Review: Clinical Varieties of Transference

The article reviewed here is ‘Clinical Varieties of Transference’, a transcript of a talk given by Donald Winnicott at the 19th International Psycho-Analytical Congress in Geneva 1955. Despite being fairly brief (just a few pages) the article is rich in ideas and I found it took some reading and rereading. As it’s one of his latter papers, there is a lot of referencing to his earlier work as well as that of his contemporaries. He first of all remarks that in initial years, psychoanalytic theory was developed through work with a group of patients who had passed through certain phases of development without difficulty as there had been ‘good enough infant care’. As a result

‘The earlier stages of the establishment of the ego could be taken for granted by the analyst‘

He then refers to the primary identification and describes it as a period in the infant’s development in which the individual has not been distinguished from the environment. On progressing from this primary identification, Winnicott outlines two possibilities – either there is a good-enough adaptation of the ego to the environment or there isn’t in which case

‘instead there develops a pseudo-self which is a collection of innumerable reactions to a succession of failures of adaptation‘

This pseudo-self he refers to as the false self which allows the real self to experience a ‘continuity of being’ but ‘cannot, however, experience life or feel real’. Then Winnicott suggests that in therapy session the analyst may make mistakes which are helpful in the therapeutic process but overall when the therapy is considered ‘good-enough’ then

‘raises a hope that the true self may at last be able to take the risks involved in its starting to experience living‘

There follows a period in which the ego can ‘experience id impulses’. He distinguishes the ‘objective anger’ at the analyst’s mistakes from the ‘negative transference of neurotic analysis’.

The ideas discussed here are profound and relate to the very practical aspects of the therapeutic process. While it would have been helpful to have excerpts from the therapy sessions to illustrate the points, this paper was derived from a talk where perhaps the primar aim was to disseminate practical insights to fellow therapists rather than develop the underlying theory at that point.

References

Donald Winnicott. Clinical Varieties of Transference [1955-1956]. Read before the 19th International Psycho-Analytical Congress, Geneva, 1955. Int J Psycho-Anal, Vol XXXVII, p386, 1956. Chapter XXIII (pp295-299) In D.W.Winnicott. Through Paediatrics to Psycho-Analysis. With an Introduction by M.Masud R.Khan. The International Psycho-Analytical Library. Edited by M.Masud R.Khan. The Hogarth Press and the Institute of Psycho-Analysis. 1978.

Steps to Treatment

STT3 (Advice is relevant to treatment but needs to be tested in intervention studies which then need to be incorporated into relevant policies if successful).

Steps To Treatment (STT)

STT = Steps To Treatment. An estimate of the number of steps between the results and translation into treatment. This is an opinion.

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Review: Discussion of Puzzlingly High Correlations in fMRI Studies of Emotion, Personality and Social Cognition

The featured article is a response by Lazar to Vul et al’s paper on statistics used in fMRI (and reviewed here) and Lazar’s article is freely available here. Vul’s article presents a useful focus for examining the statistical techniques used in fMRI and a systematic analysis of the responses to this paper should offer insights into the diversity of approaches considered in such analysis. Lazar is based in the Department of Statistics at the University of Georgia. He starts off the article with this neat observation

‘Statistical tools were originally devised for a rather specific set of circumstances – mostly small or moderately sized data sets, collected under controlled experimental conditions’

I was reassured to find that Lazar refers to Vul et al’s use of the term ‘non-independence error’ as a ‘selection bias’ which I had also considered in my original review above. He discusses the issue of selection bias in other fields further and I was intrigued to read of Benjamini’s experience in discussing a possible selection bias in the field of genetics.

Lazar has many interesting sessions and reiterates an important point made elsewhere

‘Increased transparency in reporting the details of an analysis will also help’

Lazar tells us that he is working with colleagues to develop new statistical approaches to analysing imaging data and suggests that researchers will move away from the correlation analysis as more appropriate forms of analysis take their place. He also warns us against the basic mistake of analysing the same data set twice and notes the increasing complexity of data available for analysis.

While relatively brief, I thought this was a thought-provoking article which suggests changes not just in neuroimaging but also in the field of statistics.

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

News Round-Up: June 2009 4th Edition

Research in Dementia

In one post-mortem study all subjects with Lewy Bodies were retrospectively found to be functionally impaired although the calculation of an odds ratio was not possible (paper freely available here) (Byford et al, 2009)(STT4). A type of swelling in the Purkinje cell axons referred to as a Torpedo was found to be elevated in people with Alzheimer’s Disease, Parkinson’s Disease and to a greater extent in cerebellar essential tremor in this post-mortem study (Louis et al, 2009)(STT5). In an autopsy series (n=466) there was found to be no association between a measure of atherosclerosis in the circle of Willis (a marker of large vessel disease) and amyloid plaque in the frontal cortex or neurofibrillary tangles in the hippocampus (Luoto et al, 2009)(STT4).

Research in Psychosis

A naturalistic study (n=325) provided evidence that had greater efficacy for treatment of schizophrenia (using outcome measures including the PANSS) than chlorpromazine or haloperidol (Ravanic et al, 2009)(STT4).

News in Brief

In a prospective 5-year study of 906 older adults decreasing social activities (using a Likert Scale) were significantly associated with decreasing motor skills including strength and balance. A comparison of elderly people in the United States (from the Health and Retirement Study) and England (from the English longitudinal study of Aging) found that the American cohort performed significantly better on a number of cognitive measures than their counterparts in England. Members of the researcher team suggested that different treatment approaches to hypertension between the two countries may have contributed to these differences. The long and short versions of the period3 gene have been implicated in response to sleep deprivation and this study found that a different pattern of recruitment of cortical regions in a working memory task which the authors suggest as a potential intermediate step in the causal chain from gene to sleep deprivation response. A study has provided evidence that Amitriptylline binds to the tRKA and tRKB receptors causing dimerisation and results in outgrowth of neurites actions which parallel those of Nerve Growth Factor.

An MRI study (n=77 roughly) of people with dyslexia and a roughly equal number of controls without provided evidence of a difference between the groups in the right cerebellar declive and the right lentiform nucleus (the original article is freely available here). There have been previous studies which have implicated the cerebellum in language. The Canadian ‘Center for Addiction and Mental Health’ recently estimated that 1/25 of deaths globally are alcohol related (also covered here). Gaze is important in human social interactions and one study provided evidence that our interpretation of another person’s direction of gaze is influenced by our understanding of their internal state. These findings are relevant to social cognition theory. The authors of a recently published meta-analysis concluded that CBT was not effective in treatment of schizophrenia or in prevention of relapse in Bipolar Disorder and it will be interesting to see responses to this meta-analysis. A recent study provided evidence that Rhesus monkeys and humans share a similar mechanism for recognising faces by using a paradigm which involved the ‘Thatcher Effect’. This involves inverting facial features, the eyes and mouth and interferes with the task of facial recognition in both species.

In one study, students with higher levels of anxiety were found to spend more time focusing on irrelevant words (distractors) in a reading task. They were also given a maths task and it was found that the correct responses were similar in both the anxiety and control groups but the former group took longer to complete the tasks. (the article is freely available here). A recent study involved 1224 bloggers and found that the main principles which bloggers valued were ‘truth, accountability, minimising harm and attribution’. Depending on the purpose of the blog, the priority of these values differed. Three 35,000 year-old bone and ivory flutes have been found in Germany.

References

Byford M, Brayne C, McKeith I, Chatfield M, Ince PG, Matthews FE, Cfas. Neuropathology Group M.BMC Geriatr. 2009 Jun 15;9(1):22. [Epub ahead of print]. Lewy bodies and neuronal loss in subcortical areas and disability in non-demented older people: a population based neuropathological cohort study.

Louis ED, Faust PL, Vonsattel JP, Honig LS, Rajput A, Rajput A, Pahwa R, Lyons KE, Ross WG, Elble RJ, Erickson-Davis C, Moskowitz CB, Lawton A. Mov Disord. 2009 Jun 12. [Epub ahead of print]. Torpedoes in Parkinson’s disease, Alzheimer’s disease, essential tremor, and control brains.

Luoto TM, Haikonen S, Haapasalo H, Goebeler S, Huhtala H, Erkinjuntti T, Karhunen PJ. Eur Neurol. 2009 Jun 12;62(2):93-98. [Epub ahead of print]. Large Vessel Cerebral Atherosclerosis Is Not in Direct Association with Neuropathological Lesions of Alzheimer’s Disease.

Ravanic DB, Dejanovic SM, Janjic V, Jovic SD, Milovanovic DR, Jakovljevic V, Pantovic V, Ravanic B, Pantovic M, Pantovic MM.Arq Neuropsiquiatr. 2009 Jun;67(2A):195-202. Effectiveness of clozapine, haloperidol and chlorpromazine in schizophrenia during a five-year period.

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.