EMDR-based treatment of psychotraumatic antecedents in illicit drug abusers: a report of two cases

The co-occurrence of PTSD and of substance use disorder (SD) is known to be very high. However the question of whether and how to treat such patients remains largely unanswered in the EMDR community. We report on two cases of EMDR-based treatment of heavily affected SD patients in whom psychotraumatic antecedents were identified. EMDR sessions focused on trauma-related material and not on the expression of cue-induced drug craving. The treatment appeared to be a difficult and challenging endeavour. However, some beneficial effects on general comfort and on drug consumption could be observed. A long stabilization phase was mandatory and the standard EMDR protocol needed to be conducted with much flexibility. Interestingly, there was no provocation of a prolonged psychological crisis or of relapse. Experiencing of emotional stress could be limited to the sessions and dissociation could be absorbed with specific well-known techniques without permanently increasing drug craving. These observations are discussed in relation to previously published concepts of using EMDR in the field of trauma and substance abuse.

Psychometric properties of the french translation of the constructive thinking inventory in a sample of adolescents and young adults

The Constructive Thinking Inventory (CTI) measures cognitive coping strategies used in everyday problem solving. The main objective of this study was to assess the factorial structure, the internal consistency, the correspondence with the American normative values, and the discriminant validity of the French translation. A community sample of 777 students aged 12 to 26 years, recruited from schools, colleges and universities, answered the 108item selfreport CTI questionnaire during a class period. A sample of 60 male adolescent offenders aged 13 to 18 years, recruited from two institutions for juvenile offenders, answered the CTI during an individual interview. Results show that the French translation of the CTI follows an identical factorial structure as the Epstein's American version in both adolescents and young adults, and that its internal consistency is satisfactory. Differences in Constructive Thinking profiles according to gender and age and between Swiss and American samples, are discussed. Juvenile offenders differed from community youths on most of the scales, speaking for a good discriminant validity of the CTI. In conclusion, the French translation of the CTI appears to preserve the original version's psychometric properties. The present study provides normative values from a community sample of Swiss adolescents and young adults.

The Island of Drive. Representations, somatic states and the origin of drive

Freud defined the drive as "a concept on the frontier between the mental and the somatic". Today this view that was based on clinical observations interpreted within the psychoanalytical framework, can be revisited in light of the current neuroscientific notions of neuronal plasticity and somatic states. Indeed, through the mechanisms of plasticity experience leaves a trace that forms the neural basis of a representation of the experience. Such a representation R is associated with a somatic state S in the sense taken from the "somatic marker" model of Damasio. Thus, the internal reality of the subject, particularly the unconscious one, is constituted by such connected R's and S's. In the model that we discuss, the posterior insula represents the primary interoceptive cortex where information about somatic states S converges, while in the anterior insula the connection between R and S can take place and establish a neurobiological correlate for the notion of drive. We posit that the re-representations of S associated with R in the anterior insula may correspond to the Vorstellungsrepräsentanz postulated by Freud. We further propose that the tension between R and S established in the anterior insula is discharged according to the notion of drive through the motor arm of the limbic system, namely the anterior cingulate cortex which is heavily connected with the anterior insula.

La qualité des soins dans les consultations ambulatoires pédopsychiatriques du canton de Vaud: résultats d'une enquête de satisfaction

It is common knowledge that patients' satisfaction influences their compliance with the proposed treatment and their future use of health services, and that the therapeutic alliance represents a recognised factor in the success of psychotherapeutic management. In May and June 2011 we conducted an enquiry in all the paedopsychiatric outpatient units of the Canton of Vaud in Switzerland, from which we gathered 1261 questionnaires from consulting children and their parents. The questions covered inter alia overall satisfaction concerning the quality of the care on off er, perception of the therapeutie alliance and the helpfulness of the varions types of treatment. The instruments used are recognised and validated internationally (HAQII and CSQS). The results reve al a high degree of satisfaction and a good perception of the therapeutic alliance's quality: an average of 4.9 for children and 5.9 for parents concerning the therapeutic alliance, on a scale from 1 (totally disagree) to 6 (totally agree), and concerning patient satisfaction an average of 3.2 for children and 3.4 for parents on a scale of 1 to 4. Regarding perception of the benefit derived from different forms of treatment, individual and family interviews were overwhel~ningly approved (3.2 out of 4), while compliance with drug treatment was less recognised as helpful to children (2.3 out of 4).

Prise en soins de la schizophrénie chez la personne âgée

Care of the elderly schizophrenic patient : Despite the development of new aetiopathological models the treatment of late-life schizophrenia is still based essentially on antipsychotic medication. The absence of research specifically targeting late-life schizophrenics limits the value of recommendations on indication, dosage and treatment alternatives, particularly as the latter have scant regard for the age of schizophrenia onset (early, late, very late onset), for the various comorbidities and the polymedication so common in the elderly. The use of atypical neuroleptics at adapted doses should be combined with biopsychosocial care and treatment of psychiatric and somatic comorbidities. The choice of an adapted treatment is often conditioned, especially if early schizophrenia is con sidered, by many years of treatment and side effects which may limit compliance when the evolution itself has been unfavourable with persistent, sometimes handi capping residual symptoms. Moreover, schizophrenia is complicated by cognitive disorders for which the best therapeutic approach in the elderly remains uncertain.

Sequential therapist interventions and the therapeutic alliance: a pilot study

(from the journal abstract) Scientific interest for the concept of alliance has been maintained and stimulated by repeated findings that a strong alliance is associated with facilitative treatment process and favourable treatment outcome. However, because the alliance is not in itself a therapeutic technique, these findings were unsuccessful in bringing about significant improvements in clinical practice. An essential issue in modern psychotherapeutic research concerns the relation between common factors which are known to explain great variance in empirical results and the specific therapeutic techniques which are the primary basis of clinical training and practice. This pilot study explored sequences in therapist interventions over four sessions of brief psychodynamic investigation. It aims at determining if patterns of interventions can be found during brief psychodynamic investigation and if these patterns can be associated with differences in the therapeutic alliance. Therapist interventions where coded using the Psychodynamic Intervention Rating Scale (PIRS) which enables the classification of each therapist utterance into one of 9 categories of interpretive interventions (defence interpretation, transference interpretation), supportive interventions (question, clarification, association, reflection, supportive strategy) or interventions about the therapeutic frame (work-enhancing statement, contractual arrangement). Data analysis was done using lag sequential analysis, a statistical procedure which identifies contingent relationships in time among a large number of behaviours. The sample includes N = 20 therapist-patient dyads assigned to three groups with: (1) a high and stable alliance profile, (2) a low and stable alliance profile and (3) an improving alliance profile. Results suggest that therapists most often have one single intention when interacting with patients. Large sequences of questions, associations and clarifications were found, which indicate that if a therapist asks a question, clarifies or associates, there is a significant probability that he will continue doing so. A single theme sequence involving frame interventions was also observed. These sequences were found in all three alliance groups. One exception was found for mixed sequences of interpretations and supportive interventions. The simultaneous use of these two interventions was associated with a high or an improving alliance over the course of treatment, but not with a low and stable alliance where only single theme sequences of interpretations were found. In other words, in this last group, therapists were either supportive or interpretative, whereas with high or improving alliance, interpretations were always given along with supportive interventions. This finding provides evidence that examining therapist interpretation individually can only yield incomplete findings. How interpretations were given is important for alliance building. It also suggests that therapists should carefully dose their interpretations and be supportive when necessary in order to build a strong therapeutic alliance. And from a research point of view, to study technical interventions, we must look into dynamic variables such as dosage, the supportive quality of an intervention, and timing. (PsycINFO Database Record (c) 2005 APA, all rights reserved)