Bulletin of the Menninger Clinic (B MENNINGER CLIN)

Publications in this journal

• Article: Ambivalence: Its development, mastery, and role in psychopathology.

  Richard B Corradi
  [show abstract] [hide abstract]
  ABSTRACT: The term ambivalence-meaning the coexistence of love and hate toward a person or object-is commonly used both in the vernacular and in psychiatry. However, how ambivalence contributes to understanding and treating some important psychiatric disorders has not been well defined. This article reviews Bleuler's original use of the concept, as well as contributions by Freud and other theorists, as background. The author proposes that mastery of ambivalence-depolarization of the primary drive expressions of love and hate so that a degree of ambivalence toward a loved object can be tolerated-is a fundamental developmental task. The significant role that ambivalence plays in some major psychiatric disorders-schizophrenia, borderline personality, and depression-is illustrated with case material and discussed.
  Bulletin of the Menninger Clinic 01/2013; 77(1):41-69.
• Article: Integration of psychoanalytic concepts in the formulation and management of hospitalized psychiatric patients.

  Paul Ian Steinberg, David Cochrane
  [show abstract] [hide abstract]
  ABSTRACT: Although psychoanalysis and psychodynamic psychotherapy have flourished theoretically and in practice for an increasingly widespread population of patients, the mental health professions have in recent decades experienced a hegemony of managed care, a preoccupation with pharmacological approaches at the expense of psychological approaches, and a predilection for brief symptom-focused, more easily researchable manualized psychotherapies, in spite of literature demonstrating the effective contribution of psychoanalysis and psychodynamic thought to the practice of the mental health professions. In this article a psychiatric inpatient is considered from the point of view of what psychodynamic theory can offer practically to understanding and managing her. It is not suggested that this patient might necessarily benefit from formal psychodynamic psychotherapy, but rather that incorporation of a psychodynamic understanding of her can lead to a more effective management approach, especially regarding dealing with staff reactions to disturbing patients. Consideration of the patient's personality and recognition of the patient's having a comorbid personality disorder appeared important in her management, and have practical implications regarding staff members' understanding of the patient and the consequent identification and handling of transference and countertransference manifestations. Problems that are likely to occur as enactments on the inpatient unit can more readily be anticipated or identified earlier and a consistent staff approach prepared. A psychodynamically informed management approach on the inpatient unit can help to anticipate challenging interpersonal experiences such as enactments. Psychodynamic thought has developed in a manner so as to be applicable in an increasingly wide range of clinical situations, not only in terms of the varieties of patients who are deemed to be able to benefit from psychodynamic treatment per se, but also regarding the clinical venues in which psychodynamic concepts can be usefully applied.
  Bulletin of the Menninger Clinic 01/2013; 77(1):23-40.
• Article: Seeing red: Affect modulation and chromatic color responses on the Rorschach.

  Johanna C Malone, Michelle B Stein, Jenelle Slavin-Mulford, Iruma Bello, S Justin Sinclair, Mark A Blais
  [show abstract] [hide abstract]
  ABSTRACT: Psychoanalytic theories suggest that color perception on the Rorschach relates to affective modulation. However, this idea has minimal empirical support. Using a clinical sample, the authors explored the cognitive and clinical correlates of Rorschach color determinants and differences among four affective modulation subtypes: Controlled, Balanced, Under-Controlled, and Flooded. Subtypes were differentiated by measures of affective regulation, reality testing/confusion, and personality traits. Initial support for the relationship of chromatic color response styles and affective modulation was found.
  Bulletin of the Menninger Clinic 01/2013; 77(1):70-93.
• Article: Borderline personality disorder, bipolar disorder, depression, attention deficit/hyperactivity disorder, and narcissistic personality disorder: Practical differential diagnosis.

  Otto F Kernberg, Frank E Yeomans
  [show abstract] [hide abstract]
  ABSTRACT: The challenge of accurate diagnosis remains at the heart of good psychiatric treatment. In the current state of psychiatry, a confluence of forces has increased this challenge for the clinician. These include practical pressures-such as limited time for diagnostic evaluation, the question of what is reimbursed by insurance, and the issue of directing patients to acute treatments-and also trends in nosology, such as the descriptive focus on signs and symptoms in the current official diagnostic system. The authors offer observations that we hope will help clinicians who have to make difficult diagnostic differentiations often under pressured circumstances. The paper is motivated both by the high frequency of diagnostic errors observed under such conditions and also by the belief that considering symptoms in the context of the patient's sense of self, quality of interpersonal relations, and level of functioning over time will help guide the diagnostic process.
  Bulletin of the Menninger Clinic 01/2013; 77(1):1-22.
• Article: Key stakeholder perceptions regarding acute care psychiatry in distressed publicly funded mental health care markets.

  B Christopher Frueh, Anouk L Grubaugh, Anthony T Lo Sasso, Walter J Jones, John M Oldham, Richard C Lindrooth
  [show abstract] [hide abstract]
  ABSTRACT: The role of acute care inpatient psychiatry, public and private, has changed dramatically since the 1960s, especially as recent market forces affecting the private sector have had ripple effects on publicly funded mental health care. Key stakeholders' experiences, perceptions, and opinions regarding the role of acute care psychiatry in distressed markets of publicly funded mental health care were examined. A qualitative research study was conducted using semi-structured thematic interviews with 52 senior mental health system administrators, clinical directors and managers, and nonclinical policy specialists. Participants were selected from markets in six regions of the United States that experienced recent significant closures of acute care psychiatric beds. Qualitative data analyses yielded findings that clustered around three sets of higher order themes: structure of care, service delivery barriers, and outcomes. Structure of care suggests that acute care psychiatry is seen as part of a continuum of services; service delivery barriers inhibit effective delivery of services and are perceived to include economic, regulatory, and political factors; outcomes include fragmentation of mental health care services across the continuum, the shift of mental health care to the criminal justice system, and market-specific issues affecting mental health care. Findings delineate key stakeholders' perceptions regarding the role acute care psychiatry plays in the continuum of care for publicly funded mental health and suggest that public mental health care is inefficacious. Results carry implications for policy makers regarding strategies/policies to improve optimal utilization of scarce resources for mental health care, including greater focus on psychotherapy.
  Bulletin of the Menninger Clinic 01/2012; 76(1):1-20.
• Article: A four-year retrospective study of Assertive Community Treatment: Change to more frequent, briefer client contact.

  Paul B Gold, Danson R Jones, Cathaleene Macias, Leonard Bickman, William A Hargreaves, Jana Frey
  [show abstract] [hide abstract]
  ABSTRACT: The authors explored the feasibility of providing frequent, brief client contact as a strategy for reallocating Assertive Community Treatment (ACT) staff time to new clients, while preserving relationships with current clients and ACT program fidelity standards. A retrospective analysis of 4 years of service records for a high-fidelity ACT team revealed gradual increases in staff-client contact frequency, and corresponding decreases in contact duration. During these years, fidelity to ACT standards remained moderately high, and clients' employment and hospitalization outcomes improved.
  Bulletin of the Menninger Clinic 01/2012; 76(4):314-28.
• Article: Development of an object relation-based typology of adolescent sex offenders.

  Dominick Gamache, Louis Diguer, Olivier Laverdière, Jean-Pierre Rousseau
  [show abstract] [hide abstract]
  ABSTRACT: The aim of this study was to develop a typology of adolescent sex offenders based on object relations theory and Otto F. Kernberg's model of personality organizations (PO). A secondary objective was to compare the identified subtypes on offense characteristics as well as some psychological variables of adolescent sex offenders. Clinical files from 40 male adolescent sex offenders in treatment were examined. Cluster analysis based on PO and object relations variables identified six subtypes of offenders, in line with Kernberg's PO model. These subtypes differed from one another on various variables pertaining to characteristics of sex offenses, general delinquency, relational/sexual history, and trauma history.
  Bulletin of the Menninger Clinic 01/2012; 76(4):329-64.
• Article: Transference interpretation in the treatment of borderline personality disorder patients.

  Justin K Higa, Paul M Gedo
  [show abstract] [hide abstract]
  ABSTRACT: Transference is seen as an important change mechanism in psychotherapeutic technique, although questions remain about its therapeutic use, especially with borderline personality disorder (BPD) patients. This article illustrates the lively debate about transference interpretation through the perspective of two psychotherapeutic techniques under empirical scrutiny-transference-focused psychotherapy (TFP) and mentalization-based treatment (MBT). Each technique offers a similar understanding and appreciation of transference, but they differ in their technical use of this change mechanism. The article presents a brief case study of a BPD patient. The treatment highlights the utility of each psychotherapeutic technique in understanding the developmental progress made by the patient in therapy. The authors argue that each technique may be useful in a long-term dynamic therapy, and that one can use an epigenetic framework to understand this observation.
  Bulletin of the Menninger Clinic 01/2012; 76(3):195-210.
• Article: Do attachment representations predict depression and anxiety in psychiatrically hospitalized prepubertal children?

  Geoff Goodman, Martha Stroh, Adina Valdez
  [show abstract] [hide abstract]
  ABSTRACT: Thirty-six prepubertal inpatients were videotaped completing five stories thematically related to attachment experiences and classified by their attachment representations. Children also completed the Children's Depression Inventory and Diagnostic Interview for Children and Adolescents-Revised. Mothers completed demographic questionnaires. Percentage of secure (B) attachment was only about one tenth of the normative percentage, anxious-ambivalent (C) attachment was between two and three times the normative percentage, and disorganized (D) attachment was almost twice the normative percentage. Both D attachment and the total number of disorganized story responses were associated with negative self-esteem and clinical-range depression. Anxious-avoidant (A) attachment decreased the likelihood, while C and D attachment increased the likelihood, of separation anxiety disorder. Clinical intervention needs to focus on the meaning of parental relationships represented in the child's mind, specifically the negative self-esteem and separation anxiety associated with the lack of felt security provided by the parents.
  Bulletin of the Menninger Clinic 01/2012; 76(3):260-89.
• Article: Narcissism: Its function in modulating self-conscious emotions.

  Masayo Uji, Toshiaki Nagata, Toshinori Kitamura
  [show abstract] [hide abstract]
  ABSTRACT: This study focused on the functional aspects of narcissism in regulating self-conscious emotions (guilt, shame, hubristic pride, and achievement-oriented pride) as well as two other attribution styles (externalization and detachment). The authors investigated Japanese university students (N = 452) with regard to their self-conscious emotions using the Test of Self-Conscious Affect-3 (TOSCA-3) and their narcissistic personality using the short version of Narcissistic Personality Inventory (NPI-S). Structural equation modeling was used for the analysis. The authors found that narcissism led individuals to feel achievement-oriented pride, hubristic pride, externalization, and detachment, but inhibited feelings of shame. It did not have a significant effect on guilt. Shame-proneness prompted hubristic pride and externalization. Guilt-proneness inclined an individual toward achievement-oriented pride, but deterred externalization. In this article, the authors present and interpret these results in detail and then discuss how they can be utilized in psychotherapy.
  Bulletin of the Menninger Clinic 01/2012; 76(3):211-34.
• Article: Restoring psychic containers of identity after a suicide attempt in adolescence.

  Nathalie de Kernier, François Marty, Emmanuel Devouche
  [show abstract] [hide abstract]
  ABSTRACT: Suicidal acts during adolescence reveal narcissistic vulnerabilities. The author's observation concerns the quality of ego boundaries, as well as their evolution. Longitudinal studies were conducted on the basis of interviews and projective tests performed within 15 days after the suicide attempt and once again the following year. The quantitative analyses of Fisher and Cleveland's Barrier/Penetration scores on the Rorschach show the evolution of identity mechanisms. The results underscore the importance of restoring psychic containers of identity.
  Bulletin of the Menninger Clinic 01/2012; 76(4):365-92.
• Article: Female sexual offenders in the educational system: a brief overview.

  O Lizette Solis, Elissa P Benedek
  [show abstract] [hide abstract]
  ABSTRACT: Female sexual offenders comprise the minority of sexual offenders in the criminal justice system. However, empirical research reveals that sexual offenses against adolescents by females are a bigger problem than previously thought, particularly in the educational system. The authors review some of the data in the criminal justice system as well as in empirical research studies about female sexual offenders, with a specific focus on females who commit sexual crimes against students who are minors.
  Bulletin of the Menninger Clinic 01/2012; 76(2):172-88.
• Article: Adaptive institutional transference in the treatment of individuals with borderline personality disorder.

  Bridget B Matarazzo
  [show abstract] [hide abstract]
  ABSTRACT: The author introduces "adaptive institutional transference" (AIT) and describes how it develops in some patients in response to psychotherapist transfer in psychology training clinics. Individuals with borderline personality disorder are especially likely to develop AIT because of difficulties related to abandonment depression. Directors, supervisors, and student psychotherapists in a variety of training settings should be aware of these dynamics because of their important treatment implications, which are described. Limitations and ideas for future exploratory and qualitative research are also discussed.
  Bulletin of the Menninger Clinic 01/2012; 76(4):297-313.
• Article: A novel methodology for identifying emerging themes in small group dynamics.

  Yair Neuman, Dan Assaf, Yohai Cohen
  [show abstract] [hide abstract]
  ABSTRACT: An understanding of group dynamics, such as the dynamics in family psychotherapy, is of great importance to mental health practitioners and other experts who seek to understand the group as a working whole. In this context, identifying themes emerging from the dynamics is of prime importance. However, the lack of formal tools makes it difficult to validly identify emerging themes. The current article presents a novel methodology for identifying themes emerging from group dynamics. With this methodology, the verbal utterances of group members are automatically analyzed to produce a "group matrix." Motifs that emerge in the complex network of signs that is generated by the group are analyzed by means of a computer program, and the explanatory value of the identified motifs is elaborated. The methodology and its benefits are presented and illustrated through the analysis of (1) the family dynamics in a literary piece, Tennessee Williams's The Glass Menagerie and (2) the group dynamics of Israeli and Palestinian participants discussing the notion of forgiveness.
  Bulletin of the Menninger Clinic 01/2012; 76(1):53-68.
• Article: Termination of psychodynamic psychotherapy with adolescents: A review and contemporary perspective.

  Sergio V Delgado, Jeffrey R Strawn
  [show abstract] [hide abstract]
  ABSTRACT: In psychodynamic psychotherapy with adolescents, termination-the phase of treatment during which the patient and his or her parents end a therapeutic relationship with a therapist-has received limited attention in the extant literature. Despite this oversight, termination is of critical clinical importance. This phase of psychotherapy with adolescents is heralded by the integration and consolidation of progress, relational changes, and the relinquishing of the symptoms that brought the adolescent to treatment. Herein, the relevant literature surrounding termination in psychodynamic psychotherapeutic work with adolescents will be reviewed. Important aspects of termination will be highlighted and discussed, including (1) criteria for termination, (2) techniques for working with parents, (3) "forced terminations," (4) countertransference, and (5) common complications that arise during this phase of treatment. Finally, the complexities of the termination process as well as recent contributions to our understanding of this critically important process from attachment theory and intersubjectivity will be illustrated with clinical material.
  Bulletin of the Menninger Clinic 01/2012; 76(1):21-52.
• Article: Psychodynamic psychotherapy for posttraumatic stress disorder related to childhood abuse--Principles for a treatment manual.

  Wolfgang Wöller, Falk Leichsenring, Frank Leweke, Johannes Kruse
  [show abstract] [hide abstract]
  ABSTRACT: In this article, the authors present a psychodynamically oriented psychotherapy approach for posttraumatic stress disorder (PTSD) related to childhood abuse. This neurobiologically informed, phase-oriented treatment approach, which has been developed in Germany during the past 20 years, takes into account the broad comorbidity and the large degree of ego-function impairment typically found in these patients. Based on a psychodynamic relationship orientation, this treatment integrates a variety of trauma-specific imaginative and resource-oriented techniques. The approach places major emphasis on the prevention of vicarious traumatization. The authors are presently planning to test the approach in a randomized controlled trial aimed at strengthening the evidence base for psychodynamic psychotherapy in PTSD.
  Bulletin of the Menninger Clinic 01/2012; 76(1):69-93.
• Article: On not praying for the return of an amputated limb: Conserving a relationship with God as the primary function of prayer.

  Simon Dein, Kenneth Pargament
  [show abstract] [hide abstract]
  ABSTRACT: Prayer is commonplace at times of illness. But what do people pray for? After reviewing recent work in the cognitive science of religion, the authors argue that pray-ers preferentially ask for psychological as opposed to physical outcomes because these are easier to accommodate God's intervention in the healing process. The authors exemplify this argument with recent studies of illness-related prayer. The findings from this study accord with other studies which demonstrate that those who follow spiritual pathways engage in efforts to conserve their understanding of and their relationship with the sacred. Thus, the authors argue that prayers to God are designed to enhance human health and well-being in ways that conserve the sacred. Unanswered prayers in a health-related context then may elicit spiritual struggles and significant distress to patients. The authors conclude by discussing the implications of unanswered prayer and theodicy for psychotherapy, emphasizing the seminal work of Anna-Maria Rizzuto.
  Bulletin of the Menninger Clinic 01/2012; 76(3):235-59.
• Article: A preliminary study of the relation between trauma symptoms and emerging BPD in adolescent inpatients.

  Amanda Venta, Robyn Kenkel-Mikelonis, Carla Sharp
  [show abstract] [hide abstract]
  ABSTRACT: The relation between trauma and borderline personality disorder (BPD) has been studied in great detail with adults, but few studies have examined this link in adolescents. Furthermore, virtually nothing is known about how different aspects of trauma relate to BPD and whether trauma symptoms reflect actual trauma history in adolescents diagnosed with BPD. Using a sample of 147 adolescent psychiatric inpatients, the authors examined the concurrent link between trauma symptoms, trauma history, and BPD. Findings suggest that adolescents with BPD are more likely than their non-BPD counterparts to have a history of sexual trauma and to report sexual concerns. However, the link between BPD and sexual concerns is not completely explained by increased sexual trauma history in the BPD group, indicating that there is some relation between BPD and sexual concerns independent of trauma history. These findings are discussed within an attachment framework. The preliminary nature of this study is noted and used as the basis for encouraging future research in the area.
  Bulletin of the Menninger Clinic 01/2012; 76(2):130-46.
• Article: Unemployed and poor in New York: the impact of mentalization and Axis II psychopathology on job outcome.

  Emily M Bly, A Jordan Wright, Steven B Tuber
  [show abstract] [hide abstract]
  ABSTRACT: This study examined the relationships between the capacity for reflective functioning (RF) and the presence of Axis II psychopathology and their respective and combined impact on the ability of unemployed, low-income individuals to complete work-readiness training and to obtain and retain employment. Forty-one adult clients selected randomly from individuals participating in The HOPE Program, a work-readiness program in Brooklyn, New York, participated in the current study. Results indicated that RF and Axis II pathology were not only found to be related to each other, but were also found to significantly predict job outcomes. Moreover, it was determined that while the presence of an Axis II diagnosis impeded participants' ability to obtain jobs, the impact of such a diagnosis on job acquisition was attributable to having lower levels of RF ability. These results are discussed in relation to implications for the design of programs and interventions to assist unemployed and underserved populations.
  Bulletin of the Menninger Clinic 01/2012; 76(2):101-29.