La GAC 1 : grille d’analyse du contre-transfert dans le traitement des troubles graves de la personnalité

Cet article met en relief le rôle central des réactions contre-transférentielles dans le traitement de patients limites selon l’approche focalisée sur le transfert de Otto F. Kernberg (TFP : Transference Focused Psychotherapy). Une grille d’analyse du contre-transfert (GAC) est présentée pour décrire la diversité des activités mentales dans lesquelles le thérapeute s’engage pour comprendre et parvenir à utiliser les réactions que déclenchent en lui ces patients. Un exemple clinique est présenté pour démontrer l’utilité de la GAC dans le travail des réactions contre-transférentielles évoquées par une patiente présentant un trouble limite de la personnalité. Certaines données de recherche viennent appuyer l’importance du travail des réactions contre-transférentielles.This paper introduces the central role of countertransference reactions in the treatment of borderline patients in transference focused psychotherapy developed by Otto F. Kernberg. The Countertransference Rating System is presented to illustrate the diversity of the therapist’s mental activities involved in his attempts to process and use reactions call to mind by borderline patient. A clinical example is presented as such as empirical evidence in support of the usefulness of the CRS and of the importance of processing countertransference reactions.Este artículo pone de relieve el papel central de las reacciones contratransferenciales en el tratamiento de pacientes límite, según el enfoque focalizado sobre la transferencia de Otto F. Kernberg (TFP : Transference Focused Psychotherapy). Se presenta un cuadro de análisis de la contratransferencia (GAC) para describir la diversidad de las actividades mentales con las que el terapeuta se compromete para comprender y lograr utilizar las reacciones que provocan en él estos pacientes. Se presenta un ejemplo clínico para demostrar la utilidad del GAC en el trabajo de las reacciones contratransferenciales evocadas por una paciente que presenta un trastorno de personalidad límite. Algunos datos de la investigación apoyan la importancia del trabajo de las reacciones contratransferenciales.Este artigo coloca em evidência o papel central das reações de contra-transferência no tratamento de pacientes borderline, segundo a abordagem focada na transferência de Otto F. Kernberg (TFP: Transference Focused Psychotherapy). É apresentado um sistema de análise da contra-transferência (grille d’analyse du contre-transfert - GAC) para descrever a diversidade das atividades mentais nas quais o terapeuta se introduz para compreender e chegar a utilizar as reações que estes pacientes suscitam nele. Um exemplo clínico é apresentado para demonstrar a utilidade da GAC no trabalho das reações de contra-transferência evocadas por uma paciente que apresenta um transtorno de personalidade borderline. Alguns dados de pesquisa vêm apoiar a importância do trabalho destas reações de contra-transferência

La psychothérapie focalisée sur le transfert (TFP) et le fonctionnement réflexif 1

Le fonctionnement réflexif (FR) est un concept relativement nouveau et renvoie à la capacité d’un individu d’interpréter les comportements humains et les réactions interpersonnelles en termes d’intentions sous-jacentes et d’états mentaux. Il est particulièrement important dans le processus de régulation des affects et de la gestion des relations interpersonnelles difficiles. Comparativement à la thérapie comportementale dialectique (DBT) et les thérapies de soutien, la thérapie focalisée sur le transfert (TFP) a l’unique avantage de produire des changements au niveau du FR des patients limites. Dans le présent article, nous adoptons une perspective développementale pour expliquer les changements au niveau du FR induit par la TFP. Nous proposons un certain nombre de mécanismes d’action thérapeutiques par lesquels la TFP agirait chez des patients limites et plus particulièrement dans l’interprétation du transfert..Reflective functioning is a relatively new concept which broadly speaking, refers to the capacity to interpret human behaviours and interpersonal reactions in terms of underlying intentions and mental state motivations. This capacity is particularly important in the regulation of affects and the management of challenging interpersonal relations. In comparison to dialectical behavioural therapy (DBT) and supportive therapies, transference focused psychotherapy (TFP) has been shown to have unique advantages in terms of producing improvements in RF of borderline patients. In the present article, we propose a developmental perspective for understanding how TFP produces these changes in RF. Using this perspective, we identify a number of therapeutic mechanisms through which TFP facilitate the development of RF and specifically transference interpretations.El funcionamiento reflexivo (FR) es un concepto relativamente nuevo y se refiere a la capacidad de un individuo de interpretar los comportamientos humanos y las reacciones interpersonales en términos de las intenciones subyacentes y los estados mentales. Es particularmente importante en el proceso de regulación de los afectos y la gestión de las relaciones interpersonales difíciles. Comparativamente a la terapia comportamental dialéctica (DBT) y las terapias de apoyo, la terapia centrada en la transferencia (TFP) tiene la única ventaja de producir los cambios a nivel del FR de los pacientes límite. En este artículo, adoptamos una perspectiva de desarrollo para explicar los cambios a nivel del FR inducido por la TFP. Proponemos un cierto número de mecanismos de acción terapéutica por medio de los cuales la TFP actuaría en los pacientes límite.O funcionamento reflexivo (FR) é um conceito relativamente novo e refere-se à capacidade de um indivíduo de interpretar os comportamentos humanos e as reações interpessoais em termos de intenções subjacentes e estados mentais. Ele é particularmente importante no processo de regulação dos afetos e da gestão das relações interpessoais difíceis. Em comparação à terapia comportamental dialética (DBT) e as terapias de apoio, a terapia focada na transferência (TFP) tem a única vantagem de produzir mudanças ao nível do FR dos pacientes borderline. No presente artigo, adotamos uma perspectiva do desenvolvimento para explicar as mudanças ao nível do FR induzido pela TFP. Propomos um certo número de mecanismos de ação terapêutica pelos quais a TFP agiria nos pacientes borderline

Lesbianism : a post-structural/post-modernist critique of selected theories relevant to clinical practice

Bibliography: leaves 41-46.This paper aims to provide a critical framework from which to review the major trends in psychiatry and psychoanalysis pertaining to lesbianism and relevant to clinical practice. The post-structuralist/post-modernist framework employed considers lesbianism as a category constructed in a particular socio-historical context and involving particular power relations. The role of psychiatry and psychoanalysis in this process of categorisation and the production and reproduction of lesbianism as pathology relative to a heterosexual norm will also be examined. On the other hand, challenges to the lesbianism as pathology thesis, drawing on more radical psychoanalytic concepts, influencing and also influenced by post-structuralist/post-modernist theories will be discussed. Various suggestions flowing from a post-structuralist/post-modernist analysis and which may be useful in a clinical context will also be presented

Post-traumatic stress disorder in children exposed to violence

The International Society for Burns Injuries (ISBI) has published guidelines for the management of multiple or mass burns casualties, and recommends that 'each country has or should have a disaster planning system that addresses its own particular needs.' The need for a national burns disaster plan integrated with national and provincial disaster planning was discussed at the South African Burns Society Congress in 2009, but there was no real involvement in the disaster planning prior to the 2010 World Cup; the country would have been poorly prepared had there been a burns disaster during the event. This article identifies some of the lessons learnt and strategies derived from major burns disasters and burns disaster planning from other regions. Members of the South African Burns Society are undertaking an audit of burns care in South Africa to investigate the feasibility of a national burns disaster plan. This audit (which is still under way) also aims to identify weaknesses of burns care in South Africa and implement improvements where necessary

Post-traumatic stress disorder in children exposed to violence

Objectives. To investigate to what extent local children exposed to community violence develop post-traumatic stress disorder (PTSD), whether the symptom profile is typical or atypical, and how detection can be improved.Design. A cross-sectional study of two samples of children with a high risk of past exposure to violence.Setting and subjects. Sixty Xhosa-speaking children aged 10 - 16 years; 30 from the Children's Home which serves Khayelitsha, and 30 from a school in a violent area of KhayelitshaOutcome measures. A shortened version of the Survey of Exposure to Community Violence (SECV) was administered to determine exposure to violence. Structured questionnaires and a clinical assessment were used to elicit symptoms and make psychiatric diagnoses.Results. All 60 children reported exposure to indirect violence, 57 (95%) had witnessed violence, and 34 (56%) had experienced violence themselves. Twenty-four (40%) met the criteria for one or more DSM-III-R diagnoses and 13 (21.7%) met the criteria lor PTSD.Conclusions. Community violence places children at a high risk of developing serious psychiatric disorders and many children develop PTSD. None of the children in the school sample had received intervention prior to the study, pointing towards an urgent need for increased community and professional awareness of children at risk

Response: behind the closed doors of mentalizing. A commentary on "Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale"

In this thought-provoking commentary on our findings regarding the dramatic deficits in mentalization specifically regarding past experiences of abuse and neglect in adults who otherwise demonstrate that they have the capacity to think about past relationships in terms of affects and mental states despite these histories, Schimmenti re-examines our findings from the perspective of dissociation and subtly raises the question of whether we adequately consider dissociative processes in the interpretation of our findings

Mentalization, theory of mind and socioemotional development in middle childhood

Theory of Mind (ToM) and Mentalization are essential domains involved in child socioemotional development. ToM is the ability to understand people’s actions and interactions as guided by internal beliefs, emotions, desires, and intentions. In contrast, mentalization is a mental process involved in interpreting human behaviour in terms of mental states related to the self and others. ToM and mentalization constructs are frequently used interchangeably, although they play distinct roles in child development. The present study explores this issue, focusing on the mentalization and ToM interactive dynamics in relation to middle childhood socioemotional skills. Participants were 112 non-clinical children from 8 to 10 y.o. assessed with Child Reflective Functioning Scale (CRFS) on Child Attachment Interview, Reading the Mind in the Eyes test and the Roberts-2 Test. Results from network analysis revealed an association between ToM and Mentalization. Mentalization is positively connected with self-help abilities and age. ToM supports mentalization, while mentalization is related to developing a sense of self-agency involved in improving psychological resources and preventing mental health impairment

Play completion predicts fewer child psychological difficulties: A longitudinal study of mentalizing processes

Play therapy is widely used with children, including children who experienced sexual abuse. This longitudinal study examined whether more pretend play completion (PPC) at Time 1 predicted fewer child difficulties when this was assessed 3 years later at Time 2. Participants were 91 children (aged 3–8 at Time 1), including 51 children who experienced sexual abuse (child sexual abuse [CSA]). Play was coded with the Children’s Play Therapy Instrument, and child psychological difficulties were assessed with the Child Behavior Checklist. More PPC at Time 1 predicted fewer child psychological difficulties 3 years later at Time 2. This was the case in children who had experienced CSA as well as the comparison group, showing that PPC is predicts better psychological adjustment in both abused and nonabused children. The study provides the first longitudinal evidence of the important role of pretend play narrative completion in predicting less internalizing and externalizing difficulties. The findings have important clinical implications for play therapists. It suggests that interventions that encourage children to elaborate and complete their play narratives could facilitate agency and psychological adjustment, as well as recovery after trauma. This is in line with the idea that through play children discover that they can “play with reality” and gain control over how they tell their stories. (PsycInfo Database Record (c) 2023 APA, all rights reserved

Trauma-related symptoms in adolescents: the differential roles of sexual abuse and mentalizing

IntroductionMajor gaps remain in our knowledge regarding childhood sexual abuse (CSA) related symptoms in adolescent psychiatric inpatients, as well as potential resilience factors like mentalizing. CSA is a risk factor for the early emergence of borderline personality features, posttraumatic stress, and sexual concerns. Mentalizing, which involves the capacity to understand our reactions and that of others in psychological terms, is a resilience factor for self and interpersonal functioning. The aim of this study was to address knowledge gaps by examining the contributions of CSA and mentalizing in a latent factor composed of borderline personality features, posttraumatic stress, and sexual concerns in a sample of adolescent psychiatric inpatients. We hypothesized that CSA and mentalizing would independently explain the variance in this latent factor.MethodParticipants were 273 adolescents aged 12–17 recruited from an adolescent inpatient psychiatric clinic. They completed the Reflective Function Questionnaire for Youth (RFQ-Y), the Trauma Symptom Checklist for Children (TSCC), and the Borderline Personality Features Scale for Children (BPFS-C). CSA was assessed using the Child Attachment Interview (CAI), the Computerized Diagnostic Interview Schedule for Children (C-DISC), as well as the Childhood Trauma Questionnaire (CTQ).Results27.5% of adolescent psychiatric inpatients reported CSA. CSA and mentalizing were independently associated with a latent factor consisting of posttraumatic stress, borderline personality features, and sexual concerns. CSA explained 5.0% and RF explained 16.7% of the variance of the latent factor. When we consider both the unique and the shared contribution of CSA and mentalizing, the model explained 23.0% of the variance of this factor.DiscussionCSA and mentalizing independently explained variance in a latent factor constituted of borderline personality features, posttraumatic stress, and sexual concerns. The direct effect of mentalizing was stronger and mentalizing explained comparatively more variance of trauma-related symptoms in adolescent psychiatric inpatients. The findings are consistent with the theory that mentalizing is an internal resilience factor in adolescent psychiatric inpatients. By implication, clinical interventions focused on promoting the development of mentalizing, such as Mentalization Based Treatment, may palliate mental health difficulties manifested by adolescent psychiatric inpatients including those associated with CSA

Dimensional model of adolescent personality pathology, reflective functioning, and emotional maltreatment

Introduction: Childhood emotional abuse (CEA) is a recognized risk factor for adolescent mentalizing challenges. However, there's limited understanding about how CEA might influence personality development and elevate the risk of adolescent personality pathology. A deeper grasp of these pathways is crucial, given that adolescence is a pivotal developmental phase for identity integration, personality consolidation, and the emergence of personality disorders. As the emphasis shifts to dimensional perspectives on adolescent personality pathology, the spotlight is increasingly on adolescents' evolving personality organization (PO). Within this framework, personality disorder manifestations stem from inherent vulnerabilities in PO. A comprehensive understanding of how CEA leads to these inherent vulnerabilities in PO can inform enhanced interventions for at-risk adolescents. Nonetheless, our comprehension lacks insight into potential pathways to PO, especially those involving external factors like maltreatment and individual traits like mentalizing. This study sought to bridge these gaps by employing latent factor analysis and structural equation modeling to explore connections between emotional maltreatment, adolescent mentalizing, and PO. // Methods: A community-based cohort of 193 adolescents (aged 12–17) took part in self-report assessments: the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), the Reflective Functioning Questionnaire for Youth (RFQ-Y), and the Inventory for Personality Organization for Adolescents (IPO-A). // Results: The structural equation model revealed a significant direct influence of CEA on both RFQ-Confusion and PO, and a noteworthy direct effect of RFQ-Confusion on PO. Remarkably, the model accounted for 76.9% of the PO variance. CEA exhibited a significant indirect impact on PO through RFQ-Confusion, which was accountable for 52.3% of the CEA effect on PO, signifying a partial mediation by mentalizing. // Discussion: These insights carry substantial clinical implications, especially for devising integrated, trauma-informed strategies for adolescents with personality pathologies. This is particularly relevant for enhancing mentalizing and bolstering personality consolidation among adolescent CEA survivors