Taking outside in, turning inside out: Exploring social dimensions and psychotherapeutic process in the play therapy of a young girl in foster care.

This paper, a collaborative effort, describes the work of A Home Within (AHW), a volunteer community-based organization providing pro-bono long term psychotherapy to current and former foster youth. We provide a brief description of the treatment model, present a report of treatment conducted by an AHW volunteer, and discuss further reflections on the societal context of our psychoanalytically-informed work. In-depth psychotherapeutic process from the treatment of a young girl in a pre-adoptive foster placement elucidates the psychotherapeutic possibilities when a psychoanalytic treatment model is accessible to current and former foster youth, usually deprived of this form of treatment due to overburdened, underfunded community mental health systems in the U.S. Open-ended psychotherapy afforded this traumatized child an unusual opportunity to work through past relational traumas in order to form new and more secure attachment relationships. We reflect further on the case from the vantage points of both the psychotherapeutic process and the greater societal context of this community-based program.

Troubling Gender or Engendering Trouble? The Problem With Gender Dysphoria in Psychoanalysis.

This paper reviews existing case reports in the psychoanalytic literature of children diagnosed with gender identity disorder (GID), now called gender dysphoria. It concentrates on a review of problems and psychoanalytic dilemmas inherent in the use of the term GID and elucidates the concurrent quandaries this term both signifies and is symptomatic of. The focus is on reports of child psychoanalyses published during or after 1991, when the American Psychoanalytic Association formally adopted a nondiscrimination policy against homosexuality. These cases reflect common problematic themes in these treatments, for example, the lack of neutrality in specifying the treatment goal of same-gender identification. This paper explores the effects of these problems on the treatments, raises questions regarding the emphasis on gender in the treatments, and discusses an alternative psychoanalytic approach to children with gender variation.

Attachment and the metabolic syndrome in midlife: the role of interview-based discourse patterns.

OBJECTIVE: Adult attachment discourse patterns and current family relationship quality were examined as correlates of health behaviors and number of metabolic syndrome (MetS) criteria met, and as mediators of the link between childhood adversity and these health outcomes. METHODS: A sample of 215 white/European American and black/African American adults aged 35 to 55 years were examined using a cross-sectional study design. Discourse was assessed with the Adult Attachment Interview, using coherence (a marker of attachment security), unresolved trauma/loss (a marker of disorganized cognitions related to trauma or loss), and idealization (minimizing stressful experiences and their impact) scores. Relationship quality, adverse childhood experiences, and current depressive symptoms were assessed, as were health behaviors of diet, exercise, and smoking. MetS includes obesity, elevated blood pressure, elevated fasting glucose, high triglycerides, and low high-density lipoprotein cholesterol. RESULTS: Using path analysis and including childhood adversity severity and depressive symptoms in the model, both Adult Attachment Interview coherence and unresolved trauma/loss were directly linked to the number of MetS criteria (r = 0.186 and r = 0.170, respectively). Idealization was indirectly linked to MetS through poor diet (r = 0.183). The final model explained 21% of the variance in scores for the number of MetS criteria met. CONCLUSIONS: Insecure adult attachment is associated with increased risk of MetS.