A case study of narcissistic pathology : an object relations perspective

The case-study method of psychological research was applied to the brief psychodynamic therapy of a narcissistically disordered female patient. The aim of this research was to explore, clarify and explain certain diagnostic and psychodynamic anomalies to emerge in the course of treatment, using a conceptual framework derived from select psychoanalytic object relations theorists in the area of narcissistic pathology. The author, discovering that there was no diagnostic or explanatory object relations model adequate to the therapeutic data, formulated his own diagnostic category narcissistic neurosis and an eclectic object relations model in order to explain the anomolous research findings. Narcissistic neurosis was defined as a form of psychopathology in which a primarily neurotic character structure presents with a distinctly narcissistic profile. The narcissistic false self-structure serves the functional purpose of protecting the psyche from a repressed negative self-representation derived from a destructive bipolar self-object introject. The primary etiological factor to emerge was that of a narcissistic mother conditional affection and self-object target child necessitated adaptive whose insensitivity, relationship with the premature self-sufficiency and the defensive emergence of a narcissistic surface self-representation. It was proposed that narcissistic neurosis and narcissistic personality disorder are two discrete forms of pathology differing in terms of severity, psychodynamics, defensive structure, mode of object relating, therapeutic accessibility and prognosis. Assessment criteria were proposed in order to differentiate the two areas of narcissistic pathology and assess suitability for psychotherapeutic treatment. Positive treatment results in this case-study suggest that narcissistic neuroses may receive long-term benefit from short-term psychodynamic therapy

Child observation and emotional discomfort: the experience of trainee psychologists

Young Child Observation (YCO) is a foundational component of psychoanalytic training in many parts of the world and has been adapted for various training courses in psychology, psychotherapy, education and social work. While the professional benefits of YCO are established, the experience of observers conducting observations outside of traditional psychoanalytic training settings is under-researched. YCO observers experience significant emotional discomfort; however, this has not been well documented, nor has its impact on observers and their professional development. This study addresses that gap by analysing the emotional discomfort experienced by 10 postgraduate psychology students from a single university, who completed a seven-week YCO and wrote self-reflective reports on their personal experience. Participant reports and notes from each completed observation were analysed using Reflective Thematic Analysis. Three main themes were identified: Managing the Observer Role, The Struggle for Belonging, and Countertransference. Participants reported a range of experiences eliciting emotional discomfort, which, in the course of individual and supervision group reflection, led to personal and professional development. Findings from this study indicate that a short YCO enriches the quality of professional psychological training, even when this training is not explicitly psychoanalytic in nature

The gender paradox: understanding the role of masculinity in suicidal ideation

It is important to understand the role of social determinants, such as gender, in suicidal ideation. This study examined whether conformity to specific masculine norms, particularly high self-reliance and emotional self-control, moderated the relationship between psychological distress and suicidal ideation for men. The other norms explored were those pertaining to behavioral–emotional or social hierarchy status aspects of masculinity, and whether they moderated the psychological distress–suicidal ideation relationship for men and women. The Conformity to Masculine Norms Inventory, the Kessler Psychological Distress Scale, and the Suicidal Ideation Attributes Scale were administered to an Australian community sample in an online survey ( n = 486). As predicted, higher psychological distress was associated with higher suicidal ideation. Self-reliance enhanced the relationship and was the only moderator among men. High self-reliance levels might be an important indicator of risk, which can be used when assessing and working with men who are hesitant to openly discuss suicidal ideation with clinicians. For female participants, higher endorsement of behavioral–emotional norms and lower conformity to social hierarchy status norms appear to increase suicide risk in the presence of psychological distress. Our findings suggest that high self-reliance is of particular concern for men experiencing psychological distress. It is also important to consider the roles of masculine norm endorsement in the psychological distress–suicidal ideation relationship among women

Social connectedness and suicidal ideation: the roles of perceived burdensomeness and thwarted belongingness in the distress to suicidal ideation pathway

Background Suicide is a serious public health issue. Distress has been identified as a common risk factor, with research also suggesting that a lack of social connectedness is involved. Methods This quantitative, cross-sectional study investigated the role of perceived burdensomeness and thwarted belongingness in the psychological distress/suicidal ideation pathway in a community sample of 480 Australian adults. Results As expected, distress was found to be a strong predictor of suicidal ideation. Perceived burdensomeness and thwarted belongingness both moderated and mediated the relationship between distress and suicidal ideation. Specifically, distress was more strongly linked to suicide ideation when burdensomeness or thwarted belongingness were also high. This moderating effect was stronger for thwarted belongingness than it was for burdensomeness. These variables also mediated the pathway, in that higher distress related to higher burdensomeness and thwarted belonging, which in turn related to higher suicide ideation. This mediating effect was stronger for burdensomeness than for thwarted belonging. Conclusions Overall, the findings confirm the importance of our social relatedness in suicide. Increasing belongingness and reducing the perception of being a burden on others may be an important intervention strategy for weakening the link between distress and suicide ideation

The Melbourne Study of Psychoanalytic Psychotherapy III: Patients' and psychotherapists’ perspectives on progress and challenges

Qualitative exploration of the experience of psychoana-lytic psychotherapy complemented the quantitative eval-uation of mental health and life functioning improvements in the Melbourne Study of Psychoanalytic Psychotherapy. Twice-weekly treatment was offered to adults for 2years by the private sector Glen Nevis Clinic for Psychoanalytic Psychotherapy, established by the Victorian Association of Psychoanalytic Psychotherapists as a subsidized, low-cost community service over 8years. This paper is the second of two presenting the qualitative arm of the study, involv-ing in-depth narrative interviews with patients and psycho-therapists. Analysis of 143 transcripts further contributes to evidence of the Reach, Effectiveness, Adoption, Imple-men tation and Maintenance of psychoanalytic psycho-therapy in a community setting. The first qualitative paper reports themes concerning patient expectations of psycho-therapy and perspectives of both patients and psychother-apists on the experience and benefits of the treatment. This paper reports what was perceived by participants as facili-tative or challenging for therapeutic progress, illuminating how experiences of the nature of psychoanalytic psycho-therapy may have affected the Implementation, Effectivenessand Maintenance of the program. The most notable facilita-tive factors emerging were the exploratory, insight-oriented nature of the work, elements of the patient-psychotherapist relationship, and the frame of the treatment. Challenges were also often seen as inherent to Effectiveness; however, proposing the frame of 2-year treatment, as both an expecta-tion and a limit, probably inhibited program Reach, Adoptionand overall Implementation. The limitations and strengths of the qualitative arm of the research, together with implica-tions for further investigation, are discussed

The Melbourne Study of Psychoanalytic Psychotherapy II: Patients' and psychotherapists' perspectives on expectations, therapeutic experience and benefits

The naturalistic, longitudinal Melbourne Study of Psycho-analytic Psychotherapy was conducted in a subsidized community clinic established by the Victorian Association of Psychoanalytic Psychotherapists as a demonstration project operating over 8years. It offered lower SES adults twice-weekly psychoanalytic psychotherapy for 2years. An independent research program used the RE-AIM planning and evaluation framework to investigate the Reach, Effectiveness, Adoption, Implementation and Maintenance of the service. Complementary quantitative and qualitative methodologies studied mental health and general-life functioning outcomes and underlying processes of treatment. Two papers pres-ent the qualitative arm of the research, exploring the lived experience of the psychotherapy, reported contemporane-ously and retrospectively by patients and psychotherapists. This first paper details the qualitative design and methods employed. In-depth semi-structured narrative interviews during psychotherapy, upon completion at 2years, and at an additional 8-month follow-up point for patients, were conducted. Analysis of the narrative transcripts of 143 participant interviews revealed themes regarding patient expectations of treatment and the perceptions of both patients and psychotherapists of the long-term psychoana-lytic psychotherapy experience and its benefits. Narratives thus provided evidence of the Reach, Effectiveness, Adoption, Implementation and Maintenance of the service. The findings enrich understanding of the effective processes underlying the outcomes of the quantitative arm of the study reported separately. The second qualitative paper presents the find-ings concerning participants' experiences of facilitative and challenging aspects of the treatment, as well as the implica-tions of the qualitative findings overall

The Melbourne Study of Psychoanalytic Psychotherapy low‐cost clinic I: Implementation, mental health and life functioning gains

The Melbourne Study of Psychoanalytic Psychother-apy examined the implementation, lived experience, and perceived therapeutic gains of psychoanalytic psychother-apy in a low-cost, private-sector community clinic. A first in Australia, this 8-year demonstration project allowed natural-istic study of the impact and process of intensive, long-term, time-limited psychoanalytic psychotherapy delivered to self-referred adults by clinicians with a common theoretical frame of practice. Presented in three papers, the research employed the RE-AIM planning and evaluation framework, using complementary quantitative and qualitative methods, to study the psychotherapy service in terms of Reach, Effec-tiveness, Adoption, Implementation and Maintenance. This first paper reports the Reach of the program to be 67% for those presenting for assessment for psychoanalytic psycho-therapy, with Adoption of the full 2-year treatment program being 60%. Improvements in mental health and life function-ing provided quantitative evidence of Effectiveness for those completing the 2-year treatment program, with Maintenanceat 8-month follow-up. Patient age, gender and personality

Skeletal muscle gene expression in response to resistance exercise: sex specific regulation

<p>Abstract</p> <p>Background</p> <p>The molecular mechanisms underlying the sex differences in human muscle morphology and function remain to be elucidated. The sex differences in the skeletal muscle transcriptome in both the resting state and following anabolic stimuli, such as resistance exercise (RE), might provide insight to the contributors of sexual dimorphism of muscle phenotypes. We used microarrays to profile the transcriptome of the biceps brachii of young men and women who underwent an acute unilateral RE session following 12 weeks of progressive training. Bilateral muscle biopsies were obtained either at an early (4 h post-exercise) or late recovery (24 h post-exercise) time point. Muscle transcription profiles were compared in the resting state between men (n = 6) and women (n = 8), and in response to acute RE in trained exercised vs. untrained non-exercised control muscle for each sex and time point separately (4 h post-exercise, n = 3 males, n = 4 females; 24 h post-exercise, n = 3 males, n = 4 females). A logistic regression-based method (LRpath), following Bayesian moderated t-statistic (IMBT), was used to test gene functional groups and biological pathways enriched with differentially expressed genes.</p> <p>Results</p> <p>This investigation identified extensive sex differences present in the muscle transcriptome at baseline and following acute RE. In the resting state, female muscle had a greater transcript abundance of genes involved in fatty acid oxidation and gene transcription/translation processes. After strenuous RE at the same relative intensity, the time course of the transcriptional modulation was sex-dependent. Males experienced prolonged changes while females exhibited a rapid restoration. Most of the biological processes involved in the RE-induced transcriptional regulation were observed in both males and females, but sex specificity was suggested for several signaling pathways including activation of notch signaling and TGF-beta signaling in females. Sex differences in skeletal muscle transcriptional regulation might implicate a mechanism behind disproportional muscle growth in males as compared with female counterparts after RE training at the same relative intensity.</p> <p>Conclusions</p> <p>Sex differences exist in skeletal muscle gene transcription both at rest and following acute RE, suggesting that sex is a significant modifier of the transcriptional regulation in skeletal muscle. The findings from the present study provide insight into the molecular mechanisms for sex differences in muscle phenotypes and for muscle transcriptional regulation associated with training adaptations to resistance exercise.</p