exclusion of psychologists from psychoanalytic training by institutes affiliated with the American Psychoanalytic Association represented an attempt on the part of the medical psychoanalysts to maintain a monopoly over what at that time was a very lucrative profession, or whether it had to do with the whole issue of the identity of the psychoanalyst. Of course the legal case centered around the psychologists' claim that it was indeed a "pocketbook issue," but Wallerstein does not think so. From his point of view the problem arose from a collision between "two counterposed visions of what psychoanalysis is all about" (p. 454), with the balance at this time tipping in the direction recommended by Freud: "Psychoanalysis as a distinct discipline, a psychology with all the interfaces I have stated, rather than in the opposed direction of a therapeutic arm of medicine in a particular area of its domain" (P. 454). This results in a change of identity for psychoanalysts over the course of these events, writes Wallerstein: "It is no longer 'I am a physician who has specialized in psychiatry and, within that, psychoanalysis, as a way of understanding and trying to ameliorate human mental and emotional distress', or that I am in the first instance a physician and secondarily a psychoanalyst. The fundamental shift has been to: 'I am a psychoanalyst, devoted to understanding the human mind psychoanalytically, in all its dimensions and activities, who has come to this endeavor by way of prior training and study in medicine, or in psychology, or in whatever' " (p. 455). Wallerstein implies in his book that this transition is essentially complete, although a substantial proportion of the members of the American Academy of Psychoanalysis, who recently voted against the admission of psychologist -psychoanalysts to that organization, would disagree. What is stunning, as one goes over the intricate details of this controversy documented rather objectively and meticulously, almost obsessively, by Wallerstein, is the astonishing amount of politics and bureaucratic maneuvering that characterizes these psychoanalytic organizations, both medical and psychological. …

Applying Fairbairn's object relations theory to the dynamics of the battered woman.

Abstract: Fairbairn's secular object relations model of the development of the human personality emphasizes the power of the environment to form inner ego structures and the ensuing tragic results for all human infants who are faced with an unnurturing environment. Every act that children take to insure their continuing attachment to a frustrating, yet tantalizing object undermines their developing ego structure. The consequence of severely compromised ego structures is repetition compulsion in adulthood, as illustrated by the battered-woman syndrome. Each of the engorged and unrealistic part-ego structures seeks out external objects to re-enact the original relationship that created them. The consequence of a severely rejecting childhood can be endless abuse or death.

The Jung Cult: Origins of a Charismatic Movement

Abstract: RICHARD NOLL: The Jung Cult: Origins of a Charismatic Movement. Princeton University Press, 1994; Currently available from Free Press Paperbacks, $14.00 ISBN 0-684-83423. RICHARD NOLL: The Aryan Christ. Random House, New York, 1997, $25.95, ISBN 0-679-44945-0. These two volumes are essential reading for anyone interested in understanding Jungian analytic psychology, the history of psychoanalysis, modern concepts of mythology and the new-age religions. Written by a Lecturer in the History of Science at Harvard University, we finally have an exposition that explains where Jung was coming from and what he hoped to achieve. In addition the author provides us with an enlightening view of the intellectual climate that led not only to the development of Jungian ideas, but also to the rise of Nazi ideation, much of which Jung shared. Originally from a Roman Catholic family, his grandfather abandoned this faith to become deeply involved with the Evangelical Protestants and Pietists who played an important role in the development of Volkish self-consciousness or the concept of a German nation-for previously what is now Germany was politically highly fragmented. At the same time, he became deeply involved with the esoteric (illuminati) aspects of Masonry. In addition, the grandfather was rumored to be the illegitimate son of Goethe. The significance of this family history lies in the fact that Carl Jung believed in "ancestor possession" and therefore felt he had incorporated into himself the values and genius of his forebears. At other times, he expressed the opinion that he had himself been Goethe in a previous incarnation, and not only Goethe, but also Meister Eckhart. During his formative years, he was deeply involved in spiritualism, and while he abandoned this during his medical training, he returned to it at a later date with a vengeance. In the Turm (Tower) which Jung built in 1923 at his home on the banks of Lake Zurich, there is an unsettling mural that covers the entire wall of the bedroom. This painting depicts his first spirit guide, Philemon, the "transpersonal entity" whom Jung met in visions-an old man with a long white beard who is a sort of Gnostic-Mithraic guru that lived or lives in timeless space or what Jung called the "Land of the Dead." It was from his discussions with this "spirit guide" that Jung received his most profound insights about the nature of the human psyche, his ideas about the collective unconscious and the notion of archetypes. Aware of the fact that such concepts were unacceptable in the scientific world, he renamed the spirits "complexes," and the spirit world of the mediums, the "unconscious." At the turn of the century, psychopathology was primarily seen to be the result of hereditary degeneration, which explains the emphasis in that era on nosology, and which also created a hopeless attitude resulting in few cures; and, indeed, Jung feared such traits were present in his own family. Jung originally became attracted to Freud's work because he saw in psychoanalysis a way to circumvent or overcome the stigmata of hereditary degeneration in his institutionalized patients, for Freud had shifted the focus from the biological to the psychodynamic. When he finally met with Freud in 1907, he rapidly developed a "religious crush" with erotic overtones. (He had an earlier homosexual experience with a mentor he admired.) At the same time, he saw in psychoanalysis the possibility of a mass movement that would liberate European culture from its ties with Christianity-that, indeed, it would be a religion in its own right. This, combined with Jung's rising interest in the occult and spiritualism, was bound to lead to the break with Freud. By 1909 (the split with Freud occurred in 1913) Jung was developing his ideas about the collective unconscious. Much influenced by Darwinian theory and, especially, by this theory as presented in Europe by Haeckel, he applied the principle of "ontogeny recapitulates phylogeny" to the unconscious. …

Assessment of suitability for psychotherapy. II. Assessment based on basic process goals.

Abstract: Part II of this paper presents an outline for the assessment of suitability for psychotherapy based on the patient's ability to participate in the basic tasks of the therapeutic process and provides a coherent approach to this complex and difficult task. Several factors, such as therapeutic interaction and relational history, influencing the patient's ability to form a productive working relationship can be assessed clinically and are well supported by research. Others, such as motivation and supportive life circumstances, although less supported by research, still appear to be clinically important. Influences on the ability to create a model of the patient's psychopathology, such as introspection, circumscribed focus, and some aspects of the model itself, are supported by limited research but important for some therapies. There is little research on trial interventions, though these remain a crucial assessment dimension for short-term therapies, particularly. Countertransference, although traditionally not viewed as part of assessment, is actually an important tool that has been validated by research.

The Adolescent Journey: Development, Identity Formation, and Psychotherapy

Abstract: MARSHA LEVY-WARREN, PH.D: The Adolescent Journey: Development, Identity Formation, and Psychotherapy. Jason Aronson Inc., Northvale, NJ, and London, 1996, 359 pages, $45.00, ISBN 1-56821-546-0. In The Adolescent Journey, Dr. Levy-Warren provides a useful developmental perspective on three phases of adolescence-the early phase beginning with pubescence, accompanied by beginning separation from the family; a peeroriented middle phase with the focus on sexual-identity establishment; and a late adolescent phase with identity consolidation and the formation of a more mature ego-ideal. The author makes an especially helpful contribution in reviewing both the physiological and psychological changes of adolescence, highlighting in early adolescence the differences between male and female puberty and the assimilation of masturbation experiences. Examples of psychosexual development are presented from literature, such as Jamaica Kincaid's work, as are points from pertinent psychoanalytic theoretical papers, including the work of Hans Loewald. The groundwork of clinical theory as the basis for thoughtful clinical intervention is laid out. In the discussion of middle adolescence, gender consolidation is discussed, and clinical vignettes related to sexual experimentation with peers are presented. The anxiety and urgency of this teen individuation process comes out best in these vignettes. The author's active, clarifying, and educating style in therapy with teens emerges here. In the sections about late adolescence, there is edifying clinical material on a male teenager's struggle to accept his own limitations when forming a healthier ego-ideal. In a chapter on ethnocultural identity, the important role of culture and group affiliation for the late adolescent in furthering both separation and individuation is well explicated. Clinical examples highlight how individuals cope with senses of estrangement or difference from others. Respect for the fact that adolescent development is an uneven process, despite the well-laid-out specificity of phases, is made clear. In the psychotherapy section of the book, the "Adolescent Psychotherapy" chapter gives an overview on the phases of therapy and demonstrates how the therapist connects with the teenager, keeps therapy interesting, observes, shows concern, uses humor, educates, and encourages phase-appropriate growth and development. The next chapter, on subphase considerations with bulimia, seems less compelling, especially when conceptualizations derived from psychoanalytic drive-theory are introduced but not well supported by the clinical material. The heart of the psychotherapy portion of the book is in the presentation of three cases in chapters eight to ten. Interestingly, each case presents a different history of trauma. The author as therapist is particularly adept at appreciating and sensitively working with issues of trauma and loss within a traditional exploratory therapeutic framework. With the early adolescent, Maggie, traumatized by shards of a plate thrown by her mother, a positive transference, with positive identifications with her therapist, is used by Maggie to facilitate disidentification with her mother, and allows her adolescent development to progress. With Kevin, chronologically a middle adolescent, with arrested self-differentiation, progress was more difficult. Kevin had been subjected to multiple moves, physical trauma, had witnessed sex between his mother and stepfather, and had a history of fighting and break-ins. …

The tactical-integration model for the treatment of dissociative identity disorder and allied dissociative disorders.

Abstract: The ebb and flow of the diagnosis of Dissociative Identity Disorder (DID) and other dissociative conditions has led to the evolution of theories and treatment modalities to resolve the fluctuating and ephemerous symptoms of these conditions This paper summarizes the structured cognitive-behavioral-based treatment of dissociative disorders that will foster not only symptom relief but also an integration of the personalities and/or ego states into one mainstream of consciousness This model of DID therapy is called the tactical integration model; it promotes proficiency over posttraumatic and dissociative symptoms, is collaborative and exploratory, and conveys a consistent message of empowerment to the patient

Therapy manuals and the dilemma of dynamically oriented therapists and researchers.

Abstract: The presence of therapy manuals in clinical settings is increasing and the related concepts of adherence and competence are becoming familiar. The benefits of manuals for research and training are ...

Status enhancement: a further path to therapeutic change.

Abstract: Historically, psychotherapists have targeted change efforts primarily on clients' behaviors, beliefs, unconscious conflicts, and patterns of interaction with significant others The present article explores a further, and very powerful, path to change: that of bringing about changes in the client's status

The “Adualistic” Representation of Trauma: On Malignant Internalization

Abstract: This paper suggests that traumatic memories are represented in a way that is qualitatively different from nontraumatic memories. The argument depends upon a concept of self, derived from Hugh lings...

Tradition and Change in Psychoanalysis

Abstract: RoY SCHAFER: Tradition and Change in Psychoanalysis. International Universities Press, Madison, CT, 1997, xvi + 271 pp., $42.50, ISBN 0-8236-6632-8. It is always a pleasure to read and review anything published under Roy Schafer's name. The present collection might have been better entitled "Tradition and Change in Roy Schafer" since it predominantly consists of essays published by him during the last decade or so. All the familiar elements are here to delight Schafer buffs-the easy style, the thoughtful balancing of ideas, the complexity of perspective and, above all, the careful probing of controversial frontiers of analytic exploration. The material is divided into three parts. The first extends Schafer's longstanding and ambivalent debate with Hartmann regarding conceptualizing clinical facts, aspects of gender, and more. The second is more clinical, focusing on humiliation and mortification, "blocked" introjection, enactment and countertransference, and the third offers an extended reflection on issues related to authority, morality, and their reverberations in therapeutic technique. Much of the discussion revolves around familiar themes-the role of narrative as encompassing the range of clinical content and, along the same line, theories as forms of master narratives. One is reminded in this regard of Wittgenstein's approach to language games. There is also the strain of relativism in terms of which narratives, following Spence's now classic distinction between narrative and historical truth, are evaluated more in terms of their coherence and subjective appeal than objective truth. There is also Schafer's more recent assimilation of current Kleinian persuasions, particularly the emphasis on total countertransference. Schafer makes his case on all three counts, as he always has, persuasively. Schafer buffs will find much to savor, but as a skeptical reviewer, I find much to question. The narrative approach is salient and, without question, the analytic endeavor can be meaningfully cast in such terms. And there is no argument that there is no one narration that carries all the weight. But Schafer seems to neglect the narrator behind the narration who should, I would think, claim our primary attention regardless of the narration. Further, I would insist that only that narrative will do that encompasses the patient's experience, the analyst's experience (especially in comprehending the patient) and the relevant and knowable facts. Rather than simple narrative, there is tension between the evolving narrative process of the analysis and some asymptotic endpoint-perhaps never reached or known, but nonetheless relevant. There is a similar tension in the realm of theory-not only between the analyst's theory or theories and the patient's theory (the patient does have a theory), but between the analytic theories themselves. Again, consistent with Schafer's perspective, there is no single theory that encompasses everything-they all have a piece of the action. …

Curiosity: reflections on its nature and functions.

Abstract: This paper attempts to clarify the nature, function and centrality of curiosity in the development of object relations and the consolidation of the self It demonstrates how the primary relationship between the infant and the caregiver influences the development of curiosity, the ability to use it productively for thinking and for building the internal world. Curiosity, in its schizoparanoid forms, is an attempt at freezing states of primary undifferentiatedness. In its more mature forms, it serves as an integrative agent and signifies both the possibility and the need to know, as well as the boundaries of knowledge. It is an essential element in the individual's psychic fabric and counterbalances splitting and projective identification. Hence, in analysis, it is vital to be constantly attentive to all the diverse expressions of curiosity or, conversely, to its absence. In the transference, the analyst, as well as the analytic setting, often become the aims of that curiosity and its containers. By allowing curiosity and surviving it, curiosity is transformed from an expression of destructiveness and disintegrating intrusiveness to a necessary prerequisite for psychological growth, self-discovery and creativity. Several vignettes illustrate the impact of curiosity during therapy. In this paper, we focus on the phenomenon of curiosity and attempt to examine its importance in human development and within the psychoanalytic process. We try to examine the nature and function of curiosity as a universal human phenomenon, and discuss its many faces and functions. We draw from theoretical and clinical material which place curiosity as a major force in the process of linking the self with others and in establishing intrapsychic, external and transitional spaces. Freud (1) viewed curiosity as a derivative of the sexual drive, and its various forms as related to the ego's sublimational activity. We believe that curiosity may also be closely linked with the primary anxieties described by Melanie Klein (2,3), within the concept of the paranoid-schizoid and depressive positions and by Winnicott (4) as "unthinkable anxieties." According to this approach, curiosity is an active interest in one's own internal environment and in that of the other. On the one hand, it may be motivated by attempts to annihilate the differences between self and other and, as a consequence, become invested with persecutory, invasive and paralyzing meanings. On the other, it can assume an organizing and calming function by making an attempt to learn about one's self and about the other through a process of identifying and locating the source of early anxieties and the manner in which both the environment, as well as internal objects, may help the individual to cope with them. Simultaneously, curiosity can be a powerful means to counteract splitting and fragmentation, as it binds internal experience with reality testing. Thus, curiosity is linked with more primitive forms of being where a desperate attempt is often made to annihilate separation between self and object, and to use accumulated knowledge as a means to possess and control the object. In its more mature form, it may facilitate communication, learning from experience, and contribute to the process of anchoring the other in oneself and anchoring the self in the other. The analyst is faced with the difficult task of assessing the nature and function of the patient's various manifestations of curiosity, or its absence. For wherever curiosity, sexual or otherwise, is encountered, we will often pinpoint anxieties linked to annihilation and disintegration side by side with a complementary process of creativity, in which private theories about the self and the other are generated. An examination of curiosity, within transference and outside it, frequently provides essential information about self-development, object relations, symbolization, and creativity. THE ORIGINS OF CURIOSITY In spite of the fact that all patients are curious about their analysts, either manifestly or in secret, surprisingly, little has been written specifically on this subject (5). …