The black box of the therapeutic community clarified by means of mentalisation theory: a participant observation study

Drug free Therapeutic Communities (TC’s) for addiction developed outside the medical and mental health care. Although these program have proven to be effective, the why and how of the treatment process stays misunderstood. This ‘Black Box of the TC’s’ threatens the continued existence of TC’s and has led to a call for qualitative research. To clarify the treatment process, the author fully immersed herself in the Belgian TC ‘Trempoline’. She lived amongst the residents for 3 weeks and then took on the staff position for 2 more weeks. The full participation strongly affected research possibilities: record equipment was taken away and the exigent day’s schedule left few moments to note. Paradoxically, such frustrating experience proved to be an integral part of the treatment process. The data-set was analyzed with thematic analysis. This resulted in a model consisting of 5 main themes which clarifies how the TC program (themes 2 and 4) influences its residents (themes 1, 3, 5). The frustrating but at the same time holding environment reactivates the residents’ drowned emotional life. By applying symbolization-tools they learn to deal with the increasing tension in a mentalised way instead of acting out their discontent. We conclude that a TC tackles the disruptive affect-regulation in people suffering from addiction by triggering and developing their mentalisation process

Governance of substance use as a by-product of policing in Norway : a historical account

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A Lacanian view on Balint group meetings : a qualitative analysis of two case presentations

Background: GPs'subjectivity is an intrinsic instrument in their daily work. By offering GPs a platform to present and discuss difficult interactions with patients, Balint group work be might provide them an opportunity to explore and articulate aspects of their subjectivity. In order to get a more profound understanding of what participation in a Balint group can offer, we focused on the process of change that can be observed during Balint group meetings. To that end, this study scrutinized two Balint group case discussions on a micro-level. Method: Two cases were selected from a larger data set of 68 audio-taped case discussions in four Balint groups. In order to shed light on the type of change that characterizes the presenter's narrative, we used Lacan's theoretical distinction between imaginary and symbolic modes of relating to the other. Results: In both case discussions, the GPs presenting the case initially appeared to be stuck in a fixed image of a situation, referred to as ` imaginary relating to the other.'Through a range of interactions with the group, the presenters were encouraged to explore different subject positions, which allowed them to broaden their initial image of the situation and to discover other issues at stake. This was referred to as a more symbolic way of relating to the other. Conclusion: This study throws light on the type of change Balint group participation allows for and on the way this might be achieved. We conclude that Balint group work is potentially beneficial to the participating GPs as well as to the relationship with their patients

Interpersonal problems and cognitive characteristics of interpersonal representations in Alexithymia: a study using a self-report and interview-based measure of Alexithymia

In this study, associations between alexithymia, interpersonal problems, and cognitive-structural aspects of internal interpersonal representations were examined. Alexithymia was measured using the Toronto Structured Interview for Alexithymia (TSIA) and the 20-item Toronto Alexithymia Scale (TAS-20). To measure interpersonal problems, the dominance and affiliation dimension scores of the Inventory of Interpersonal Problems were used, and cognitive-structural characteristics of interpersonal representations were measured using the Social Cognition and Object Relations Scale (SCORS). As hypothesized, alexithymia was related to cold and withdrawn, but not to dominant or submissive, interpersonal functioning. In terms of the SCORS, alexithymia was negatively related to complexity of interpersonal representations, both in TAT and in interview narratives, indicating a link between alexithymia and mentalization. However, alexithymia was related only to the dimension of social causality when this dimension was scored on TAT narratives. Overall, the TSIA provides the most consistent and stable results after controlling for negative affectivity