Focal psychotherapy and self pathology: A clinical illustration

This paper examines the concept of “focal psychotherapy” as a form of psychoanalytic psychotherapy utilizing essentially the same conceptualization of the therapeutic process as long-term psychotherapy or psychoanalysis, mainly that the primary interventions are interpretive. Since in this treatment process a narrower sector of the psychopathology is reactivated than in long-term psychotherapy, the psychotherapy is restricted to the exploration and working through of a focal conflict precipitated by a recent event which has overwhelmed the patient's characterological defense mechanisms. The case report illustrates the applicability of focal psychotherapy to patients whose core pathology is understood to consist of deficits in the structure of the self rather than structural conflict.     

Returning to psychotherapy with the same therapist: A self psychological perspective

Terminations or interruptions of psychotherapy which have been followed by a patient's resuming therapy with the same therapist at a later time have often been viewed as premature with the implication that the initial therapy has been inadequate or deficient. This paper suggests, however, that a patient returns to the same therapist because the selfobject bond established in the initial treatment is still intact, and that the hiatus between treatments can be a time of further development and strengthening of self structure. Two clinical cases are described which illustrate these ideas.     

The empathic use of sarcasm: Humor in psychotherapy from a self psychological perspective

A case is made for the therapeutic benefits of well-timed, prudently ventured sarcastic comments directed at persons in the patients'llives, including the therapist, who are experienced as failing them. Literature on use of humor in therapy is reviewed. The circumstances under which humor may be experienced empathically are suggested, as well as instances in which it may be contraindicated.     

The capacity to parent: A self psychological approach to parent—child psychotherapy

Clinicians who work with dysfunctional parent-child relationships face the dilemma of evaluating and effectively treating the psychopathology of parenting, which is often elusive and difficult to extrapolate from behavioral reports or social statistics alone. Fundamental concepts of the self psychological theory of development, particularly empathy and the self-selfobject matrix, are especially useful for elucidating the complexities of parenting because they explain the psychological components of the interaction as well as its intrapsychic significance. These concepts will be applied to the process of parent-child psychotherapy. A case is presented to illustrate the explanatory advantages of a self psychological conceptualization.This work was conducted while both authors were employed as CoDirectors, Infant Development Project at the Juvenile Protective Association, Chicago, Illinois.The Infant Development Project is funded by a grant from the Kate Maremont foundation, Chicago, Illinois.     

Cultural issues in disclosures of child sexual abuse

Cultural norms affect the likelihood that child sexual abuse will be discovered by an adult or disclosed by a child. Cultural norms also affect whether abused children's families will report child sexual abuse to authorities. This article explores the ways ethnic and religious culture affect child sexual abuse disclosure and reporting, both in the United States and internationally. Guidelines for culturally sensitive child abuse interviewing are provided to facilitate disclosures of abuse from culturally diverse children in formal settings.     

Coming out: Lesbians' disclosures to parents

This research explores homosexual coming out as an interpersonal process involving disclosure of a deviant identity to selected audiences. More specifically, this paper focuses on disclosure of a lesbian identity to parents. Based on in-depth interviews with 53 self-identified homosexual women, the factors which are most strongly associated with disclosure to parents are self-perception of the possession of stereotypical lesbian characteristics and level of education for both respondents and parents. Future researchers should focus on the temporal ordering of variables associated with the disclosure of a deviant identity and should also examine risk-lessening factors in other areas of lesbians' lives, such as the workplace and within heterosexual friendship networks.     

Gender and dependency in psychotherapy

Abstract

Gender is central to our understanding of ourselves, our actions in the world, how we feel about ourselves and others, what we conceive of as being possible for ourselves, even what we believe it is likely or possible for us to feel, and how we describe what we feel. and yet its importance is something we take for granted without examination. Like the force of gravity, we live with the effects of gender without retaining much conscious awareness of how it constantly affects the way we live our lives.

In this paper I focus on the importance of incorporating into our work as psychotherapists a consciousness of how gender acquired in the early mother-child relationship constructs aspects of a girl's psychic structure. The current construction of femininity means that girls and women are highly defended against their desires desire for dependency and desire to initiate. This phenomena has implications for treatment.     

Redirecting blaming in marital psychotherapy

This paper will address the methods utilized in encouraging the redirection of blaming in marital therapy. In this author's view, significant and lasting changes in marital interaction require that each spouse address his or her individual contributions to the conflictual relationship. Case material will be presented which illustrates the couple's shift from nonproductive blaming to greater self-understanding as the therapist orchestrates the shift from externalization to self-exploration.     

Neurocognitive differences,self cohesion,and incoherent self narratives

This paper attempts to develop a framework through which the concepts of neurocognitive delays or deficits (generally referred to as learning disabilities) may be integrated into psychodynamic theory. The impact of these delays or deficits on the developmental dialogue is discussed. The child who suffers from such delays or deficits experiences the world in a unique way forming representations that encode personal meanings. These meanings are integrated into self narratives that have elements of incoherence in them. The incoherences in the self narratives result in the absence of self cohesion.Faculty, Continuing Education and Certificate Program, Smith College School for Social Work; in private practice.     

Social reactions to child sexual abuse disclosures: a critical review

Recent studies have examined disclosure of child sexual abuse to determine the correlates and consequences of telling others about this form of victimization. The present article reviews the current empirical literature on disclosure and reactions to adult survivors to assess what is known about the process of disclosure and whether telling others is therapeutic and leads to positive outcomes. Most studies assessing social reactions in detail have concerned adult survivors retrospectively reporting on their disclosures of child sexual abuse. Few empirical studies have been conducted in this area but research suggests that few victims tell anyone about child sexual abuse as children, and that the type of reactions to disclosure vary according to when disclosure occurs (childhood or adulthood), the extent and nature of the disclosure, and the person to whom one discloses. Clear evidence shows that negative social reactions are harmful to survivors' well-being, but better assessment of specific reactions and their effects are needed in theoretically-based studies to evaluate how these responses affect survivors' recovery in the context of other variables. Suggestions for future research on social reactions of others to adult survivors disclosing child sexual abuse are presented.     

Feminist social movements and whistleblowing disclosures: Ireland's Women of Honour

Feminist social movements based on workers disclosing sexual harassment and sexual violence have had a dramatic impact on workplaces worldwide. But what are the specific dynamics shaping organizations founded on acts of disclosure? Organizational whistleblowing research has overlooked this topic, while literature on feminist social movements has not, to date, focused on whistleblowing disclosure as a shared experience prompting collective action. In this article I address these lacunae. I isolate disclosure-based feminist movements (DFMs) as a specific, and important, organizational form, and I draw on relevant insights from whistleblowing theory to shed light on the dynamics therein. I find that first, DFMs are founded on a distinct kind of whistleblowing where members speak out about personally-experienced embodied violence. Second, movements are galvanized through affective connections formed through the sharing of such experiences, and third, the perceived credibility of individual disclosures are uniquely enhanced through the salience emerging from collective speaking. Extant whistleblowing theory—and literature on feminist social movements—fails to account for organizations based upon embodied and collective experiences of disclosure. In this article a novel theoretical framing based on feminist theory is developed, emphasizing embodied, affective forms of parrhesia involving collective salience that counters whistleblower reprisal. Ideas are illustrated throughout with insights from an exemplar case within the worldwide military #MeToo movement: Ireland's Women of Honour. Contributions for scholarship on feminist social movements and organizational whistleblowing conclude the article alongside insights for practice.     

Touch: its use in psychotherapy

The use of touch as a therapeutic intervention is a matter of controversy. While the literature reflects the healing potential of touch, it also identifies concern that touch can be harmful to our clients. This article reports the results of an exploratory research project on how social work therapists are touching their clients, as well as their reasons for using touch or not using touch. The results of the study show that the therapists sampled use touch with their clients, but have received little education, training or supervision on the use of touch. The authors encourage further dialogue and research about this potentially powerful but complex intervention.     

Self-regulation of distance in supportive psychotherapy

The authors present the case of a schizophrenic man treated in the setting of a supportive care clinic. The course of treatment from beginning to termination is illustrated by treatment vignettes and by excerpts from the patient's letters to the therapists. Case discussion centers around the handling of the classic schizophrenic conflict over intimacy versus isolation. The authors stress that the therapists must be acutely sensitive to the patient's need and ability to regulate his or her own emotional and therapeutic distance over the course of treatment. They make a case for utilizing this conceptual framework in the treatment of chronic psychiatric patients in supportive clinic settings.     

Human immunodeficiency virus (HIV) testing and false disclosures in heterosexual college students

The authors assessed factors that motivate individuals to report negative human immunodeficiency virus (HIV) antibody test results, although they had never been tested. In particular, they investigated sexual intimacy motives associated with the needs for affiliation, sex, and dominance as contributing factors for faulty disclosures. Participants were 246 sexually active heterosexual students. Overall, 21% of the sample had been tested for HIV, and most individuals disclosed their results to intimate partners. Of the entire sample, 5% had previously told an intimate sexual partner they were HIV-negative, although they had not been tested. HIV testing and perceptions of partner deceptions with reference to primary prevention efforts and applications are explored.     

The effects of interviewer race and child race on sexual abuse disclosures in forensic interviews

This study examined the impact of interviewer race and child race on disclosures by alleged child sexual abuse victims during forensic interviews. Despite findings that supportiveness of caretaker, gender of interviewer, gender of child, and age of child affect disclosure, previous studies have failed to examine race as a variable impacting disclosure in a real-world setting. The study examined 220 cases from an archive of reports generated from forensic interviews in an urban setting. The reports were reviewed and coded for degree of disclosure, focusing on African American and Caucasian children and interviewers. The results indicate that child race and the interaction of child race and interviewer race reliably distinguished between no disclosure, tentative disclosure, and disclosure with detailed account of activity, while interviewer race alone failed to serve as a significant predictor. The interaction between child race and interviewer race was not in the predicted direction, with cross-race dyads disclosing more than same-race dyads. Results are discussed in the context of real-world applications versus the previous analogue child sexual abuse literature.