Working with the complexities of adolescent mental health problems: applying Time‐limited Adolescent Psychodynamic Psychotherapy (TAPP)

This article discusses the application in a CAMHS setting of a distinctive intervention for adolescent mental health difficulties, Time‐limited Adolescent Psychodynamic Psychotherapy (TAPP). TAPP has been developed specifically for working with adolescents and the characteristic developmental and psychosocial complexities they present to mental health services. It is widely recognised that supporting the developmental process in adolescence is central to therapeutic interventions and the therapeutic aim of TAPP is to enable recovery of the capacity to meet developmental challenges. The key factors of TAPP are described, including the formulation and working with a developmental focus, the therapeutic stance, working with transference and counter‐transference, working with time limits, and the emphasis on engagement of adolescents in therapy in TAPP. The experiences of introducing and developing TAPP in the CAMHS service are discussed with two brief and one extended case examples and this leads to a discussion of the kinds of outcomes achieved. It is concluded that TAPP is a key and relevant intervention for adolescents in complex and vulnerable situations; further work will be undertaken to continue its application in these settings and to formally assess outcomes.

Autistic Functioning and Language Development

This thesis is a retrospective qualitative study based on psychotherapy sessions with children presenting autistic features who use language in atypical ways. The aim was to understand, through the transferential relationship, what psychological context in terms of anxieties and defences prevents the child from using language efficiently. Hypotheses concerning children‘s use of language in the context of their emotional oscillation and evolution during the course of treatment were noted and checked against subsequent developments. They were also triangulated with the outcome of a grounded theory analysis. The grounded theory analysis led to the emergence of higher-level themes that were compared within and across cases and allowed factors surrounding the children‘s use of language to be conceptualized. The grounded theory method was used in parallel with the usual process of evaluation of the dynamics of each session and patient used by psychoanalysts a posteriori and which is part of the researcher‘s background. This procedure was enhanced by the use of Bion‘s Grid, here in a version adapted to the aims of the research. This approach is discussed in detail in the Methodology chapter. The psychoanalytic theoretical background that supported the research was mainly based on the tradition of Object-Relations Theory, particularly the evolution of Kleinian thinking represented by Bion‘s works, and as far as autism is concerned, by Frances Tustin and Donald Meltzer‘s formulations. Concerning the subject of language development, Meltzer‘s explorations on the necessary conditions for its development and the philosopher Wittgenstein‘s investigations on the social function of language were the main influences of this work. The evolution of the children‘s use of language in parallel with their emotional development in the context of their psychotherapies was analyzed and some hypotheses about the oscillations in their emotional and mental functioning were made. The oscillation in the children‘s emotional state, language use and thinking processes was also studied in terms of a general fluctuation between different mental states that was considered to be present in different degrees and quality in mental life and more strongly when there are limitations in communication skills and social interaction. A few excerpts from notes on adolescent and adult cases with autistic features were included in the Discussion Chapters to briefly illustrate this aspect.

Scholarly chronographics: can a timeline be useful in historiography?

Our paper is concerned with the visualisation of historical events and artefacts in the context of time. It arises from a project bringing together expertise in visualisation, historiography and software engineering. The work is the result of an extended enquiry over several years which has included investigation of the prior history of such chronographics and their grounding in the temporal ontology of the Enlightenment. Timelines - visual, spatial presentations of chronology - are generally regarded as being too simple, perhaps too childish, to be worthy of academic attention, yet such chronographics should be capable of supporting sophisticated thinking about history and historiography, especially if they take full advantage of the capabilities of digital technologies. They should enable even professional academic historians to 'make sense' of history in new ways, allowing them insights they would not otherwise have achieved. In our paper we highlight key findings from the history of such representations, principally from the eighteenth and nineteenth centuries, and show how, in a project to develop new digital chronographics for collections of cultural objects and events, we have explored new implementations of the important ideas we have extracted about timewise presentation and interaction. This includes the representation of uncertainty, of relations between events, and the epistemology of time as a 'space' for history. We present developed examples, in particular a chronographic presentation of a large database of works by a single author, a composer, and discuss the extent to which our ambitions for chronographics have been realised in practice. Keywords: timeline, chronographics

Othering, blame and shame when working with people living with HIV

Significant advances in HIV treatment has meant that for the majority of patients with HIV they are able to live a normal lifespan. However, HIV remains a highly stigmatizing disease with the potential to significantly impact on ones social identity and sense of self. This paper draws on data from a qualitative study of interviews with five gay men, to explore the experiences of shame in relation to living with HIV. The paper adopts a psychoanalytic lens to highlight the mechanisms of splitting that may be involved at both a social and individual level, and the experience of shame among the participants. The paper aims to use this research data to supplement our understanding of what may be occurring ‘on the couch’ with patients who are living with HIV.

Psychotherapy and its alternatives: Commentary on a critique

In this commentary, Michael Rustin reviews the articles in the symposium, outlining their main aims and arguments. He goes on to provide some critical reflections, asking questions about the key concept of the ‘therapeutic state’. He notes that little attention is given to psychoanalytic or other psychological theories of the mind, as distinct from the biological models which are the main object of criticism in the symposium. He argues that just as it is justifiable and useful to take account of theories of the mind in considering issues of mental health and therapy, so it is desirable also to take account of the structures of society which have responsibility for generating conditions of mental well- or ill-being, and to reflect on how these may be changed. The commentary argues that the counter-cultural and somewhat ‘post-modern’ critical approach which informs the symposium can only form part of a sufficient response to the problems which the symposium identifies.

Adequação de estratégias de ensino-aprendizagem numa turma reduzida : estudo de caso

Relatório da Prática de Ensino Supervisionada, Mestrado em Ensino (Economia e Gestão/Contabilidade), Universidade de Lisboa, Instituto de Educação, 2011

Aphomoioo : existir entre o processo e a obra

Coming from the need to express an image – aphomoioo – is more than a dissertation trying to prove its argument. It is the result of an experimentation born from within an anguish felt through an image. An uncontrollable desire that transforms my need into an answer to my craft. Through a discursive organization of speech enmeshed by psychoanalytic, biological, philosophical and linguistic concepts, we are allowed to discover that existing is more than agreeing on a target with an end but, as the relationship that it is, it does not define us as beings, but as an active/interactive limit. And this identity which puts us face to face with the reality - constructed and constructive - seeking to describe the similarity of the existence of things, the images. These beings from the reality that sends us to the symbolic place of our existence, the mundanity. A restlessness that is embedded into every action of knowing that, through language, establishes as true everything which silences the symbolic through a rule of conduct - the principle of reason - a formal rule of all knowledge that establishes the contemplative way for all knowledge originally set up as one signification event. The nature of our organization as living beings, our structural coupling, is what enables us to conclude that all formalities established as knowledge are born into a delirium that is expressed in the conformity of an answer. That being the end of an aphomoioo. The purpose of a "doing" that expresses itself into an image that is projected into a representation. A "doing" made after an image through an ergo genesis – the "artwork" – an answer to my making that expresses the image of my separation from myself as an image of ego established in a represented projection of my hallucinatory image

The sound of a breaking string: critical environmental law and ontological vulnerability

This is a thought-provoking contribution on the space of ontological vulnerability as the awareness of being existentially exposed. This space, conceptualised as a space of ‘the middle’ (as opposed, emphatically, to ‘the centre’) offers an opportunity to think away from the sterile debate on eco/anthropocentricity and from such limiting hierarchies as animal/human, human/environmental, natural/artificial. This new, vulnerable position of the middle allows the reconfiguration of ecological processes, and more specifically the position of environmental law in relation to them. Environmental law now finds itself amidst a new, moving, ‘open ecology’ of social, biological and ecological processes. This is a new, radical conceptualisation of what the author has called ‘critical environmental law,’ based upon an epistemology of observation and an ontology of being part of this open ecology. Environmental law, in this light, is simultaneously reformulated as an invitation to disciplinary and ontological openness and yet a call to remain immanent within existing legal structures. This finds expression in four critical environmental positions that set the stage for the further elaboration of a critical environmental law.

Repressive desublimation and the great refusal in Bret Easton Ellis's fiction

In 1968, Herbert Marcuse believed that a Great Refusal was possible, one that would deny the exploitative power of corporate capitalism. Marcuse's vision was never realised. This essay argues that society today is in an advanced state of that which the Frankfurt School termed repressive desublimation and questions whether a liberationary praxis is still possible. It claims that Bret Easton Ellis's fiction choreographs an internalising of the forms of critique that marked 1968 and about which Marcuse writes. It is Ellis's act of double voicing that allows him to develop a duplicitous recalcitrant voice within the state of assimilation and it is double voicing which emerges as the key technique in Ellis's work that effects an ongoing critique in commodity society. Looking at Slavoj iek's recent revisionism of the notion of repressive desublimation, which connects Marxism and psychoanalysis, the essay considers how Ellis's novels, American Psycho, Glamorama and Lunar Park, function to address and reconfigure the relationship between the status of the Marxist fetishised object and the psychoanalytic phobic object in the present-day era of late capitalism. This essay seeks to illuminate how Ellis's fiction, through an involution of Marcuse's political theories, enacts a contemporary refusal from within the state of reification.

The world without outside

The world is all that there is. In the world, ontology and epistemology coincide. The thing and the perspective are part of it, scale is ingested in its multiplicity, communication stops at the world's edge. By reading together Deleuze and Guattari's plane of immanence and Niklas Luhmann's proto-global concept of Weltgesellschaft (“world society”), I suggest a conceptualisation of the world as the materiality of the multiple spaces of creation in an insular, all-inclusive immanence. Deprived of an outside, the world pushes its own understanding of circumference through, first, the expansion of its own limits through the process of worlding, and, second, the multiplication of modes of material (self-)production through its process of othering. Thus, the world swells up from the inside and expands on both the material and the semantic level, producing a multiplicity of fractal microcosms. Issues of responsibility and justice arise that are intricately linked to the materiality of the world and take place in and between the various bodies and spaces of the world but without an overarching hierarchy or principle. This approach is a way of counteracting the all-pervasive Hegelian understanding of synthesis, arguing instead for a plenitude that brims with positivity and that can never become fully complete. The world remains its own infinite process of worlding.

Did We Fail? (Counter-)Transference in a Qualitative Media Research Interview

Drawing on Joke Hermes’ (2006) account of a troubling interview, this article reproduces and reflects on passages from a qualitative interview with a user of a social networking site that was experienced as uncomfortable by both interviewee and interviewer (myself). The psychoanalytic concept of (counter-)transference is used to analyse the possible processes that led to the emergence of two narratives by the interviewee and interviewer and resulted in an unsuccessful research encounter. It is suggested that the analysis of the interview narratives may contribute to Wanda S. Pillow’s (2003) notion of an ‘uncomfortable reflexivity’. It may further add to methodological discussions of the interview in media research by placing an emphasis on a complex theory of the subject and intersubjective dynamics.

Media Research and Psychoanalysis: A Suggestion

This short commentary outlines psychoanalysis as a theory and method and its potential value to media research. Following Dahlgren (2013), it is suggested that psychoanalysis may enrich the field because it may offer a complex theory of the human subject, as well as methodological means of doing justice to the richness, ambivalence and contradictions of human experience. The psychoanalytic technique of free association and how it has been adapted in social research (Hollway and Jefferson 2000) is suggested as a means to open up subjective modes of expression and thinking – in researchers and research participants alike – that lie beyond rationality and conscious agency.

Estudo sobre o insight em pessoas com psicose

Para além das variáveis clínicas e sociodemográficas existem concerteza importantes componentes individuais que desempenham um contributo importante no nível de insight apresentado por cada pessoa doente, por exemplo, o nível de inteligência, personalidade, cultura, experiências passadas, memória, etc. A natureza clínica, emocional e/ou intelectual do termo ajuda-nos a compreender a complexidade da dificuldade que existe na sua tradução e, inclusive, na sua compreensão. Daí que as definições atribuídas ao conceito sejam muito distintas e variem consoante a formação teórica do autor/investigador. Pretende-se, a partir dessa identificação/compreensão, promover a qualidade de vida destas pessoas através do desenvolvimento de novas aprendizagens que possibilitem uma cooperação activa. É igualmente fundamental ir ao encontro das capacidade intactas de maneira a possibilitar a aquisição de novos(s) comportamento(s) que tenham um impacte positivo nas queixas, sinais, sintomas, incapacidade e disfuncionalidade apresentados pelo/a utente. Uma vez que a própria conceptualização do termo traduzirá aquilo que se pretende avaliar,será efectuada uma reflexão detalhada acerca dos instrumentos e definições que têm sido mais utilizadas para explorar o insight nas psicoses.Procurei, no meu trabalho de investigação, realçar e promover a importância que cada sujeito, alvo de intervenção, desempenha ao longo do seu processo de recuperação e na prevenção de recaídas. No seguimento dos objectivos acima descritos, para além da revisão teórica efectuada ao fenómeno em termos de conceptualização e estudos desenvolvidos na área de investigação, foi,neste estudo, realizada a contribuição para a validação do instrumento “Assessment of Insight in Psychosis: a re-standartization of a New Scale” de Marková & Berrios (2003).O fenómeno de insight escolhido pela Insight Scale, relata menos as mudanças vividas em relação à doença mental, e mais a actual consciência e articulação de tais mudanças. Tendo como base uma abordagem psicopedagógica, o fenómeno do insight aqui explorado assentou numa perspectiva reabilitativa, actual e multidimensional, que fosse para além das dimensões clínicas tradicionais. Neste sentido é apresentada uma escala original, intitulada “Escala de Avaliação do Insight e Identificação das Necessidades em Pessoas com Psicose”, bem como um modelo de intervenção psicopedagógico breve, assente nos pressupostos descritos ao longo do trabalho.-----------------------------------------ABSTRACT: The importance of insight in people with mental illnesses was first studied in psychiatry, in the first decades of the 20th century, by people as important as Lewis (1934) and Jaspers (1959). However, this field of investigation was left unexplored for many years. Only in the last decade has this phenomenon become the object of numerous scientific investigations, having been given special attention by its investigators. For this reason a significant number of instruments for evalauting insight in psychotic disorders were developed. Since then many papers have been published, which has allowed for a more in depth knowledge on the subject. Therefore, in recent years, the concept of insight has been developed in an attempt to clarify its compexity. A once dichotomic phenomenon, described in terms of presence or absence, became considered multidimensional, which made the identification of different levels of insight and different dimensions possible. Current concepts categorize insight into five dimensions: the awareness of the patient in relation to his/her mental illness, the awareness of the patient in relation to the social consequences of his/her illness, the awareness of the need for treatment, the awareness of the symptoms and the explanation of those symptoms in relation to the illness. The lack of insight in psychiatry, in general terms, and as this phenomenon has been described, the lack of awareness of having a mental illness, represents one of the most common symptoms of schizophrenia and affects a big part of the population that suffer from this illness. It is estimated that bewteen 50 and 80 per cent of patients with schizophrenia do not believe that they are ill, which, consequently has a big impact in the process of adherence to treatment. It is still not possible, however, to identify all the factors that determine the lack of insight in schizophrenics. There are psychological, social and cultural influences that almost certainly play their role in the lack of insight registered in this pathology.Since the impact of scizophrenia is felt in many aspects of the individual’s life, its effective treatment should be directed at various levels, including the improvement of insight. One of the objectives of this study is to explore the relationship between the level of insight in psychosis and the clinical and sociodemographic variables, the psychopathology and its global functioning. As well as the clinical and sociodemographic variables, there are of course important individual components that contribute to the level of insight seen in each patient, for example, their level of inteligence, personality, culture, past experiences, memory, etc. The clinical, emotional and/or intelectual nature of the term helps us understand the difficulty that lies in its interpretation as well as in its comprehension. Therefore, the definitions attributed to the term are very different and vary according to the theoretical training of the investigator. It is intended, from this identification/understanding, to promote the quality of life of these people through the development of new findings that might enable an active cooperation. It is equally fundamental to observe their unimpaired capacities in order to enable the acquisition of new behaviour(s) that have a positive impact on the complaints, signs, symptoms, incapacity and disfunctioning seen in the patient.As the actual comprehension of the term explains what we intend to evaluate, a detailed reflection is made on the instruments and definitions that have been used the most to explore insight in psychosis.In this investigation I tried to underline and promote the importance that each subject, undergoing medical intervention, plays during his/her process of recovery and prevention of relapses. Considering the above mentioned objectives, as well as a theoretical review of the phenomenon in terms of conceptualization and investigative studies developed, this study contributed to the validation of the instrument.The insight phenomenon chosen by the “Insight Scale”, records less changes experienced in relation to the mental illness and more actual awareness and articulation of these changes. Based on a psychopedagogical approach, the insight phenomenon explored here settled on a rehabilitation, current and multidimensional perspective that would go beyond the traditional clinical dimensions. For this reason an original scale entitled “Insight Evaluation Scale and Need Identification in Psychosis Patients” is presented, as well as a psychopedagogical intervention model soon to be used with admitted patients based on the presuppositions described in this study.

From Consciousness to Knowledge – The Explanatory Power of Revelation

Epistemology in philosophy of mind is a difficult endeavor. Those who believe that our phenomenal life is different from other domains suggest that self-knowledge about phenomenal properties is certain and therefore privileged. Usually, this so called privileged access is explained by the idea that we have direct access to our phenomenal life. This means, in contrast to perceptual knowledge, self-knowledge is non-inferential. It is widely believed that, this kind of directness involves two different senses: an epistemic sense and a metaphysical sense. Proponents of this view often claim that this is due to the fact that we are acquainted with our current experiences. The acquaintance thesis, therefore, is the backbone in justifying privileged access. Unfortunately the whole approach has a profound flaw. For the thesis to work, acquaintance has to be a genuine explanation. Since it is usually assumed that any knowledge relation between judgments and the corresponding objects are merely causal and contingent (e.g. in perception), the proponent of the privileged access view needs to show that acquaintance can do the job. In this thesis, however, I claim that the latter cannot be done. Based on considerations introduced by Levine, I conclude that this approach involves either the introduction of ontologically independent properties or a rather obscure knowledge relation. A proper explanation, however, cannot employ either of the two options. The acquaintance thesis is, therefore, bound to fail. Since the privileged access intuition seems to be vital to epistemology within the philosophy of mind, I will explore alternative justifications. After discussing a number of options, I will focus on the so called revelation thesis. This approach states that by simply having an experience with phenomenal properties, one is in the position to know the essence of those phenomenal properties. I will argue that, after finding a solution for the controversial essence claim, this thesis is a successful replacement explanation which maintains all the virtues of the acquaintance account without necessarily introducing ontologically independent properties or an obscure knowledge relation. The overall solution consists in qualifying the essence claim in the relevant sense, leaving us with an appropriate ontology for phenomenal properties. On the one hand, this avoids employing mysterious independent properties, since this ontological view is physicalist in nature. On the other hand, this approach has the right kind of structure to explain privileged self-knowledge of our phenomenal life. My final conclusion consists in the claim that the privileged access intuition is in fact veridical. It cannot, however, be justified by the popular acquaintance approach, but rather, is explainable by the controversial revelation thesis.

Contra os semi-sábios — notas sobre a racionalidade nos Pensamentos de Pascal

Ao longo dos Pensamentos, Pascal expressa a sua antipatia filosófica por alguns tipos de pensadores. Um desses tipos de pensadores corresponde à figura do "demi-savant". Os "demi-savants", ou semi-sábios, caracterizam-se essencialmente por uma pretensão de saber fracassada: são homens que julgam estar na posse de um saber que na verdade não possuem. O objectivo desta investigação é fixar, com o maior detalhe possível, o que está em causa na denúncia dos semi-sábios — um aspecto pouco trabalhado no âmbito dos estudos sobre o pensamento de Pascal. A primeira parte da investigação consiste assim na delimitação formal da categoria semi-sábios. Quais são as notas definitórias destes pensadores? Que tipo de erro está em jogo na sua atitude? Que opiniões fazem de alguém um semi-sábio? Estas perguntas acabam rapidamente por nos levar a outras, que dizem directamente respeito à tentativa de determinação do poder de fogo da razão humana. Com efeito, o fundamento filosófico da crítica aos semi-sábios é o diagnóstico arrasador que Pascal faz da capacidade da nossa razão na tarefa do conhecimento — de tal modo que estudar o problema que os semi-sábios representam é estudar sob um determinado ângulo o problema geral da procura da verdade. Nesse sentido, depois de esclarecido o significado da designação semi-sábio, analisamos dois argumentos apresentados nos Pensamentos que visam contestar a compreensão habitualmente constituída acerca das possibilidades do homem na tarefa do conhecimento. Procuramos ainda, por último, desfazer possíveis equívocos quanto à fixação da posição de Pascal no campo da epistemologia. Embora haja poucas referências aos semi-sábios nos textos que compõem os Pensamentos, trata-se de uma figura que funciona como ponto de cruzamento de vários aspectos relevantes de um problema que está no centro do projecto apologético de Pascal: o problema do modo de apuramento da verdade.