Development from archaic to mature selfobject transferences

Heinz Kohut has contributed a new understanding of altered states as fixations on aspects of early developmental forms of selfobjects. Fixations can occur as a result of inadequate empathic relatedness necessary for the internalization of anxiety relieving functions. Fixations on aspects of archaic forms of the idealized selfobject may take the form of ecstatic, trance-like religious feelings. These altered states provide needed sensations that substitute for missing psychic structure. Understanding the self sustaining function that these altered states provide is crucial to the treatment. The author shares moment to moment steps in the treatment of a highly successful professional who is addicted to heightened sensation states. The development of new editions of the selfobject transferences are followed in the treatment—from primitive idealization to more mature forms of selfobject transferences.Presented at the Third National Clinical Conference of the Committee on Psychoanalysis, National Federation of Societies for Clinical Social Work.     

From psychoanalysis to clinical social work: An evolutionary process

The development of psychoanalytically oriented social work is traced from its beginnings in 1918. The author distinguishes between practitioners who do social work and those who do psychoanalytic therapy. Such therapy is defined as a method which attends to the dialectic interplay between conscious and unconscious forces. Social workers who receive analytic training may facilitate a much needed revival of psychoanalysis as the social enterprise which Freud originally envisioned.Keynote address at the Third National Clinical Conference of the Comittee on Psychoanalysis at New York on November 1, 1990.     

Developing a community-based care system for seriously emotionally disabled children and youth

The needs of emotionally disabled children and their families are not optimally served within traditional mental health service delivery systems. Policies are inadequate, delivery systems are insufficient and underfunded, and supporting research is sparse. As communities begin addressing the needs of the seriously emotionally disabled child and family, planning should address community coordinated services. Such systems, however, are not easily established and maintained in communities accustomed to addressing children's needs in terms of existing fragmented categorical structures. National models exist but care and time are required to adapt critical elements from these models to local need. This article will review the rationale for integrated community-based, case management services for children and adolescents. A case example is offered illustrating issues affecting the development of one community support system.     

Treatment of an acting-out adolescent girl: An interpersonal experience

The current emphasis on psychotherapy as an interpersonal or intersubjective experience is highly relevant to clinical work with adolescents. This paper presentes and discusses the treatment of an acting out adolescent girl from the perspective of the two-person relationship, emphasizing the interaction between the patient's dynamics and the therapist's responses.     

The Impact of Caregiver-Care Recipient Relationship Quality on Family Caregivers of Women With Substance-Use Disorders or Co-Occurring Substance and Mental Disorders

This cross-sectional study utilized a stress-process model to examine the impact of caregivers' (N = 82) perceptions of their relationship quality with a female family member (i.e., care-recipient) with substance-use or co-occurring substance and mental disorders on caregivers' perceived burden. Regression findings indicate that relationship quality impacts both subjective and objective burden. Higher levels of emotional support given to the care recipient by the caregiver predicted lower levels of caregiver displeasure; whereas higher levels of undermining of the care recipient by the caregiver predicted higher levels of caregiver stigma. Higher levels of emotional support received by the caregiver from the care recipient were associated with lower levels of caregiver displeasure and lower objective burden; higher levels of undermining of the caregiver by the care recipient predicted higher objective burden. Implications for practice and service delivery are presented.