The therapist as selfobject

In the treatment of severely disturbed patients in private practice, the author discovered that a shift from a traditional analytic approach to one that utilized self-psychological concepts produced improved success in the outcomes of treatment. These patients included those with narcissistic and borderline pathology in addition to substance abuse. All the patients had histories of one or more previous treatments.     

The Desomatizing Selfobject Transference: Analysis of an Eating Disorder

This article documents the manner in which psychological treatment, with its attentiveness to the vicissitudes of the unfolding selfobject transference, gradually enabled a patient to contain and articulate painful affect states. The patient's passionate relationship with food, strikingly illustrated in the clinical material, including her dreams, endowed eating with the functions of an idealized selfobject. Over the course of treatment, she seemed to traverse a psychic bridge that took her from an isolated reliance on food through a more focal awareness of her body and her feelings, to an investment in, and capacity for, deepened relationships with other people.     

God as Selfobject and the Therapeutic Potential of Divine Failure

Although early psychoanalytic theorists took a disapproving stance towards religious belief, later theorists recognized the critical support that a relationship with God provides the believer. This shift has allowed social workers to continue utilizing psychodynamic theory without taking a condescending attitude towards their clients’ religious beliefs. Kohut’s articulation of selfobject needs that persist throughout adulthood provided a prism through which to understand the support for the underlying structures of the self that a connection with the divine offers. However, Kohut’s identification of God as a selfobject limits itself to only its supportive element. This article explores the potential for psychological growth inherent in a relationship with God. The ability to acknowledge and mentally process divine failure—those moments where for the believer God does not offer sought after support—seem to be the primary catalyst for exercising this potential growth. Clinical examples are provided to demonstrate how a relationship with God can be addressed in a therapeutic context.     

Selfobject functions of the family: Implications for family therapy

The application of Self-Psychology theory to family functioning adds to our models of understanding and intervention in family therapy. This article develops a theory of the family as a supraordinate selfobject and explores diverse clinical applications of the theory. The family as a selfobject matrix enhances the self development of the child by the provision of continuity through the maintenance of proximity over time, and by an enhanced quality and quantity of selfobject responsiveness for the individual. This application of Self Psychology theory has wide implications for family therapy with children in foster care, family therapy with elderly couples coping with dementia in one spouse, and family therapy as a component of treatment with suicidal adolescents.     

The Future of Human Service Information Technology

The immediate future of human services and information technology is examined in terms of their unifying principles and potentials. Effects on human relationships are used as a departure point to forecast changes in professional training and work and changes in the problems people experience. Professional training will incorporate high skill levels in the use and application of information technology. Changes in professional work may include more home based work and more automation of professional tasks. Changes in the problems people experience are addressed in four areas: (1) near consequences of life in an intellect intensive society; (2) human services subject to dramatic improvement; (3) information technology as a "male" technology; and (4) the growth in social support networks. Suggestions are made to explore the conjunction of human service work and information technology.     

Deconstructing Reparative Therapy: An Examination of the Processes Involved When Attempting to Change Sexual Orientation

Reparative therapy is a process through which reparative therapists believe they can and should make heterosexuals out of homosexuals. At the present time, most professional regulating bodies have banned the use of reparative therapy. In addition, reparative therapy is not supported by any reliable quantitative or qualitative studies. In spite of the lack of empirical substantiation, reparative therapists continue to practice, arguing that prior quantitative studies, as well as client self-determination, validate their methods. With a knowledge base originally grounded in psychoanalytic theory, current applications of reparative therapy cross not only scientific and psychological, but also social, political, and religious boundaries. The current trend promoting reparative therapy occurs through the conglomeration of the social, political, and religious dimensions of organizations that champion the cause of creating former homosexuals. Persons who identify as former homosexuals espouse the saving graces of a mixture of reparative therapy with various forms of religious counseling, on occasion offered by faith-based providers. The purpose of this paper is shed new light on the process and theory behind reparative therapy. This paper will attempt to provide social work clinicians with the knowledge necessary to understand and formulate an informed opinion about the use of reparative therapy for homosexuality.     

The privileged position of religion in the clinical dialogue

The paper reviews the history of the relationship between the fields of depth psychology and religion and then offers three approaches to understanding religious material in the clinical setting: the metaphorical, the functional and the foundational. Clinical vignettes are offered for illustrative purposes.     

The Role of Coercion in Affecting Women's Inferior Outcomes in Divorce

An investigation was conducted by the author into concessions of rightful property, child support and maintenance awards from ex-spouses under pressures from emotional blackmail of coercion. Information was obtained from legal and sociological literature, divorce records in Hennepin County, Minnesota, along with informal interviews with one attorney and eight divorced women. Spousal attempts at coercion during divorce negotiations may influence some women to make stipulations, agreements honored by this court, to less child support, property and/or maintenance than suggesteed guidelines or if they were to litigate those matters through the court system. This has economic, theoretical, therapeutic and research implications.     

Therapeutic Musings: The Models Which Contribute to My Practice

The author attempts to discern themes underlying his clinical practice. Although his approach is somewhat behaviourist in orientation, it is hoped that the 12 themes (or organising principles) can be compared and contrasted with those arising from other approaches to child, adolescent, and family work. The author invites readers to analyse the way they have pieced together a composite approach from a range of sources.     

A self psychological study of dehumanization in Eugene O'Neill'sThe Hairy Ape

Experiences of isolation, alienation, and self-fragmentation have been expressed by literary artists throughout this century. Many of the plays of Eugene O'Neill depict human suffering in these terms. Applying the constructs of self psychology, particularly those relating to selfobjects and the selfobject milieu, these experiences in O'Neill's plays can be described as shifts in self-cohesiveness. O'Neill'sThe Hairy Ape depicts a man with a fragile sense of self who suffers a disruption of the selfobject milieu which had sustained him. As a consequence of this change in his social embeddedness, the character Yank experiences a sense of fragmentation and ultimately feels that he does not belong to the human race. The play depicts in a powerful way the necessity of a selfobject milieu in sustaining one's sense of self.     

Therapy of the Conscience: Technical Recommendations for Working on the Harsh Superego of the Patient

An indispensable goal of intensive psychotherapy is to modify areas of the superego which are unreasonably harsh and punitive—yet, surprisingly little is written on this topic. In this paper, after discussing various aspects of the superego, I recommend an active treatment technique which involves educating the patient, over time, about how pervasive and punitive is—for lack of a better word—the conscience—of his or her mind. During this process, one can expect a softening and lessening of the patient's punitive superego and an expansion of the patient's benign or benevolent superego, as the patient begins to identify with and introject more of the compassionate attitudes which have been imparted and experienced in the intimate relationship of psychotherapy.     

Toward a More Optimal Selfobject Milieu: Family Psychotherapy from the Perspective of Self Psychology

This paper applies the theory of self psychology to the understanding and treatment of families. The healthy family is viewed as a reliable source of selfobject experience for its members, while problems in or between family members are seen as due to a lack of adequate selfobject experience for one or more members. Causes of selfobject failures or misattunements in the family are examined, with an emphasis on the influence of previous relational experiences on current needs, capacities, and experiences of others. Curative factors in this form of family therapy are then outlined, and a treatment approach designed to help family members become better able to provide empathically attuned responses to each other is described, with a case example used to illustrate key points.     

Identity Concerns in Intercountry Adoption-Immigrants as Adoptive Parents

The psycho-social sense of identity, which is an important component of the sense of self, emerges during childhood and adolescence but is a lifelong process. In intercountry adopted children, additional layers are added to the initial difference of being adopted—in outward appearance and in cultural heritage—that do not match those of the adoptive parents. These may interfere with empathic bonding and with the integration of facets of identity into a meaningful narrative. The article addresses a particular subgroup of adoptive parents—those who have immigrated to Israel in their recent or remote past. Using the framework of self psychology, it suggests ways of helping immigrant adoptive parents to create an empathic affect-bridge with their children, who immigrate to a new family as well as to a new country, by tapping their own experiences as immigrants.     

Toward an Integrated Understanding of Dreams

In this paper four different schools of dream analysis—classical, object relations, modern psychoanalytic, and self-psychological—are described, compared, and contrasted. Each approach is then applied to an analysis of the first dream reported by a patient. As each interpretations is accurate and useful in understanding this patient's psyche, it is concluded that an integrated framework should be used in dream analysis.     

The Money Taboo: Its Effects in Everyday Life and in the Practice of Psychotherapy

A cultural taboo regarding discussion of money affects psychotherapists as well as the lay public. As a result, the psychological literature regarding money is sparse while issues relating to money are seldom addressed in our training, our self analyses, or the treatment of our patients. This article cites some of the literature that does exist, discusses the reasons for and effects of the money taboo, provides a psychological definition of money, and offers some case material that should help to focus thinking about money through the lens of psychodynamic, object relations, and self psychological theories.     

The Relevance of Psychoanalytic Ideas to Crisis Work

The therapeutic aim of crisis work typically has been to help the patient regain a pre-morbid state of functioning with an almost exclusive focus on the amelioration of immediate symptomatology. Drawing on our experience in a crisis team of a major metropolitan hospital with a large Hispanic and African-American population, we contend that crisis work ought not to focus myopically on symptom removal and must include, to the highest degree possible, an exploration of the multiple meanings contained in what is possibly a turning point in the patient's life. Toward this aim, we describe three psychoanalytic principles believed to be particularly relevant to crisis work that have, nonetheless, traditionally been deemed inappropriate for this treatment modality. These principles are historicity, neutrality, and fantasy. Discussion of the principles are presented within the context of case material.     

世界科技创新趋势与启示

现阶段"现代化进程强大的客观需求"和"知识技术体系的内在矛盾"正孕育着新一轮科技革命,世界正处在第六次科技革命的前夜。200多年的工业化进程催生出一系列问题。经济发展的客观需求迫切需要开发新的资源能源,创新发展模式和发展途径,创建新的生产方式和生活方式。"基础科学领域""能源和资源域""信息网络领域""先进材料和制造领域""农业领域""人口健康领域"这六个方面孕育着重大的创新突破。科学问题的重大突破和技术的变革将深刻影响人类的生产和生活方式,影响社会发展的进程,影响国家的国际竞争地位。把握新一轮科技革命的战略机遇,将大幅提升我国自主创新与规模产业化的能力。     

Incremental Change: The Pace of Progress in Health

Abstract

In a prospective study of acute diarrheal illness among college students, during one academic year, the incidence of Campylobacter enteritis was 5.57 per 1,000. Approximately 17% of all patients with acute diarrheal illness had Campylobacter enteritis. Campylobacter enteritis is briefly discussed. The value of the stool wet-mount examination is emphasized. It can serve as a guide to which stools to culture and often can lead to a presumptive diagnosis of Campylobacter enteritis. Student health center labs are urged to perform stool wet-mount exams and to provide cultures for isolating the Campylobacter organism.