A developmental approach to resistance

Diagnosis, treatment and technical interventions are dependent on a theoretical interpretation of the behavior of a patient. The clinical material presented addresses an initial alternative assessment of resistances, not from a classical theoretical position of opposition to the analytic procedure, the defense of the neurosis and a safeguard against pain and danger, but behavior that expresses a developmental need and deficit in the patient that is expressed in the treatment and relationship to the therapist.     

From delusion to play

Winnicott suggested that delusions are a failed form of play. Using Winnicott's theories of the play space, this paper illustrates through clinical material how the therapist can join a delusion and convert it into an area of play. Discussion includes an analysis of the use of play in working with the transference and countertransference as well as the therapist's resistances to engaging in play.     

Re-Framing and de-Pathologizing Behavior in Therapy for Children Diagnosed with Psychosocial Disorders

The increasing number of children diagnosed with psychosocial disorders reflects a trend toward pathologizing behavior that is unusual, challenging or extreme. Although these behaviors may match items on the symptom lists for various disorders, a therapist must first consider the origin and context of those behaviors for an individual child through a non-pathological lens. This paper proposes a framework for understanding the behavior of difficult children based on core issues rather than diagnostic symptoms: arousal/excitability, range of focus, perfectionism, intensity, interpersonal sensitivity, sensory sensitivity, cognitive/perceptual style, perception of time, reaction style, and affiliation/integrity. Each trait is examined from two perspectives: how it can lead to or be interpreted as a problem, and how a therapist can re-frame the trait and build on it to identify effective interventions. This approach affirms children’s strengths and upholds social work values.Barbara Probst, Adjunct Professor is affiliated with Graduate School of Social Service, Fordham University, NY, USA.Address correspondence to Barbara Probst, MSW, LCSW, Graduate School of Social Service, Fordham University, Neperan Road, Tarrytown, NY 10591, USA; e-mail: barbprobst@aol.com     

Thinking empathically: The video laboratory as an integrative resource

The use of video taped, simulated interviews is an effective means of addressing the dynamics of affect in clinical practice. This mode of training, grounded in ego and self psychological concepts, is instrumental in identifying, understanding and integrating feelings—the goal of which is to help trainees think empathically. The theoretical framework and structure of the laboratory mode are presented; examples of the teaching/learning process are also discussed.     

REVIEWS

Bigner, J. J., & Wetchler, J. L. (Eds.). (2004). Relationship therapy with same-sex couples .
Cling, B. J. (Ed.). (2004). Sexualized violence against women and children: A psychology and law perspective .
Folberg, J., Milne, A., & Salem, P., (Eds.). (2004). Divorce and family mediation: Models, techniques and applications .
Rholes, S. W., & Simpson, J. A. (Eds.). (2004). Adult attachment: Theory, research and clinical implications .
Sperry, L. (Ed.). (2004). Assessment of couples and families: Contemporary and cutting edge strategies .     

Abstracts

Bennett, D., Fox, C, Jowell, T., & Skynner, A. C. R. Toward a family approach in a psychiatric day hospital.
Blechman, E. A., Olson, D. H. L., & Hellman, I. D. Stimulus control over family problem-solving behavior: The family contract game.
Butler, J. F. The toilet training success of parents after reading "Toilet Training in Less Than a Day."
Dell, P. F., & Appelbaum, A. S. Trigenerational enmeshment: Unresolved ties of single-parents to family of origin.
Kalter, N. Children of divorce in an outpatient psychiatric population.
Kelly, J. B., & Wallerstein, J. S. Divorce counseling: A community service for families in the midst of divorce.
Kelly, J. B., & Wallerstein, J. S. Brief interventions with children in divorcing families.
Klein, M. H. Feminist concepts of therapy outcome.
Krell, R., & Miles, J. E. Marital therapy of couples in which the husband is a physician.
Leiber, L., Plumb, M. M., Gerstenzang, M. L., & Holland, J. The communication of affection between cancer patients and their spouses.
Rubenstein, R. Briefing on inner space.
Strean, H. S. The extramarital affair: A psychoanalytic view.
Turkel, A. R. The impact of feminism on the practice of a woman analyst.
Wincze, J. P., Caird, W. K. The effects of systematic desensitization and video desensitization in the treatment of essential sexual dysfunction.
Wyatt, G. E., Strayer, R. G., & Lobitz, W. C. The treatment of sexually dysfunctioning couples of Afro-American descent.     

Treatment of psychogenic seizures in adolescents

This article will review the problem of psychogenic seizures in adolescents and the impact of family therapy and individual therapy on treatment. Why particular individuals are prone to psychogenic seizures, the relationship between psychogenic seizures and family dynamics, and unresolved individual issues will be covered. The article will address a selected case, with a specific clinical paradigm for treatment.     

Assessing clinical progress: A case study of Daryl

In this single case study, the authors conceptually framed their understanding of dissociation and splitting as defensive/adaptive coping mechanisms through which children respond to abusive/neglectful environments and the developmental deficits of abused/neglected children as related to failure in separation/individuation. Case study methodology with a nested experimental research design employed content analysis of process recordings to identify targeted defenses and developmental themes and then to assess therapeutic effectiveness during the first six months of psychodynamic play therapy with Daryl. In-session cliniial progress was assessed through charting changes in defenses and developmental themes, identifying degree of goal achievement, and clinically observing treatment stage progression. Visual analysis of the frequency charts identified a slight cyclical decline in use of splitting and guarding against dissociation and a somewhat uneven increase in the developmental theme of coexistence/integration. While these changes in targeted outcome variables were not statistically significant, the amount of change did exceed the predetermined outcome goals for decreased splitting and increased coexistence but not the goal of decreased guarding against dissociation. Review of the process recordings also identified clear markers of treatment progression through two therapeutic stages in the first six months of long term psychodynamic play therapy and further supported the clinical meaningfulness of the observed changes.