ABSTRACT
In this report first results are presented from a pilot study on the Mentalizing Vocational Training that aims to increase the effectiveness of vocational rehabilitation programs with adolescents diagnosed with learning disabilities. The prevention program was based on the hypothesis that adolescents' difficulties in motivation and relationships are related to deficits in mentalizing. Thus, we created a prevention program that supports an enduring mentalizing social system following Twemlow's and Fonagy's suggestions for peaceful schools. The program consists of four modules: a psychoeducative training for all professionals within the rehabilitation program, an ongoing supervision for two selected teams, two mentalizing training groups for selected adolescents and a weekly intervision group for the research team analyzing the organizational perspective. During the pilot study, mentalization interest and attachment styles were assessed from all adolescents and professionals. Additionally, adolescents' mentalization capacities were assessed using an objective videobased test as well as general intelligence. Results showed that participants had significantly more attachment anxiety and avoidance as well as less interest to think about themselves and others in a complex way. Furthermore, participants achieved very low scores in the mentalization test (comparable to the autistic spectrum) which were independent from general cognitive deficits. On the organizational level, professionals appeared to be conflicted about the changes in management towards more economic efficiency and overwhelmed by participants with traumatic backgrounds. This led to a regression of the whole organization on the teleological mode.
Subject(s)
Learning Disabilities/psychology , Learning Disabilities/rehabilitation , Rehabilitation, Vocational/psychology , Theory of Mind , Adolescent , Adult , Curriculum , Faculty , Female , Germany , Humans , Inservice Training , Intelligence , Interpersonal Relations , Male , Middle Aged , Motivation , Object Attachment , Pilot Projects , Psychoanalytic Theory , Psychotherapy, Group , Reactive Attachment Disorder/diagnosis , Reactive Attachment Disorder/psychology , Reactive Attachment Disorder/rehabilitation , Young AdultABSTRACT
There is a high incidence of trauma and posttraumatic stress disorder (PTSD) in people with a diagnosis of psychosis. Sequelae of trauma may affect the ability to engage in both attachment and therapeutic relationships. This study investigated associations between trauma histories, PTSD, attachment styles, and working alliance in a sample of 110 individuals with psychosis and substance misuse. Anxious attachment was associated with number of interpersonal traumas and PTSD reported, but there were no associations between trauma and alliance. There were discrepancies in number of traumatic events reported by care coordinators and patients. The findings of this study highlight the potential use of attachment theory in working with trauma and PTSD in psychosis.
Subject(s)
Life Change Events , Physician-Patient Relations , Psychotic Disorders/psychology , Reactive Attachment Disorder/psychology , Schizophrenia/diagnosis , Schizophrenic Psychology , Stress Disorders, Post-Traumatic/psychology , Substance-Related Disorders/psychology , Adolescent , Adult , Case Management , Female , Humans , Interview, Psychological , Male , Middle Aged , Personality Inventory/statistics & numerical data , Psychotic Disorders/diagnosis , Reactive Attachment Disorder/diagnosis , Reactive Attachment Disorder/rehabilitation , Schizophrenia/rehabilitation , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/rehabilitation , Substance-Related Disorders/diagnosis , Substance-Related Disorders/rehabilitation , Young AdultSubject(s)
Cleft Lip/psychology , Cleft Palate/psychology , Cooperative Behavior , Family Therapy , Interdisciplinary Communication , Patient Care Team , Adaptation, Psychological , Adolescent , Child , Child Behavior Disorders/psychology , Child Behavior Disorders/rehabilitation , Child, Preschool , Cleft Lip/rehabilitation , Cleft Palate/rehabilitation , Female , Humans , Infant , Infant, Newborn , Male , Object Attachment , Parent-Child Relations , Reactive Attachment Disorder/psychology , Reactive Attachment Disorder/rehabilitation , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/rehabilitationABSTRACT
OBJECTIVE: Two centuries of clinical observations have suggested that conversion symptoms are associated with strong emotions or situations that threaten the individual's physical or psychological integrity. This study tested the hypothesis that childhood conversion reactions reflect the motor-sensory components of two distinct emotional responses (one inhibitory, one excitatory) that develop as adaptations to recurring threats within intimate relationships. METHOD: Emotional responses to interpersonal threats were assessed in 28 children with conversion disorders using Dynamic-Maturational-Model (DMM) assessments of attachment. Attachment strategies (the inhibitory, Type A; the balanced, Type B; and the excitatory, Type C) provide information about (1) the child's behavioural (motor-sensory) organization in the face of interpersonal threats, and (2) the information processing that underpins this behavioural organization. RESULTS: Twelve children (43%) used an inhibitory attachment strategy. Twelve (43%) used an excitatory attachment strategy. A smaller group (14%) alternated between inhibitory and excitatory strategies, their conversion symptoms reflecting the latter. DISCUSSION: These data suggest that conversion reactions are not a single clinical entity and reflect the motor-sensory components of two distinct human emotional responses to threat. This distinction may help to account for the broad range of conversion symptoms seen in clinical practice, both those that involve loss of function and can be explained by a central inhibition hypothesis and those that involve positive symptoms and secondary gain.
