A Neuropsychoanalytic Approach to Case Studies

Neuropsychoanalysis is an interdisciplinary field that attempts to generate links between psychoanalytic schools and the neurosciences. Historically speaking, neuropsychoanalysis emerged as a response to ‘cognitive’ views of the mind/brain problem, which tended to neglect the influence of emotional and instinctual processes in the constitution, and functioning, of the human mind. Since its origins, neuropsychoanalysis has used case studies, of brain injured individuals undergoing psychoanalytic treatment, to explore how focal damage to specific brain areas is related to changes in non-cognitive domains of the mind, such as emotion, motivation or personality. This approach is a useful contribution to the neurosciences since it allows observing, at the same time, objective and subjective aspects of the mind/brain, thus bridging third and first person methodologies. In this article a neuropsychoanalytic approach to case studies is introduced, describing both its historical roots as well as its present status. Then, a brief case study, of a man with focal damage to the left dorso-lateral prefrontal cortex, who presented with changes in his capacity to intrinsically regulate feelings, is used to exemplify this approach.     

A Counseling Plan for Randall

The “Case of Randall” illustrates many common issues that underlie the provision of career counseling to individuals with brain injury. Often, brain-injured individuals experience a diminished capacity to perform work-related functions, and require anywhere from 6 months to 5 years of rehabilitation before they are ready for job placement. As Kay, Ezrachi, and Cavallo (1986) have noted, the rate of return to work among brain-injured individuals is between 25% and 75%. Hence, the length of rehabilitation time required by Randall is not unusual. As is true with Randall, many individuals who have suffered brain injury have difficulty adjusting to changes in their cognitive and physical functioning. Frequently, these individuals experience anger and frustration, and have difficulty accepting and understanding their newfound limitations.     

Sullivan's Approach to Inner Psychotic Experiences: A Case Illustration

Harry Stack Sullivan's concept of interpersonal psychiatry has been recognized as a landmark in the American psychoanalytic movement, in particular his influence on the development of object-relations theory. He is an influential figure in interpreting the inner experiences of persons with schizophrenia. Psychotic experiences represent a failure of one's self-system and the dissociation dynamism. Delusions and hallucinations are experiences in lost control of self-awareness. The person regresses to dreams or experiences from infancy and childhood in facing spontaneous conflicts and anxiety in interpersonal transaction. As a result, the tripartite self-system is fractured. In this paper, the writer applies Sullivan's concept in interpreting the inner psychotic experiences of a client with schizophrenia. Its implication for clinical social work practice is also discussed.     

A Case Study Approach to Reducing the Risks of Child Sexual Exploitation (CSE)

ABSTRACT

The risk of child sexual exploitation is a growing concern, both within community and child care settings. Within community services working with vulnerable young people, the risks of exploitation are pervasive and present a constant management problem for professionals. This makes the need for focused educational interventions within such settings all the more vital. This case study aims to describe the assessment, formulation, intervention, and outcomes of a young female considered to be at risk of sexual exploitation. It was hypothesised that, after completion of a psychoeducational group designed to enhance knowledge and skills around child sexual exploitation, positive outcomes would be seen in psychometric assessment, risk-taking behavior, and risk awareness. Results demonstrated no clinically significant change for measures of impulsivity, resourcefulness, or self-reported difficulties. A significant increase was seen for self-reported self-esteem, and all outcomes revealed a positive direction of change. Observational accounts of behavioral and attitudinal change produced more positive results, revealing an increase in prosocial behaviors and a reduction in risk-taking behaviors. Outcomes are discussed in relation to the individual’s history and the residential care environment. Implications for future research and practice are outlined, and the study limitations are considered.     

Nursing-Home Resident Quality of Life: A Longitudinal Case Study Approach

Longitudinal quality-of-life (QOL) research incorporating multiple perspectives can add to knowledge about how nursing home residents experience QOL, but these methods are seldom used. This study employed interviews and participant observation to conduct multiple-perspective, longitudinal case studies of six residents. Close, reciprocal relationships with staff members, staff knowledge of residents, and autonomy were fundamental to QOL. Autonomy was experienced through choice and self-advocacy. Changes in QOL over time related to changes in resident health status, acclimation to the setting and family member availability. Study results may have implications for staffing and staff training.     

A Blumerian Approach to Storytelling

Blumer's work on life histories and symbolic interactionism represents an important contribution in the twenty-first century. I join his work with research on storytelling to build a Blumerian approach to storytelling. This approach holds that social actors use stories to construct subjective meanings, stories exist in some social context, stories are told or written for some audience, a wide range of social processes produce stories, the temporal sequence of storytelling audiences is important, social actors use interactional techniques of showing story preferences, and symbolic structures and narrative linkages are the resources social actors use to compose stories. Future research can continue to develop this approach.     

A Narrative Approach to Groups

This paper considers the ways that narratives can be used in groups to create meaning, organize the past, explain the present and consider alternatives for the future. Narratives are formats for self-creation; they can also be used to provide support or education, promote self-understanding and interpersonal effectiveness. Already familiar in self-help groups and reminiscence groups for the elderly, narrative approaches can be useful in many other formats. In this paper I discuss ways of eliciting narratives, understanding their meaning from many perspectives and using them to promote growth and healing in groups. The group leader's role is reconfigured into that of participant observer and manager of the group process. It is up to the leader to provide a context in which multiple accounts can emerge for consideration.     

A Cultural-Historical Approach to Closing the Achievement Gap

This article explores Vygtosky's (1978) notion of the imaginary situation through analysis of interaction and activity in a Fifth Dimension after-school setting, one of a network of programs designed with an aim to realize developmental concepts proposed by Vygotsky and others in the cultural-historical tradition (see, e.g., Cole &; the Distributed Literacy Consortium, 2006). The discussion centers on intergenerational interaction between a child and undergraduate as they engage in activities that represent two varieties of the imaginary situation proposed by Vygotsky: Playing a game and orienting to the “mythical figurehead,” a fantasy figure common to all Fifth Dimension sites. Analysis focuses on the interplay of spoken interaction with literacy-based artifacts that mediate the participants' activity and serve as points of departure for imagination-related talk. As the interaction unfolds, child and undergraduate are seen to engage creatively with both game and site rules as they create a collaborative and increasingly complex representation of the mythical figurehead. The participants' engagement with rules, a crucial element in Vygotsky's notion of the imaginary situation, provides the child with multiple opportunities, together with those prompted by the site artifacts, to affect and negotiate the Fifth Dimension experience.     

A Comprehensive Approach to the Treatment of Gender Dysphoria

After a brief historical review of the clinical management of gender dysphoria, the authors argue for a comprehensive treatment model that recognizes a wide spectrum of gender identity disorders. This treatment model explores the meaning of a gender dysphoric individual's desire for sex reassignment in the context of the individual's biography and psychosociosexual adjustment. Unlike previous treatment approaches, this model makes no attempt to identify the 'true' transsexual. The model's treatment tasks are: assessment, management of comorbid psychiatric disorders, facilitation of identity formation, sexual identity management, and aftercare. The implications of this treatment model for classification and ethical standards of care are discussed.     

Assessing Competency in A Specialized Program

This paper discusses the results of fusing different social work education trends in planning a relevant curriculum. These trends include a focus on practice-specific competencies, specialization of graduate programs, and the emerging role of students as consumers and evaluators of their educational experiences. Recommendations for designing processes of evaluation are offered.     

A Regional Multiplier Approach to Estimating the Impact of Cash Transfers on the Market: The Case of Cash Transfers in Rural Malawi

This article analyses the impact on the local economy of an emergency cash–transfer programme in rural Malawi. The results are of interest, given the growing use of cash transfers as development aid as well as the increasing popularity of such transfers as a form of social protection across sub–Saharan Africa. It uses a form of social accounting matrix to show that there are widespread benefits for the regional economy as a whole (with multiplier estimates of 2.02 to 2.45), especially during the most ‘lean’ periods of the year, and for small farmers and small businesses in particular, as this is where poorer households' purchases are focused; education and health also benefit.     

A Holistic Approach to the Treatment of the Crisis of Infertility

The purpose of this paper is to discuss the importance of assessing the impact of infertility on couples/individuals and understanding the relevance of the impact in the context of psychological treatment. The assumption is that infertility can have a significant negative impact which can at least be minimized by therapeutic intervention. Three psychological-behavioral categories are posited as the result of several years work with infertile individuals/couples. Detailed case presentations of couples in each category are given so that the total impact of the crisis of infertility and the role of psychological intervention can best be understood.     

A New Approach to Jewish Divorce

The traditional Jewish law of divorce, which permits a husband to divorce his wife, but does not sanction the wife's divorcing him, has created hardship for Jewish women for centuries. In view of the new attitudes toward the equality of women, the rabbis of the Reconstructionist Movement in Judaism have innovated an egalitarian "get" (divorce), a bold effort to prevent Jewish women from becoming agunot (abandoned wives.) By means of the new type of divorce, the Jewish woman takes the initiative and divorces the husband.     

A Systems Approach to Marital Process

An event of marital communication and negotiation is conceived as a cybernetic system composed of many parts and stages, following the framework of general systems theory. Couple communication is presented as a feedback loop based on the congruent transmission and effective reception of personal and interpersonal information. Couple negotiation is viewed as a system in development. Connections between component subsystems are mapped along with the pathways of progression from one stage to the next. No subsystem is taken as final but is constantly reworked in relation to the system as a whole. Implications for counseling, education, and research are suggested.     

A New Approach to Religious Commitment

Abstract

The authors propose a new framework for studying religious commitment. Commitment is viewed as a general social process which occurs in various aspects of life (e.g., marriage, work, politics, and religion). It consists of subjective and behavioral components. Religious commitment is defined as the interaction between people's religious consciousness and religious participation. Other religious beliefs, feelings, and intellectual inclinations are considered to be parts of people's religious orientations, not aspects of commitment as other approaches have suggested. Data from members of six Christian denominations are used to explore this conceptualization and the relationships among these variables. Some determinants and consequences of commitment also are considered. The evidence yields several propositions regarding factors that affect commitment and the effects of religion on people's attitudes and behaviors. The paper's implications for future research on religious commitment in particular and commitment in general also are discussed.