Virginie Debaere

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

Abstract 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 As hypothesized, alexithymia was related to cold and withdrawn, but not to dominant or submissive, interpersonal functioning.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.

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

BackgroundGPs’ 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.MethodTwo 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.ResultsIn 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.ConclusionThis 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.

Beyond the “black box” of the Therapeutic Community for substance abusers: A participant observation study on the treatment process

Therapeutic Communities (TCs) for substance abusers are an effective recovery oriented treatment for residents who finish the program. Over the years, the TC approach has been challenged by changes in society and by new perspectives on treatment. Moreover, the therapeutic process that takes place in TCs is barely understood or documented, often referred to as the “black box” of TCs. In order to gain insight into this process, there is a growing demand for qualitative research. This article presents the findings from a participant observation study in a Belgian TC. The first author fully immersed herself amongst the residents of a TC peer group for three weeks. By interpreting naturalistic participant observation data through psychoanalytic theory on addiction and mentalization, the process of change is discussed. It is argued that the TC program challenges former substance abusers in terms of problems they have with affect regulation. This process is understood in terms of a growing ability to manage disturbing affective experiences in a more mentalized way. The frustrating and holding TC environment together with the TC tools provide the condition and techniques to make this process manifest. Limitations of the study and suggestions for future research are discussed.

The Assessment of the Social Cognition and Object Relations Scale on TAT and Interview Data

This study examines the reliability and convergent validity of 2 versions of the Social Cognition and Object Relations Scale (SCORS), one for use with Thematic Apperception Test narratives (SCORS–TAT; Westen, 1990) and one for use with clinical interview data (SCORS–CDI; Westen, Barends, Leigh, Mendel, & Silbert, 1990). Four SCORS dimensions were evaluated. Data were collected in a psychiatric sample (N = 74). Results show that although interrater reliability was good for all dimensions, internal consistency was low, especially for the affective dimensions. Structural equation modeling, in which a model with 2 factors (i.e., SCORS–TAT and SCORS–CDI) and 4 dimensions each was tested, indicated low convergence between corresponding dimensions of SCORS–TAT and SCORS–CDI. Correlational analyses suggested that this was due to a strong method factor. Regression analyses, however, revealed that the presence of a personality disorder operated as a moderator for convergence between corresponding cognitive-structural dimensions.

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

Aim: The aim of this article was to study governance of drug use in Norway through a historical account. Method: A genealogy was conducted through the study of documentation and legal texts from the 1600s until contemporary times. Findings: Based on legal texts addressing people using substances (both drugs and alcohol) various strategies for governance of drug use appears. The first section describes the emergence of institutions where people with alcohol problems were confined in a system originating the Dutch discipline houses. The second section describes the poor laws of the 1800s and the practice of the local poorhouses. The third section takes a look at the Vagrancy Act of 1900 and the state-owned labour camp at Opstad. The fourth section discusses the establishment of the sobriety boards and their role in confining alcoholics at cure homes. The fifth section describes developments in post-world-war Norway, with increased attention to illicit substances. Conclusions: The terminology justifying interventions is increasingly medicalised. Descriptions of the “drunkard” that appeared in 18th-century legal texts as immoral and free are contrasted by a positioning of this character as being a slave to his drinking in 20th-century political discourses, or as substance-dependent patients in the 21st century, alongside concerted efforts to dissolve open drug scenes.

Identity change in a drug-free therapeutic community : a Lacanian interpretation of former residents’ perspectives on treatment process and outcome

Purpose In drug-free Therapeutic Communities (TCs), people with addictions live together in order to achieve recovery in terms of a modified drug-free lifestyle. Central to the TC approach is the assumption that this shift is only achievable when “identity change” has taken place. However, this claim has rarely been addressed in TC research. Further insight into the nature and realization of such identity change might help to understand how this community approach contributes to long-term recovery. The paper aims to discuss these issues. Design/methodology/approach The present qualitative interview study explores the perspectives of ten former TC residents on their treatment and their process of change. To organize the interview data, Lacanian psychoanalytic theory on identity formation/change is used as a framework. Findings The common thread in the participants’ process of change is presented in three parts: their life before, in and after the TC. The substeps within these parts are illustrated with several quotes. Originality/value The findings highlight the value of innovative qualitative research designs to address the many challenges to addiction treatment research. A Lacanian reading of the data makes it possible to describe the subjective logic of the process of change in the TC, focusing on how substance (mis)use functions as an attempted solution in dealing with identity issues. By linking crucial TC ingredients such as the TC law and TC tools to the process of the identity change, a new reading of this long-term group approach is achieved.

P01-24 - The black box of the therapeutic community for addiction 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 programs have proven to be effective, the why and how of the treatment process stays misunderstood. This ‘Black Box of the TCs’ threatens their continued existence and has led to a call for qualitative research. To investigate the treatment process, the first author fully immersed herself in the Belgian TC ‘Trempoline’ for 3 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) (see figure 1). Download : Download full-size image figure 1 . 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.