Regression and Formlessness in the Work of Winnicott and Bion

This paper focuses on a convergence of late Bion's (1970) and late Winnicott's (1969a, b) discovery and technique. Both authors describe a special state of mind which adds formlessness, un-differentiation to regression as a major mechanism of psychic change. Bion describes this state mainly in the analyst, while Winnicott focuses on this state of mind in the patient. The combination of both approaches brings us in contact with an essential phenomenon of psychoanalysis which seems difficult to reach and contain without the psychoanalytic frame and in which both analyst and patient play a complementary role.

Conversation: Bion and Winnicott

In 2023, THE A-SANTAMARIA PSICOANALISIS MEXICO ASSOCIATION planned the Online Conversations of W. Bion to generate dialogues with outstanding colleagues about the divergences and convergences of Bion with the work of André Green, Jean Laplanche, Ignacio Matte Blanco and D.W. Winnicott. The need to share thoughts about these authors' works and their links with others, facilitated widespread international dialogues about these authors and placed them all in a field of exchange, debate and challenge. The Online Conversations underlined the new dimensions in which Bion and Winnicott placed psychoanalytic theory and technique. Five outstanding presentations illustrate their understanding and grasping of these dimensions, each followed by an author exchange. These authors provide an in-depth inquiry into a wide range of topics: Angela Joyce looks at object constancy and absence through the lens of Winnicott's (1977) The Piggle; Dominque Scarfone examines the concept of contact barriers among Freud, Bion and Winnicott; Howard B. Levine discusses absence, failure and the negative in the work of Bion, Winnicott and Green; Lesley Caldwell links the works of Bion and Winnicott in addressing being alone and with others, and communicating and not communicating; finally, Rudi Vermote shows how Bion's and Winnicott's views on regression and formlessness complement each other.

Student-teacher relational entitlement and its association with students' and teachers' characteristics

INTRODUCTION

One's sense of entitlement-the subjective perception of what one deserves from another person-can contribute to social attitudes and behaviour in positive or negative ways, depending on the way in which one construes this subjective sense. Previous work has examined how adolescents' sense of entitlement towards their parents contributes positively or negatively to their well-being. In this study, we extend this line of research and focus on adolescents' sense of entitlement towards another important authority figure-teachers, while examining its associations with both students' and teachers' characteristics and implications for students' functioning at school.

METHOD

We adapted the Adolescents' Sense of Relational Entitlement towards Parents scale to tap students' relational entitlement towards their teachers. We then examined the factor structure of the adapted scale and its associations with students' and teachers' relevant psychological measures in three samples (N = 1588).

RESULTS

Findings confirmed the three-factor structure of student-teacher entitlement. Studies 2-3 also revealed that students' sense of entitlement was associated with both students' variables (e.g., psychological well-being, self-esteem, perceptions of teachers' acceptance of them and students' school engagement) and teachers' emotional difficulties. Study 3's findings indicated that students' sense of entitlement was associated with their school engagement.

CONCLUSION

Students' sense of entitlement towards teachers seems to be associated with teachers' emotional makeup and attitudes towards students. In addition, this subjective sense is associated with students' school engagement. These findings suggest that there is theoretical value and practical implications for further unpacking both teachers' and students' factors associated with students' sense of entitlement and examining its association with academic functioning at school.

Childhood trauma and social anxiety in adolescents: Mediating role of cardiovascular response to social stress

Adolescents exposed to childhood trauma are at an elevated risk for social anxiety. However, the physiological mechanisms linking childhood trauma and adolescents' social anxiety remain poorly understood. This study examined whether cardiovascular reactivity to acute social stress was a mechanism underlying this association. Participants were Chinese adolescents (N = 172; Mage = 12.95). They first reported their childhood trauma and social anxiety using the Childhood Trauma Questionnaire and the Social Interaction Anxiety Scale. They then participated in a social stress task, during which their cardiovascular data [heart rate (HR) and systolic and diastolic blood pressure (SBP, DBP)] were monitored. The results showed that high levels of childhood trauma were associated with blunted HR, SBP, and DBP reactivity, which in turn were associated with high levels of social anxiety. Mediation analysis indicated that childhood trauma was indirectly associated with social anxiety via blunted cardiovascular reactivity. The findings suggest that blunted cardiovascular reactivity may serve as a physiological pathway linking childhood trauma and adolescents' social anxiety.

Contact barriers between Freud, Bion and Winnicott

The author discusses the idea that psychoanalysts could benefit from a common paradigm, not necessarily a single theory, but a general frame through which to view their work. Focusing on perception as a basic modality of psychic life, in combination with the system-environment approach, could provide this common baseline. The text explores how this approach relates to the work of Freud, Bion, and Winnicott, emphasizing the interconnectedness of systems and their environments, the role of perception, and the concept of a contact barrier. The notion of tangential interlocking is proposed as a way of illustrating how the system Freud called perception-consciousness is the contact-barrier common to all the psycho-somatic functions of interest to psychoanalysis.

Premonition: Hope and Dread in the Analytic Hour

Analytic awareness of the process of meaning-making involves tracking premonitions and intuitions to their sources. As precursors of symbolic processing, premonitions are essential elements in any relationship, including the analytic relationship. They provide unconscious communication that informs and amplifies internal and external body and object relations. These relations facilitate depth and dimensionality between and within persons. They also enable the representational processes to establish psychic structure. When traumatized, a person can lose faith in these processes and defend against relationship. Exploring precursors of the emotional experiences of hope and dread enables the analytic dyad to re-vitalize lost potentials and the representation of experience. A clinical example is given to demonstrate the application of these ideas.

Association between childhood trauma and social anxiety in adolescents: The mediating role of self-compassion and loneliness

BACKGROUND

Previous studies have shown a correlation between childhood trauma and social anxiety. However, the underlying mechanism of this association is not well understood.

OBJECTIVE

The aim of this study was to examine the relationship between childhood trauma and social anxiety in adolescents, and to explore the mediating role of self-compassion and loneliness.

PARTICIPANTS AND SETTING

In total 1309 adolescents (531 of whom were female) were recruited, and their mean age was 15.4 ± 2.30 years.

METHODS

Participants completed the Adolescent Social Anxiety Scale, Childhood Trauma Questionnaire Short Form, Self-Compassion Scale, and University of California, Los Angeles Loneliness Scale. Pearson correlation analysis was conducted to investigate the relationships among childhood trauma, self-compassion, loneliness, and social anxiety. The PROCESS Macro Model 80 was used for regression analysis to explore the mediating effects of self-compassion and loneliness on the relationship between childhood trauma and social anxiety.

RESULTS

After controlling for the influence of gender and parental marital status, self-compassion mediated the association between childhood trauma and social anxiety, in which positive self-compassion alleviated the relationship between childhood trauma and social anxiety, while negative self-compassion aggravated the relationship between childhood trauma and social anxiety. Furthermore, self-compassion and loneliness chain-mediated the relationship between childhood trauma and social anxiety.

CONCLUSION

These results offer theoretical support for the research and intervention of adolescents' social anxiety, and are crucial for developing adolescents' mental health education and promoting interpersonal communication.

A systematic scoping review of the literature on sexual orientation obsessive compulsive disorder (SOOCD): Important clinical considerations and recommendations

Obsessive Compulsive Disorder (OCD) is characterised by the occurrence of persistent thoughts, urges, or images that are experienced as intrusive and unwanted (obsessions), and compulsive actions that the individual feels driven to act on in response to an obsession. These actions are carried out by an individual in order to try and prevent or reduce anxiety or distress, or to prevent something terrible from happening (American Psychiatric Association, APA, 2013). The aim of this review was to identify studies which have explored SOOCD. Because this is a relatively under-researched field, the decision was made for the present systematic review to take an inclusive approach. A systematic PRISMA review was conducted. A total of eleven studies were identified in this review. Two were cases and nine were empirical studies. Overall, the studies in this review highlight that although relatively common in individuals with OCD, SOOCD is frequently misunderstood by both clinicians and patients. This emphasises the need for education and training (or they are not even aware of the condition).

Object constancy and absence in Winnicott through the lens of the piggle

This paper revisits D. W. Winnicott's famous account of his patient Piggle to examine the profound nature of her response to the birth of her baby sister in the light of the concepts of object constancy and absence. The author speculates that recent scholarship revealing the mother's Holocaust family history enables us to hypothesise that Piggle's infancy might have been marked by her mother's psychic absence. This contributed to difficulties in the establishment of object constancy leaving her vulnerable to more extreme responses to later absences, such as at the birth of her sister. The focus of Winnicott's interpretations at an Oedipal level is critiqued as is the significance of the psychoanalysis-on-demand setting of the work.

Associations Among Beliefs Supporting Patriarchal Principles, Conflict Avoidance, and Economic Violence in Intimate-Partner Relationships of Ultra-Orthodox Jews

Beliefs that uphold patriarchal principles may influence individuals' willingness to avoid conflict in their intimate-partner relationships, which can, in turn, increase the likelihood of intimate-partner economic violence. However, these associations remain underexplored in current research. This study examines these dynamics within a sample of 321 adults from the Ultra-Orthodox Jewish community-a patriarchal and traditional culture. Specifically, it examines associations among beliefs supporting patriarchal principles at the micro (gendered domestic roles), meso, and macro (institutional power of men and the inherent inferiority of women) levels; conflict avoidance; economic violence; and sex differences in these factors. Descriptive statistics were used to analyze sex differences in the study variables, and path analysis was used to examine the correlations between research variables for men and women. The findings indicate that beliefs in patriarchal ideologies were moderate across all levels but slightly higher among men. Men were significantly more likely than women to avoid conflict with their intimate partners. Beliefs in support of patriarchal ideologies were predictive of conflict avoidance, particularly among women. Contrary to prior research, this study revealed nonsignificant sex differences in the prevalence of economic-violence victimization. These findings, however, do not negate the role of sex-based dynamics in economic-violence victimization. We discuss the findings and the meanings assigned to conflict avoidance by men and women, while considering gender disparities of power and control. We suggest that men's tendency to avoid conflict likely moderated their likelihood of perpetrating economic violence.

Mister Rogers (1928-2003) Through the Holistic "Health & Wellness" Lens : Current and Historiographic Lessons

In the 1960s, Fred Rogers created Mr. Rogers' Neighborhood ( MRN ), a television shows for children. Although Rogers may not have been aware that his series carried the potential for a public health model, such an observation becomes apparent in contemporary terms. This transdisciplinary narrative explores MRN through the lens of holistic "health & wellness." Several themes come in perspective as they relate to health as defined by the World Health Organization for present and future communities. Targeting a young population, Rogers focuses on emotional nurturing and health with safety for all and within a happy and healthy community-themes that are the core of public health. Through the "health & wellness" lens, the footprints for a child's behavioral and social model are evident; a model particularly relevant to present and future generations with emotional growth, health, and community spirit as essential. In MRN , children are learning through the visual and audio arts, self-esteem, caring, and positive behaviors for personal and social health. Through this lens, besides the footprints to an educational model, another evidence manifests itself, which is the timeless impact of the content of Rogers' life lessons that are constantly adjusting to the next audience of this age group by updating its format in parallel with an advancing technology, which supports the validity of MRN ' potential for a holistic public health model toward complete physical, mental, spiritual, and social well-being, and as previously proposed by the World Health Organization.

Effects of Social Acknowledgment and Interpersonal Shame on Complex Posttraumatic Stress Disorder Symptoms of Sexual Violence Survivors in South Korea

Sexual violence (SV) survivors face negative social reactions, which can affect their recovery. Based on the socio-interpersonal model of trauma, understanding how societal circumstances impact SV survivors' mental health is important. This study examined conditional indirect effects of interpersonal shame and social acknowledgment on the relationship between perceived SV event severity and complex post-traumatic stress disorder (CPTSD) symptoms. Cross-sectional data from 157 community-based adults who had previously experienced SV were collected from an online panel. Exploratory factor analysis of the Social Acknowledgment Questionnaire was conducted, followed by conditional indirect analyses using Models 1, 4, and 7 of PROCESS macro. First, results showed that a two-factor model of social acknowledgment consisting of "social disapproval" and "social recognition" was more suitable for this study than a three-factor model predominantly used by Western societies. Second, interpersonal shame partially mediated the relationship between perceived SV event severity and CPTSD symptoms. Third, the conditional indirect effect of social disapproval on the mediating effect of interpersonal shame was significant when the social disapproval level was high. This indicates that the indirect effect of interpersonal shame on CPTSD increases when the social disapproval level is high. This study supported the socio-interpersonal perspective of trauma and suggested that increasing social acknowledgment beyond personal-level intervention would be a critical step for recovery of SV survivors to decrease their interpersonal shame and CPTSD.

Psychological Interventions for Mesothelioma Patients and Their Caregivers: A Systematic Literature Review

Malignant Mesothelioma (MM) has a striking impact on the somatopsychic balance of patients and their families, including physical, psychological, and interpersonal problems. The aim of this systematic literature review was to investigate what psychological interventions are offered to patients with MM and their caregivers worldwide.

METHODS

The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search led to the identification of 12 articles. Results were categorized into five categories. 1. Individual psychological support, 2. Group psychological support, 3. Cognitive-behavioral group psychotherapy, 4. Brief psychoanalytic groups, 5. Multifamily group.

RESULTS

The interventions differed in terms of form, duration and resources used. Most of them were group-based and psychoanalytically oriented, although individual and cognitive-behavioral interventions were also described. Despite the differences, the interventions appeared to be fundamental in facilitating the processing of mental pain and anger related to the diagnosis.

CONCLUSION

Our study has shown that there are still few psychological interventions available for MM patients and their caregivers. The somatopsychic consequences of MM in patients and caregivers should encourage institutions and healthcare professionals to develop assessment and intervention models that address the different dimensions of their suffering and promote their residual vitality.

Confirmatory validation of a brief patient-reported outcome measure assessing psychological distress in caregivers of malignant mesothelioma patients: the Mesothelioma Psychological Distress Tool-Caregivers

Objective

The diagnosis of malignant mesothelioma (MM) can be devastating for both patients and caregivers, who may experience intense suffering from a physical, psychological, and interpersonal perspective. Despite the extensive literature on caregiver distress, there is a lack of validated measures to provide evidence of psychological distress of caregivers of MM patients. Therefore, in a previous study we developed the Mesothelioma Psychological Distress Tool-Caregivers (MPDT-C) to evaluate the specific profile of psychological distress in this population. This paper describes the item selection, factor analysis, and psychometric evaluation of the revised MPDT-C.

Methods

The analyses of this work first aimed to confirm the previous factorial structure. In the case of nonfit, it aimed to find an alternative structure and causes of nonfit in the model. Examination of the fit of the factorial model was conducted using a Bayesian approach.

Results

The final version of the MPDT-C is a 7-item self-report questionnaire consisting of one factor (Burden for the caregiver).

Conclusion

Having a short self-report questionnaire to assess the psychological distress experienced by caregivers of MM patients has several advantages. First, it is suited to epidemiological studies where multiple variables and measures are involved. Second, it is easy to administer and does not take much time to complete. Therefore, the MPDT-C can also be administered in clinical contexts, perhaps when MM patients attend follow-up medical evaluation. Lastly, short measures are less affected by cognitive fatigue, which is very common in a long battery of tests and could affect response reliability.

Socioecological factors influencing the risk of developing hypertensive disorders of pregnancy in India: a rapid review

BACKGROUND

The prevalence of hypertensive disorders of pregnancy (HDPs) in India is 11%, which is one of the highest rates globally. Existing research on HDPs in India primarily focuses on biological risk factors, with minimal research on how socioecological factors combine to increase risk of HDPs. We conducted a rapid review using Bronfenbrenner's Ecological Model to understand the social and cultural factors associated with HDPs among Indian pregnant women to identify possible intervention targets that may uniquely improve health in this population. Bronfenbrenner's Ecological Model is a framework that can be used to understand the complex relationship between multiple influences on health.

METHODS

We reviewed studies published between January 2010 and January 2024 using PubMed, Science Direct, and Scopus databases. Search terms included variants of hypertension, pregnancy, and India. Inclusion criteria were: (1) peer-reviewed journal article; (2) published between January 2010 to January 2024; (3) participants consisted of Indian women living in India; (4) studies evaluated socioecological risk factors associated with HDPs. One independent reviewer performed searches, screening, data extraction, and quality assessment. Each included study was then organized within Bronfenbrenner's Ecological Model.

RESULTS

A total of 921 studies were generated from the initial search, with 157 exclusions due to duplicates. Following screening for inclusion and exclusion criteria at the title/abstract and full text levels, 17 studies remained in the final review. Socioecological risk factors of HDPs were identified at each level, with the most commonly identified influences including: low socioeconomic status (SES), lacking community education and knowledge on HDP management and prevention, and lacking prenatal HDP screening.

CONCLUSION

This study determined that the high risk for HDPs in India is influenced by many intertwined socioecological factors. Women in rural and low SES areas need more health education on HDP management and prevention. There also needs to be more adequate prenatal HDP screening, with at least 4 and ideally 8 prenatal visits. Prenatal screenings should be accompanied with culturally appropriate patient education, especially for low SES women who have limited literacy, so that they can effectively make individual and microsystemic lifestyle decisions aimed at either managing or preventing HDPs.

"What it is like to be human": The existential dimension of care as perceived by professionals caring for people approaching death

OBJECTIVES

Existential/spiritual questions often arise when a person suffers from a serious and/or life-threatening illness. "Existential" can be seen as a broad inclusive term for issues surrounding people's experience and way of thinking about life. To be able to meet patients' existential needs, knowledge is needed about what the existential dimension includes. The aim of this study was to investigate how professionals caring for people with life-threatening disease perceive the existential dimension of care.

METHODS

This study is based on a mixed method design utilizing a digital survey with open- and closed-ended questions. Descriptive statistics were applied to closed-ended questions and a qualitative descriptive approach was used for the responses to the open-ended questions. Healthcare professionals at specialized palliative care units, an oncology clinic and municipal healthcare within home care and a nursing home in Sweden answered the survey.

RESULTS

Responses from 77 professionals expressed a broad perspective on existential questions such as thoughts about life and death. Identifying existential needs and performing existential care was considered a matter of attitude and responsiveness and thus a possible task for any professional. Existential needs centered around the opportunity to communicate, share thoughts and experiences, and be seen and heard. Existential care was connected to communication, sharing moments in the present without doing anything and was sometimes described as embedded in professionals' ordinary care interventions. The existential dimension was considered important by the majority of respondents.

SIGNIFICANCE OF RESULTS

This study indicates that with the right attitude and responsiveness, all professionals can potentially contribute to existential care, and that existential care can be embedded in all care. The existential dimension of care can also be considered very important by health professionals in a country that is considered secular.

Post-Traumatic Growth in Finnish Parents After the Traumatic Death of a Child

The traumatic death of a child may cause a wide range of emotional and behavioral responses in parents. In contrast to the extensive research and literature on the negative aspects of parental bereavement, the topic of post-traumatic growth in parents has received relatively little attention. This study addressed a need for further understanding post-traumatic growth in parents following the traumatic death of a child. To recruit participants, an online advertisement was posted on the websites of Finnish bereavement organizations, their member mailing lists, and closed discussion groups. Seventeen parents were interviewed in-depth over the phone. This qualitative involved an inductive content analysis of 401 narratives of post-traumatic growth in the grief experiences of participants. The post-traumatic growth identified featured positive attitudes toward life, positive attitudes toward death, enhancing one's spiritual life, improvements in well-being, concern about others' needs and wanting to help, and meaningful relationships. The findings highlight the increasing complexity of topics in spirituality and social work with bereaved parents.

Psychological interventions for emotional well-being in adults with advanced progressive life-limiting illness

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the benefits and harms of psychological interventions compared to treatment as usual, waiting list, active control, or another psychological intervention to improve emotional well-being in adults with an advanced progressive life-limiting illness.

Variation in grandmaternal investment in Ukraine

BACKGROUND

Grandmothers vary in their contributions to grandchildren based on their relatedness and the sex of the child. Maternal grandmothers decrease grandchildren's risk of mortality and increase grandchildren's health more significantly than paternal grandmothers, but limited evidence suggests that paternal grandmothers may invest more in female than male grandchildren.

AIMS

In this study, I test whether contact frequency between grandmothers and grandchildren is influenced by their relatedness (maternal vs paternal) or the sex of the child. This research was carried out in Ukraine because it is neither matrilocal nor patrilocal, and Ukrainian grandmothers are known to provide a high rate of childcare.

METHODS

This study included interviews with 60 grandmothers that asked about contact frequency with grandchildren, relatedness (maternal or paternal), and contact frequency between the grandchild and the other grandmother. A dataset generated for each grandchild (n = 128) included sex, age, and contact frequency with both maternal and paternal grandmothers. Linear mixed models were fit to the data to explore the relationship between grandmother relatedness and contact frequency.

RESULTS

On average, maternal grandmothers saw their grandchildren 173.8 days/year, while paternal grandmothers saw their grandchildren 87.5 days/year (p < 0.001). The sex of the child was not a significant factor in determining contact frequency.

CONCLUSION

In Ukraine, maternal grandmothers have more frequent contact with their grandchildren. This finding supports the idea that grandmaternal investment is an evolutionarily adaptive strategy. However, the bias towards maternal grandmothers may also be explained by a post-socialist cultural context, which necessitates grandmaternal care.

Stroke Experiences and Unmet Needs of Individuals of African Descent Living in High-Income Economy Countries: a Qualitative Meta-Synthesis

BACKGROUND

Stroke service disparities experienced by individuals of African descent highlight the need to optimize services. While qualitative studies have explored participants' unique experiences and service needs, a comprehensive synthesis is lacking. To address current knowledge gaps, this review aimed to synthesize existing literature on the experiences of individuals of African descent impacted by a stroke living in high-income economy countries in terms of stroke prevention, management, and care.

METHODS

A qualitative meta-synthesis incorporating a meta-study approach was conducted to obtain comprehensive and interpretive insights on the study topic. Four databases were searched to identify qualitative English-language studies published in the year 2022 or earlier on the experiences of adults of African descent who were at risk or impacted by a stroke and living in high-income economy countries. Study methods, theory, and data were analyzed using descriptive and interpretive analyses.

RESULTS

Thirty-seven studies met our inclusion criteria, including 29 journal articles and 8 dissertations. Multiple authors reported recruitment as a key challenge in study conduct. Multiple existing theories and frameworks of health behaviours, beliefs, self-efficacy, race, and family structure informed research positionality, questions, and analysis across studies. Participant experiences were categorized as (1) engagement in stroke prevention activities and responses to stroke symptoms, (2) self-management and self-identity after stroke, and (3) stroke care experiences.

CONCLUSIONS

This study synthesizes the experiences and needs of individuals of African descent impacted by stroke. Findings can help tailor stroke interventions across the stroke care continuum, as they suggest the need for intersectional and culturally humble care approaches.

Association of child maltreatment and school bullying among Chinese adolescents: the mediating role of peer relationships

BACKGROUND

School bullying, a serious problem for the physical and mental health of adolescents, is presently a significant issue in China. It is essential to recognize and comprehend potential risk factors and establish efficient preventive strategies. The purpose of this study was to examine the association between childhood maltreatment and school bullying in adolescents and to assess the mediating role of peer relationships.

METHODS

Between March and April 2024, a cross-sectional survey was conducted among 2119 adolescents aged between 12 and 18 years in Guangdong Province, China. Self-report questionnaires were employed to collect data on childhood maltreatment, school bullying, and peer relationships. Subgroup analyses and mediating effects modeling were employed to analyze the data.

RESULTS

The results indicated that adolescents who had experienced maltreatment were more at risk of bullying victimization (OR: 2.92, 95% CI: 2.34-3.64, P < 0.001), bullying perpetration (OR: 2.84, 95% CI: 1.99-4.05, P < 0.001), and bully-victimization (OR: 2.93, 95% CI: 1.95-4.41, P < 0.001), compared to adolescents who have not. Sexual abuse showed the most significant connection with all forms of bullying. The mediating effect of peer relationships was found to mediate the association between child maltreatment and bullying behaviour. The results indicated that worse peer relationships may exacerbate the adverse effects of maltreatment experiences and increase the risk of adolescents becoming bullies, either perpetrators or victims of bullying.

CONCLUSIONS

Child maltreatment has been identified as one of the most significant influences on bullying behaviour in adolescents. The quality of peer relationships has been demonstrated to play an important role in preventing and reducing the occurrence of bullying. The results underscore the crucial role of early intervention in cases of child maltreatment and the fostering of positive peer relationships in schools.

Characterizing the heterogeneity of disruptions in the resolution of trauma among women exposed to childhood maltreatment

The previously observed heterogeneity in developmental and intergenerational trajectories of childhood trauma may root from interindividual differences in the way trauma-exposed individuals have resolved these experiences. The current study explored whether distinctive patterns of impaired mentalization in relation to trauma could be identified in a sample of 825 pregnant women who experienced childhood maltreatment and whether these heterogeneous patterns were marked by significant differences in internalized and externalized problems during pregnancy, intimate partner violence, personality dysfunctions, and antenatal attachment. A latent profile analysis applied to the seven subscales of the Failure to Mentalize Trauma Questionnaire unraveled interindividual variability in mentalizing impairments among pregnant women exposed to childhood maltreatment by identifying five distinctive types of psychological responses to trauma, each being associated in cross-sectional analyses with a specific set of symptoms and dysfunctions. Overall, the study highlights the need for tailored interventions based on the individuals' specific impairments in mentalizing trauma and calls for future developmental research exploring the longitudinal correlates of the five documented profiles of trauma processing.

Migrant survivors of conflict-related sexual violence accessing a specialist health service in Turin, Italy: a qualitative analysis of clinical forensic interview transcripts

Introduction

The Sexual Violence Relief center Soccorso Violenza Sessuale (SVS) is a specialist service, situated in Sant'Anna Hospital, an Obstetrics and Gynecology facility in Turin, North-West Italy. The study aimed to qualitatively analyze the transcripts of interviews routinely conducted by gynecologist and midwife in the first part of the medical examination of migrant patients accessing care at SVS after being subjected to conflict-related sexual violence (CRSV) in their home country or during migration and to explore the adverse outcomes of such violence on their health.

Methods

Interview transcripts were purposely selected to include adult migrant patients (age > 18) subjected to CRSV in the different phases of migration and accessing SVS from January 1st, 2014, to September 4th, 2023. Data was extracted from the SVS archive, anonymized, and thematically analyzed.

Results and discussion

In total, 43 interview transcripts were eligible for inclusion. All of them were related to cisgender women of Sub-Saharan origin describing different forms of violence as a driver for migration. CRSV was disclosed by 18 survivors as occurring in their home country and by 31 in transit (e.g., Libya), the most reported type being rape. 49% of the patients described adverse physical outcomes of CRSV, while 72% reported psychological sequelae. The findings confirm high levels and different modalities of violence throughout the migratory route. Qualitative analysis of interview transcripts served as a valuable source for understanding how survivors described the CRSV they endured, its consequences, as well as other violence encountered during migration.

Perceived Emotional Invalidation, Psychological Distress and Relationship Satisfaction in Couples: An Actor-Partner Interdependence Mediation Analysis

Research has demonstrated a clear link between perceived emotional invalidation and increased psychological distress. However, available studies have predominantly focused on individual data, and leave the impact on relationship satisfaction largely unexplored. Considering the systemic-transactional model, our study aimed to examine the association between perceived emotional invalidation, psychological distress, and couple relationship satisfaction from a dyadic perspective. We conducted a cross-sectional study involving 240 mixed-gender couples from Portugal employing the Actor-Partner Interdependence Mediational Model to analyse the data to examine actor and partner direct and indirect effects. Results showed that, for both women and men, own perceived emotional invalidation was associated with own psychological distress but not with own relationship satisfaction. Also, own psychological distress was associated with own relationship satisfaction but only for women. Finally, one actor and one partner indirect effects were found. Women perceived emotional invalidation was associated with their own psychological distress which in turn contributed to lower levels of relationship satisfaction for both them and their partners. This study contributes to a deeper understanding of the dyadic effects of perceived emotional invalidation on psychological distress and relationship satisfaction within romantic relationships identifying interpersonal emotional dynamics as an important target of interventions.

Empirical examination of long-term and intensive psychodynamic psychotherapy for severely disturbed patients

Objectives This study examines the effectiveness and efficiency of intensive psychodynamic psychotherapy for severely impaired patients. Method: 104 patients in four public mental health centers underwent intensive psychodynamic psychotherapy. The number and duration of psychiatric hospitalizations were monitored for these patients from one year before therapy to eight years after. Several outcome variables were measured every six months, six times in total over two and a half years, using a longitudinal design. A multi-level analytic approach was applied to account for repeated measurements and missing data. Results: Significant improvement was found in all three symptomatic outcome measures (SCL-90, OQ-45, BDI) throughout treatment. The numbers of psychiatric hospitalizations and psychiatric hospitalization days decreased significantly from the level they were in the year before the start of psychodynamic treatment to three years after the start of treatment. These results were maintained for at least up to eight years. After capitalization, the overall cumulative 127.47-day decrease in hospitalization days equals savings of 115,850 NIS. The average cost of treatment after capitalization was 26,770 NIS. The insurer's estimated direct savings is 89,080 NIS (24,054 $). Conclusion: These findings support the hypothesis that psychodynamic psychotherapy is clinically effective and economically efficient for severely impaired patients.

Re-learning from teaching: a personal reflection on Jeremy Safran's legacy

Jeremy Safran's pedagogical style was singular in its emphasis on experiential learning through role-plays, use of session video recordings, and his full-hearted embrace of therapists' subjectivity as a tool for therapeutic change. This paper is a personal reflection on the author's experiences as Jeremy Safran's student and how they have translated into her own teaching and supervision. She shares how teaching has been a means of reconnecting with her experiences learning from Jeremy, and the ways in which she tries to carry forward his unique contributions to the next generation of students and trainees.

Remembering Jeremy Safran: continuing the conversation

This introduction provides an overview to this special issue honoring the work and legacy of Jeremy D. Safran. Born of the Jeremy Safran Memorial Conference, held on April 2nd, 2023, this issue features a wide range of contributions from leaders in the field, former students, and early career professionals whose work engages and develops central ideas from Safran's work and reflects on his impact on their own clinical work and scholarship. Themes center around the three domains of Safran's major contributions: pedagogy; psychotherapy integration; and Buddhism, spirituality, and psychoanalysis. We observe among the contributions an experiential reconnecting with the deeply relational commitments of our friend and colleague.

The heart of healing: Echoes of Sándor Ferenczi's legacy in Jeremy Safran's relational commitments

In this duet of two voices honoring Jeremy Safran's legacy, the authors celebrate some points of resonance between Sándor Ferenczi's groundbreaking relational interventions and Safran's approach to the therapeutic relationship as the heart of healing. Karen Starr first highlights Ferenczi's now well-known creative experimentation with technique and his emphasis on and care for the relational dimension of psychoanalytic treatment. Jill Bresler then links Safran's career-long dedication to the therapeutic alliance to Starr's introductory remarks, honoring Safran and Ferenczi's shared dedication to expanding options in clinical practice through focus on the relationship. Recalling Safran's naming Ferenczi as a key figure in psychotherapy integration's origin story, Bresler reflects on her own learning from Safran's groundbreaking transtheoretical research into the mutative aspects of psychotherapy and his translating a psychoanalytic focus on the therapeutic relationship to CBT researchers and practitioners.

Finding one's way

The following is a meditative reflection on an anecdote from Jeremy Safran's Psychoanalysis and Buddhism. Moving through Safran's description of an important moment in his development as a student of Buddhism, the author weaves images, practices, and ways of being and feeling into an homage to Safran's legacy integrating psychoanalytic and Buddhist praxis and epistemology.

The nested hierarchical model of self and its non-relational vs relational posttraumatic manifestation: an fMRI meta-analysis of emotional processing

Different kinds of traumatic experiences like natural catastrophes vs. relational traumatic experiences (e.g., sex/physical abuse, interpersonal partner violence) are involved in the development of the self and PTSD psychopathological manifestations. Looking at a neuroscience approach, it has been proposed a nested hierarchical model of self, which identifies three neural-mental networks: (i) interoceptive; (ii) exteroceptive; (iii) mental. However, it is still unclear how the self and its related brain networks might be affected by non-relational vs relational traumatic experiences. Departing from this background, the current study aims at conducting a meta-analytic review of task-dependent fMRI studies (i.e., emotional processing task) among patients with PTSD due to non-relational (PTSD-NR) and relational (PTSD-R) traumatic experiences using two approaches: (i) a Bayesian network meta-analysis for a region-of-interest-based approach; (ii) a coordinated-based meta-analysis. Our findings suggested that the PTSD-NR mainly recruited areas ascribed to the mental self to process emotional stimuli. Whereas, the PTSD-R mainly activated regions associated with the intero-exteroceptive self. Accordingly, the PTSD-R compared to the PTSD-NR might not reach a higher symbolic capacity to process stimuli with an emotional valence. These results are also clinically relevant in support of the development of differential treatment approaches for non-relational vs. relational PTSD.

The enchanted unconscious, impasses, negotiation and surrender: Jeremy Safran in dialogue with the Rebbes of Ishbitz/Radzin

Dr. Jeremy Safran had a unique talent to seamlessly weave together clinical work with his broad knowledge of philosophy, history, and theology. Alongside his commitment to researching the minutest clinical interactions, he was conscious of the broad values of the nature of the good life that underpinned his analytic approach. This paper will explore the concepts of the enchanted unconscious, clinical impasses, negotiation, and surrender, suggesting that these concepts together provide insight into Safran's larger philosophy of life. It will then provide the approach to these concepts of the Rebbes of Ishbitz/Radzin, a school of Polish Hasidic thought. It will conclude with an exploration of how both Safran's psychoanalytic approach and the Ishbitz/Radzin Rebbes' Hasidic approach to the Torah provide distinct insights and applications of these concepts, which can be mutually enriching for both disciplines.

EMBRACING DISAPPOINTMENT AS PSYCHOANALYTIC PRAXIS

Psychoanalysis involves studying how people maintain not knowing what they "know." As a result, how psychoanalytic psychotherapists orient toward what their patients may be experiencing but cannot say is at the core of psychoanalytic praxis. Jeremy Safran's unique psychoanalytic sensibilities were a model for how to yield to feeling states and relational dynamics that are at the heart of therapeutic action, but which all too frequently get bypassed. This brief recollection highlights how Safran's commitment to open inquiry and mutuality-not just with his patients but also with his students-continues to impact the field.

Letting go to let be: Psychoanalysis as creative flow

This paper explores experiences of surrender to an aspect of mind that is unconfined, empty of dualistic concepts, and lucidly aware. Ghent's concept of surrender, Farber's unconscious will, and Buddhist philosophers' essence of mind all link to creative processes described by Poincaré and Mozart. This impressionistic collage points to the spaciousness to know beyond our usual stories. From this essential mind more wholesome actions proceed.

Longitudinal trajectories of intensity and direction of emotions among athletes in sports competitions: do defense mechanisms matter?

OBJECTIVES

This study explored whether several subgroups of athletes representing distinct trajectories of intensity and direction of pleasant and unpleasant emotions (anger, anxiety, dejection, excitement, and happiness) could be shown to exist within the latent growth analysis (LCGA). A secondary objective was to examine whether athletes belonging to distinct trajectories of intensity and direction of emotions reported distinct scores of adaptive defense mechanisms (ADM) and maladaptive defense mechanisms (MDM).

DESIGN

A longitudinal four-wave measurement design was used in the present study.

METHOD

380 athletes completed the sports emotion questionnaire direction across four measurement times and the defense style questionnaire at the beginning of the season.

RESULTS

Results of LCGAs revealed several distinct emotional trajectories for each emotion intensity and emotion direction. Moreover, athletes belonging to distinct (adaptive or maladaptive) trajectories reported significantly different scores of ADM and MDM. Higher scores of ADM were reported by athletes belonging to adaptive trajectories of the direction of emotions.

CONCLUSIONS

Sports psychologists should try to promote ADM and defensive flexibility to help athletes perceive their emotions as facilitative.

Navigating the death attitudes and anxiety during COVID-19: Role of dispositional mindfulness and tranquil ego

BACKGROUND

Anecdotally, the concept of death consistently evokes profound unease. This study explores the intricate relationship between individuals' attitudes toward death and the associated anxiety, introducing a two-step model that posits dispositional mindfulness and tranquil ego as mediators.

MATERIALS AND METHODS

We used a correlational design in this study and assessed 209 Indian adults (111 males and 98 females) who recovered from corona symptoms on self-report measures of attitudes toward death, death anxiety, dispositional mindfulness, and tranquil ego. Bivariate correlational analyses and path analysis were used to analyze the data.

RESULTS

Findings revealed that attitudes toward death involving fear, avoidance, approach, and escape acceptance of death correlated positively with death anxiety. Dispositional mindfulness and tranquil ego correlated negatively with death anxiety. Path analyses with percentile bootstrapping supported our hypothesis and showed that dispositional mindfulness and tranquil ego sequentially mediated the relationship.

CONCLUSION

These findings indicate that various aspects of attitudes toward death differentially predict death anxiety. Moreover, the relationship between death attitudes and death anxiety is potentially mediated by dispositional mindfulness and a tranquil ego. The findings were discussed in light of existing literature.

To Talk or not to Talk About Existential Questions - An Interview Study With Elderly Persons and Patients With Fatal Disease

Background: Existential experiences often come to the fore in the case of a severe and/or life-threatening disease and in old age. This can evoke a variety of thoughts and emotions. The existential dimension is a concept that encompasses spiritual, religious and secular perspectives. Objective: The aim of this study was to gain a deeper understanding of how patients describe the existential dimension of life and whether and in what way the existential questions are raised in conversations and other forms of support within care. Methods: A qualitative design, with in-depth semi-structured interviews with patients admitted to an out-clinic oncology department at one hospital and participants living in a nursing home. The interviews were analysed using qualitative content analysis. Results: A total of 15 persons were interviewed. The respondents varied in age from 44 to 96. Two main themes emerged: What are existential questions? and Talk about existential questions. The existential questions refer to life as a whole and death as an end of life. It was summarized into three subcategories: The experience of the life, Existing within context and Spirituality and religion. About half of the participants thought it was important to talk about existential questions. They wanted to choose who to talk to, when and about what. Support was received from loved ones, professionals and experiences beyond conversations. Conclusions: The study provide new knowledge of how patients and elderly experience the existential dimension. The respondents emphasized a desire to be selective with whom they shared these questions and thoughts.

Perinatal intimate partner violence among teen mothers and children's attachment disorders in Rwanda: potential mediating factors

Background: The alarming prevalence of teen mothers' exposure to perinatal intimate partner violence (IPV, 8.3-67%) and attachment disorders (ADs) among their children is a global concern, especially in sub-Saharan Africa with high teenage pregnancy rates. This study, therefore, aimed to examine the link between teen IPV and AD in their offspring. We sought also to explore the mediating roles of postpartum depression symptoms, maternal sensitivity, parenting stress, and perceived social support in the relationship between perinatal IPV and children's ADs.Method: This cross-sectional study selected a random sample of 309 teen mothers from Nyanza district. This sample size was determined using Yamane's formula, with random sampling. Various instruments were used for data collection, including questionnaires on intimate partner violence, social support, maternal sensitivity, postpartum depression symptoms and parenting stress and early trauma-related disorders. The data was analysed using SPSS, with mediation analyses performed using the PROCESS macro (version 4.1).Results: IPV was found to be significantly associated with attachment disorders. Simple mediation models showed that parenting stress completely mediated these relationships, while postpartum depression, perceived social support, and maternal sensitivity partially mediated the relationship between IPV and children's ADs. In parallel mediation model, the combined roles of all mediators fully mediated the associations between IPV and ADs.Conclusion: These findings offer valuable insights in designing or strengthening the appropriate interventions to prevent and mitigate the perinatal intimate partner violence and its detrimental impact on children's attachment disorders. Combating intimate partner violence in post-conflict situations is challenging in teen mothers, however, our results suggest that efforts to address maternal mental health and parenting practices may protect children from attachment disorders.

Navigating the Countertransference Experience: A Transtheoretical Specifist Model

The attempt to identify and classify distinct experiences falling under the common designation of countertransference has been labelled the specifist tradition. In this paper, a model describing two dimensions differentiating four components of countertransference experience is proposed. For each experiential component (subjective countertransference, objective countertransference, therapeutic attitude and emerging experience), a brief description based on previous literature from diverse theoretical fields is offered, along with clinical implications and illustrations and an account of empirical literature explicitly or implicitly addressing the specific component. In conclusion, the model is presented as a heuristic guide that can serve different purposes across different therapeutic orientations, with valuable implications for practice, training and supervision.

Monster Menstrual: Women, Girls, and Queer Horror in Stranger Things

The 2016 Netflix series Stranger Things is a calculated homage to the 1980s; in addition to its period setting and the inclusion of star Winona Ryder, it further incorporates tropes and references from popular 1980s’ films including Stand By Me, E.T., and The Goonies. But the series does not only draw from stories about young boys coming of age in America; it also calls back to Stephen King’s Carrie and other science fiction and paranormal images marked by the fear of female sexuality. Stranger Things’ slimy passages, alien umbilical cords, “demogorgon” vaginas dentata, and liminally gendered and sexualized characters all speak to long-standing fears about the monstrous feminine, and further invoke the monstrous queer. Stranger Things is a contemporary take not only on 1980s’ cinema but on classical feminine body horror, and this analysis interrogates the series’s positioning as a feminist text.

Moms in motion: Predicting healthcare utilization patterns among mothers in Newfoundland and Labrador

Mothers have a significant influence on family dynamics, child development, and access to family services. There is a lack of literature on the typical Canadian maternal experience and its influence on access to services for mothers despite recognizing the importance of mothers. A cross-sectional study was conducted to address this research gap that employed Andersen's Behavioral Model of Health Service Use in conjunction with a feminist lens. A total of 1,082 mothers who resided in Newfoundland and Labrador (NL) participated in a province-wide survey in 2017 and reported on their wellbeing, family life, and healthcare utilization. Stepwise binomial logistic regressions and linear regressions were used to predict initiation and continued service utilization within the preceding 12 months, respectively. Mothers who participated in this survey were older, and were more likely to be in a relationship than those in the Canadian census, while no difference was observed in annual income. Approximately half of mothers accessed services for themselves over the previous 12-months, with the overwhelming majority accessing services for their children. Medical services were the most likely to be utilized, and mental health and behavioural services were the most likely services to be needed, but not available. Sociodemographic (e.g., age, education attainment), familial relationships and role satisfaction, health need, and health practices predicted maternal initiation and continued use of services, with a larger number of variables influencing maternal service initiation as compared to continuous use of services. Sociodemographic (e.g., maternal age, community population), maternal social support, health need, and maternal health practices predicted maternal access of at least one child service while family relationships, health need, and maternal health practices predicted maternal use of a range of child services conditional on initial access. These results can support the provincial health system to better support access to care by acknowledging the interdependent nature of maternal and child health care utilization. They also highlight the importance of equitable healthcare access in rural locations. Results are discussed in terms of their clinical relevance to health policy.

The Mental Health Outcomes and Cost Estimates of Korean Medicine for Anxiety Disorder Patients

Korean medicine (KM) is used to treat anxiety disorders, but there is limited research on its effects. This study aimed to examine the associations between improved QoL and reduced clinical symptoms and KM in patients with anxiety disorders. The medical records of patients with anxiety who were treated with KM (acupuncture, psychotherapy, Chuna therapy, aromatherapy, or herbal medicine) for at least 4 weeks were retrospectively analyzed. Clinical, QoL, and cost outcomes were measured at baseline and at weeks 4 and 12 (Anxiety: State-Trait Anxiety Inventory [STAI X-1 (state), X-2 (trait)], Beck Anxiety Inventory [BAI]; anger: State-Trait Anger Expression Inventory State [STAXI-S (state), T (trait)], Anger Expression Inventory [AXI-K-I (anger-in), AXI-K-O (anger-out), AXI-K-C (anger-control); depression: Beck Depression Inventory-II [BDI II], QoL: QoL-related instruments Euro Quality of Life 5 Dimensions utility score [EQ-5D], Euro QoL Visual Analog Scale [EQ-VAS]). The total costs for each item were calculated in terms of NHIS-covered costs and patients' out-of-pocket costs from the perspective of the healthcare system. The medical records of 67 patients were evaluated. The KM treatments were found to be associated with decreased anxiety (STAI X-1; STAI X-2; BAI, p < 0.0001), depression (BDI-II, p < 0.0001), and anger (AKI-K-I; AKI-K-O, p < 0.05) and increased QoL (EQ-5D; EQ-VAS, p < 0.0001). An average of USD 1360 was paid for the KM treatments for 4 weeks. The study findings suggested that KM may improve clinical symptoms and QoL outcomes in patients with anxiety disorders.

Living with mesothelioma: a systematic review of mental health and well-being impacts and interventions for patients and their informal carers

OBJECTIVES

Mesothelioma is an aggressive cancer predominantly affecting the lung and abdominal linings. It can have a unique impact on mental health and well-being (MHWB) due to its incurability, poor prognosis and asbestos-exposure causation. This review's aims were to identify/synthesise international evidence on mesothelioma's MHWB impacts; explore MHWB interventions used by patients and carers; and identify evidence of their effectiveness.

DESIGN

Systematic review.

DATA SOURCES

Databases, searched March 2022 and March 2024, were MEDLINE; CINAHL; PsycINFO; Cochrane Library; ASSIA.

ELIGIBILITY CRITERIA

We included study designs focusing on psychological impacts of living with mesothelioma and MHWB interventions used by patients and informal carers, published in English since January 2002.

DATA EXTRACTION AND SYNTHESIS

A team of reviewers screened included studies using standardised methods. Quality was assessed using validated tools: Mixed-Methods Appraisal tool for primary research and Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews.

RESULTS

Forty-eight studies met the inclusion criteria: 20 qualitative, 16 quantitative, nine reviews, two mixed-methods, one combined systematic review/qualitative study. UK studies predominated. Many MHWB impacts were reported, including traumatic stress, depression, anxiety and guilt. These were influenced by mesothelioma's causation, communication issues and carer-patient relational interactions. Participants used wide-ranging MHWB interventions, including religious/spiritual practice; talking to mental-health professionals; meaning-making. Some strategies were presented as unhelpful, for example, denial. Participants reported lack of access to support.

CONCLUSIONS

Most qualitative studies were rated high quality. The quality of the quantitative studies and reviews varied. The sparse literature regarding MHWB in mesothelioma means more research is needed into impacts on patients and carers, including trauma. To enable access to evidence-based support, research is recommended concerning MHWB interventions' effectiveness in mesothelioma.

PROSPERO REGISTRATION NUMBER

CRD42022302187.

Do Narcissist Phubs or Get Phubbed? Analyzing the Role of Motivational Systems

Phubbing is a common sight, but it is not merely a technological faux pas. The present study aims to explore phubbing (phubbing others and getting phubbed) through the lens of two types of personalities (grandiose and vulnerable narcissism). Moreover, the study also aimed to evaluate the indirect role of motivational systems (BAS/BIS) between these two sets of variables. The sample of the study comprised 525 Indian college students. Data were analyzed through Hayes Process Macro (Hayes) in SPSS (Version 26). Vulnerable narcissism was found to be positively related to phubbing others and getting phubbed. Grandiose narcissism was found to be related to phubbing others but not to getting phubbed. BAS and BIS were significantly and positively related to phubbing and getting phubbed. BAS indirectly affected the relationship between two kinds of narcissism (vulnerable and grandiose) and phubbing (phubbing others and getting phubbed); however, BIS failed to influence the relationship between narcissism and phubbing. The results of the present study challenge the notion that all phubbing behaviors are truly deviant as narcissistic personality played an important role in phubbing behavior. The study also highlighted the importance of rewards and punishment on phubbing behaviors, and therefore there is a need to focus on BAS and BIS while dealing with phubbing behaviors.

Intercultural therapy with Ultra-Orthodox Jews in Israel: the complexity of the encounter between secular therapists and Haredi clients

This paper explores the exceptional intercultural encounter between secular therapists and Ultra-Orthodox Jews in Israel, focusing on two key aspects. Firstly, it explores the distinctive attributes and conflicts inherent in treating Ultra-Orthodox individuals. On the one hand is the secular Israeli therapist, whose base is in Western philosophy that prioritizes individuality, cultural diversity, and tolerance of differences. On the other hand is the Haredi client, entrenched in values from Jewish tradition and religious principles that amplify solidarity and collectivism while rejecting prevalent secular culture. The existing socio-political climate in Israel often positions these two as potentially conflicting cultures. Secondly, the paper seeks to illuminate the uncommon dynamics of the minority-majority power balance within the therapeutic relationship. In contrast to prevalent literature in intercultural therapy, which typically frames the client as a representative of a disadvantaged minority and the therapist as a representative of a dominant majority, this article aims to unravel a nuanced power balance, where those in the minority perceive the dominant culture both as a threat to its way of life and as a despised entity, but paradoxically rely entirely on its financial support. This reveals a complex and intricate interplay of dominance and dependence, shaping a therapeutic relationship that defies conventional expectations.