Geoff Goodman

ADHD and Aggression as Correlates of Suicidal Behavior in Assaultive Prepubertal Psychiatric Inpatients

Forty-three psychiatrically hospitalized prepubertal children were assessed regarding their assaultive and suicidal behaviors. These children were subsequently classified into two groups, assaultive/suicidal (AS) and assaultive-only (AO). AS children had higher aggression and suicidal-scale scores, but not higher depression scores, and were more likely to be diagnosed with ADHD. ADHD, childs aggression, and maternal depression and state anger accounted for 33% of the variance in suicidal-scale scores. Aggression mediated the relation between ADHD and suicidal behavior. Differences in symptom pattern between these two subtypes of assaultive inpatient children are interpreted as a basis for distinctive screening procedures.

Interaction structures between a child and two therapists in the psychodynamic treatment of a child with Asperger's disorder

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – can inform therapists of what may be expected from patients with particular patterns of symptoms or behaviours in their clinical practice and how interactions change over time. Using the Child Psychotherapy Q-Set, this study aims to compare the different interaction structures that emerged in the two-year psychotherapy of a six-year-old child conducted, for one year each, by two doctoral-student therapists in a university-based community mental health clinic. The study allows for exploration of the independent role of the therapist in the psychodynamic therapy of a child diagnosed with Aspergers disorder. The results suggest that four distinct interaction structures between child and therapist could be identified in this psychotherapy and that the interaction structures differed between the two therapists and also differed over time within each treatment. The implications of these findings for training and clinical practice are discussed.

Representations of God uncovered in a spirituality group of borderline inpatients.

Abstract We present aspects of a psychoanalytically-oriented, exploratory spirituality group for nine female psychiatric inpatients diagnosed with borderline personality disorder. Through drawings and group process, the patients uncovered and elaborated on their representations of God. Two patterns of representations were identified: (1) representations of a punitive, judgmental, rigid God that seemed directly to reflect and correspond with parental representations and (2) representations of a depersonified, inanimate, abstract God entailing aspects of idealization that seemed to compensate for parental representations. Interestingly, the second pattern was associated with comorbid narcissistic features in the patients. Those patients who presented punitive God representations were able to begin the process of re–creating these representations toward more benign or benevolent images in the context of this group, while those participants who presented depersonified God representations seemed unable to do so.

Therapists' Perspectives on Optimal Treatment for Pathological Narcissism.

This study used Q methodology to explore clinicians’ perspectives regarding optimal psychotherapy process in the treatment of pathological narcissism, a syndrome of impaired self-regulation. Participants were 34 psychotherapists of various disciplines and theoretical orientations who reviewed 3 clinical vignettes portraying hypothetical cases of grandiose narcissism, vulnerable narcissism, and panic disorder without pathological narcissism. Participants then used the Psychotherapy Process Q set, a 100-item Q-sort instrument, to indicate their views regarding optimal therapy process for each hypothetical case. By-person principal components analysis with varimax rotation was conducted on all 102 Q-sorts, revealing 4 components representing clinicians’ perspectives on ideal therapy processes for narcissistic and non-narcissistic patients. These perspectives were then analyzed regarding their relationship to established therapy models. The first component represented an introspective, relationally oriented therapy process and was strongly correlated with established psychodynamic treatments. The second component, most frequently endorsed for the panic disorder vignette, consisted of a cognitive and alliance-building approach that correlated strongly with expert-rated cognitive–behavioral therapy. The third and fourth components involved therapy processes focused on the challenging interpersonal behaviors associated with narcissistic vulnerability and grandiosity, respectively. The perspectives on therapy processes that emerged in this study reflect different points of emphasis in the treatment of pathological narcissism, and may serve as prototypes of therapist-generated approaches to patients suffering from this issue. The findings suggest several areas for further empirical inquiry regarding psychotherapy with this population.

Interaction structures formed in the psychodynamic therapy of five patients with borderline personality disorder in crisis

OBJECTIVES To identify interaction structures (i.e., patterns of reciprocal interaction) that characterize the treatments of patients with borderline personality disorder (BPD) in crisis. DESIGN A 6-month naturalistic psychotherapy process and outcome study in which interaction structures were correlated with outcome data. METHODS Five BPD patients in crisis participated in 6 months of three-times-per-week psychodynamic therapy. Patients completed a measure of psychological distress every week. One hundred and twenty-seven sessions were audiotaped and coded using the Psychotherapy Process Q-Set. RESULTS Four interaction structures were identified: (1) collaborative relationship with supportive, reassuring therapist (IS1), (2) therapist empathic attunement (IS2), (3) erotized therapeutic relationship (IS3) and (4) directive therapist with compliant patient (IS4). The magnitude of these four interaction structures varied within and between the five therapist-patient dyads over time. Interaction structures correlations with time were inversely proportional to interaction structures correlations with distress levels. IS2 was correlated with two different outcomes in patient 3s and patient 5s treatments--a positive outcome for patient 3s treatment and a negative outcome for patient 5s treatment. CONCLUSIONS An effective treatment model for BPD patients in crisis needs to promote the emergence of empathically attuned interactions as well as supportive and directive interventions as dictated by the patients individual needs. These treatments require flexibility to accommodate the patients unique presentation in crisis. The therapeutic dyad senses which interaction structures to increase or decrease over time to reduce the patients distress.

Interaction structures between a child and two therapists in the psychodynamic treatment of a child with borderline personality disorder

This study examined the constellation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – that emerged in the psychodynamic therapy (PDT) of a child diagnosed with borderline personality disorder and treated by two doctoral student therapists. Identification of these interaction structures can inform therapists of what might be expected from patients with particular symptom or behaviour patterns and how interactions change over time. This study also examined each session’s adherence to three session prototypes: PDT, cognitive-behavioural therapy (CBT) and reflective functioning (RF) process. The Child Psychotherapy Q-Set (CPQ) is a 100-item instrument that assesses the processes within a single psychotherapy session. Items reflect a wide range of therapist attitudes and behaviours, patient attitudes and behaviours and interactions between therapist and patient. Experts used the CPQ to define PDT, CBT and RF process session prototypes. The results suggested that four distinct interaction structures could be identified and that their constellations differed between the two therapists and also differed over time within each treatment. Therapists were more structured and accommodating early on in their treatments and more interpretive later. Prototypical PDT process was more prominent in the sessions than RF process, which in turn was more prominent than CBT process. Unique therapeutic processes are at work in every dyad, despite holding the patient and theoretical orientation constant. An effective treatment in one dyad might not work in another due to therapist-specific and dyad-specific effects.

Rural Community Libraries in Africa: Challenges and Impacts

Around the word, in developed as well as developing countries, libraries play an important role in the dissemination of knowledge. The availability of information resources can often mean the difference between poverty and prosperity, particularly in underdeveloped African communities. Rural Community Libraries in Africa: Challenges and Impacts investigates the relationship between local libraries and community development. From the historical roots of rural libraries to their influence on the literacy, economy and culture of the surrounding region, this book will present academics, researchers, and, most importantly, librarians with crucial insight into the tangible benefits of rural community libraries and the obstacles they must overcome.

The rural library's role in Ugandan secondary students' reading habits

This study explores reading and library factors related to secondary school student academic outcomes in rural areas in Uganda. This mixed methods study utilized quantitative data collected as part of a more extensive project to explore six student factors in relation to students’ school, library, and home environments. The Kitengesa Community Library in Uganda (www.kitengesalibrary.org) served as the site for this study. The factors explored for this study include reading frequency, library use frequency, library access, overall grade average, and presence and type of reading materials in the home. Results indicated that both reading frequency and certain types of reading materials read for recreational purposes are correlated with higher overall grade average. Reading frequency was positively correlated with student overall grade average for all students.

Introduction to the special section on child and adolescent psychotherapy research

Anna Freud National Centre for Children and Families, London, UK; Psychology Department, Universidad de Chile, Santiago, Chile; Clinical Psychology Doctoral Program, Long Island University, Brooklyn, NY, USA; Department of Developmental Psychology and Socialisation, University of Padua, Padova, Italy; Department of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands; School of Social Work Mount Scopus Campus Jerusalem, Hebrew University, Jerusalem, Israel & Child and Adolescent Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

Child psychoanalytic psychotherapy: a single case study

Child psychoanalytic psychotherapy is a specific approach to the treatment of emotional, social and behavioural problems in children. There are hundreds of modalities of psychotherapy, and this continues to increase. The vast majority has not been investigated using controlled (or other types of) studies and not all of these methods are based on explicit etiological or therapeutic theories of change. A gap exists that should be filled between psychotherapeutic research and clinical practice. Based on these assumptions, the present study sought to analyse the first year of the psychotherapeutic process of a boy aged seven who was referred for psychotherapy. A descriptive study was performed, based on a single case study design. The participants were the child and his therapist and the main measure was the Child Psychotherapy Q-Set–CPQ, a procedure used to analyse the psychotherapeutic process in 3–13-year olds. The results show the main elements of the psychotherapy process, describing characteristics of the child, of the therapist and the dyad interaction.