Back to the future: when children and adolescents return to office sessions following episodes of teletherapy.

Analysts and psychotherapists are beginning to have more thorough and probing discussions about how the COVID-19 pandemic has affected their work. Shifting to online teletherapy has been necessary due to the public health measures put in place to curtail the spread of the virus. Much of the existing literature addresses how using online platforms for teletherapy works for adults. This paper instead looks at its effects on working with children and adolescents. A contrast between Winnicott's notion of holding and Bion's concept of container-contained is reviewed through a summary of a paper by Ogden. This author finds that holding might be more applicable to online work during a pandemic when the collective relationship to time and its usual parameters is severely upended. Containing could be more arduous and challenging online due to the lack of embodied presence to communicate and detect tiny nonverbal cues. A short questionnaire affirms that child analysts and psychotherapists have struggled with dimensions of online work that are particular to the developmental levels of their patients. Further, teletherapy may often not be a good fit for someone with learning differences.

Les analystes et les psychothérapeutes commencent à avoir des discussions plus profondes et plus pointues sur comment la pandémie de COVID-19 a affecté leur travail. Passer à la thérapie en ligne a été nécessaire du fait des mesures de santé publique mises en place pour freiner l'avancée du virus. La majeure partie de la littérature s'intéresse à comment l'utilisation des plateformes en ligne pour la psychothérapie a fonctionné pour les adultes. Par contraste, cet article se penche sur les effets dans le travail avec les enfants et les adolescents. A travers un résumé d'un article d'Ogden, un contraste entre la notion de « holding ¼ de Winnicott et le concept de contenant-contenu de Bion est examiné. L'auteur soutient que la notion de holding serait plus adaptée au travail en ligne durant une pandémie, quand la relation collective au temps et à ses paramètres habituels est gravement perturbée. La contenance (Bion) pourrait s'avérer plus délicate et plus laborieuse en ligne du fait du manque de présence incarnée pour détecter et communiquer les signes non-verbaux. Un court questionnaire confirme que les analystes d'enfants et les psychothérapeutes ont eu du mal avec les aspects du travail en ligne qui se rapportent aux niveaux de développement de leurs patients. De plus, la télé-thérapie peut souvent ne pas être adaptée pour quelqu'un qui présente des différences d'apprentissages.

Analistas y psicoterapeutas están comenzando a tener discusiones más minuciosas y agudas sobre cómo la pandemia por el COVID-19 ha afectado su trabajo. El cambio a la terapia virtual ha sido necesario debido a las medidas de salud pública tomadas para reducir la propagación del virus. Gran parte de la literatura existente da cuenta de como el uso de plataformas para la terapia virtual funciona para los adultos. El presente trabajo en cambio, presta atención a los efectos en el trabajo con niños y adolescentes. Se revisa a través de un trabajo de Ogden, el contraste entre la noción de sostenimiento de Winnicott y el concepto de contenedor-contenido de Bion. Este autor encuentra que el sostenimiento puede aplicarse más al trabajo online durante una pandemia cuando la relación del colectivo con el tiempo y sus parámetros usuales es severamente trastocada. La contención podría ser más ardua y desafiante de manera online debido a la falta de una presencia corporal que comunique y permita detectar pequeñas señales no-verbales. Un breve cuestionario afirma que analistas y psicoterapeutas de niños han luchado con aquellas dimensiones del trabajo online propias del nivel de desarrollo de sus pacientes. Además, la terapia virtual puede a menudo no ser una buena opción para alguien con diferencias en el aprendizaje.

Adolescents coping with the COVID-19 pandemic: 'every day is like another Sunday'.

COVID-19 has upended the way analysts and psychotherapists practice. Many use the phone for their sessions, many are using video platforms, and many use a combination of the two. Work with adolescents is very challenging in this new modality because of the loss of in-person connection and immediate non-verbal cues. The public health restrictions put in place to manage COVID-19 spread are at odds with the adolescent tasks of adventuring, experimenting and gaining new experiences. In addition, increased anxieties about infection, contamination and invasion are often manifest and adolescents can regress in the face of them. Using seminal ideas from Bion, this article looks at two process examples from adolescent boys who struggled with parts of themselves that felt disturbing and unacceptable. The author discusses the clinical exchanges in detail and offers ideas about the difficulty of creating psychic space when working virtually.

La COVID-19 a bouleversé la manière dont les analystes et les psychothérapeutes travaillent. Beaucoup font des séances par téléphone, beaucoup utilisent des plateformes vidéo et beaucoup combinent les deux. Le travail avec les adolescents est rendu très délicat par ces nouvelles modalités du fait de la perte du lien en personne et des indices non-verbaux dans l'immédiateté. Les restrictions de santé publique mises en place pour contenir la diffusion de la COVID-19 vont dans la direction opposée des tâches qui incombent à l'adolescent: s'aventurer, expérimenter, acquérir de nouvelles expériences. De plus, on observe souvent des angoisses accrues concernant l'infection, la contamination et l'intrusion, ce qui peut amener les adolescents à régresser. Utilisant des idées fondamentales de Bion, cet article étudie deux exemples de processus chez des adolescents garçons qui sont en difficultés avec des parties d'eux-mêmes qu'ils ressentent comme dérangeantes et inacceptables. L'auteur revient en détail sur les échanges cliniques et propose des idées sur la difficulté à créer un espace psychique quand on travaille de manière virtuelle.

El COVID-19 ha trastocado el modo de hacer clínica de analistas y psicoterapeutas. Muchos utilizan el teléfono para sus sesiones, muchos están usando plataformas de video, y muchos una combinación de ambas cosas. El trabajo con adolescentes es muy desafiante en esta nueva modalidad debido a la pérdida de la conexión personal y de las señales no-verbales inmediatas. Las restricciones implementadas por la salud pública para manejar los contagios del COVID-19 se encuentran en conflicto con las tareas adolescentes de aventurarse, experimentar y ganar nuevas experiencias. A su vez, se manifiesta a menudo un incremento de las ansiedades vinculadas a la infección, contaminación e invasión, frente a lo cual, los adolescentes pueden mostrar una regresión. Utilizando ideas seminales de Bion, el presente artículo mira el proceso de dos adolescentes varones, quienes luchan con partes de sí mismos que sienten como perturbadoras e inaceptables. El autor analiza en detalle los intercambios clínicos y ofrece ideas sobre la dificultad de crear espacio psíquico al trabajar virtualmente.

Apocalyptic themes in times of trouble: when young men are deeply alienated.

Boys and young men more frequently live out aspects of their psychic and social alienation online. This paper explores some of the risks and dangers that can arise from retreats into the two-dimensional world of cyberspace. It focuses more specifically on videogaming called MOBA, multi-player online battle arena games, in which players point and shoot at others. A case example emphasizes the clinical problems emerging from violent fantasies that seek a false form of containment in cyberspace. Themes of destructive fantasizing are further amplified through images of apocalypse, which are often prevalent in combat arena videogames. Textual sources from the Book of Revelation offer possible understanding for various elements of destructiveness as it appears in vulnerable male psyches. Therapeutic contact that combines a relational, containing approach and a broadly spiritual and soulful perspective can provide a path to healing such violent splits within the psyches of boys and young men.

Les garçons et les jeunes hommes vivent de manière plus fréquente par internet leur aliénation psychique et sociale. Cet article explore certains des risques et dangers qui peuvent provenir de retraites dans le monde bidimensionnel du cyberespace. Il porte plus spécifiquement sur les jeux vidéo MOBA, des jeux de combats multi-joueurs en ligne, dans lesquels les joueurs se visent et se tirent dessus. Un cas clinique souligne les problèmes cliniques qui émergent des fantasmes violents cherchant une fausse forme de contenance (containment) dans le cyberespace. Les thèmes de fantasmes destructifs sont amplifiés par des images d'apocalypse, qui sont souvent largement répandues dans les jeux vidéo de zone de combat. Des sources textuelles venant du Livre de la Révélation apportent des possibilités de compréhension de plusieurs éléments de destructivité telle qu'elle apparait dans les psychés masculines vulnérables. Le contact thérapeutique qui combine une approche relationnelle et contenante ainsi qu'une perspective spirituelle au sens large du terme peut fournir un chemin pour guérir de tels clivages à l'intérieur de la psyché de garçons et de jeunes hommes.

Niños y jóvenes, cada vez más frecuentemente, viven aspectos de su alienación psíquica y social, en el mundo virtual. El presente trabajo explora algunos de los riesgos y peligros que pueden emerger a partir del retiro al mundo bidimensional del ciber-espacio. Se focaliza más específicamente en un juego virtual llamado MOBA, batallas online de jugadores múltiples, en las cuales, los jugadores apuntan y disparan a otros. Un ejemplo clínico enfatiza los problemas clínicos que emergen a partir de las violentas fantasías que buscan una contención falsa en el ciber-espacio. Temas de fantasías destructivas son amplificadas a través de imágenes de apocalipsis, las cuales prevalecen a menudos en los combates virtuales. Fuentes textuales del Libro de las Revelaciones ofrecen una posible comprensión a los varios elementos de destructividad tal como se manifiestan en las psiques masculinas vulnerables. Un contacto terapéutico que combina un abordaje relacional contenedor y una perspectiva espiritual más amplia puede proveer un camino hacia la curación de semejantes disociaciones violentas en las psiques de niños y de jóvenes.

'Just black sometimes', part 2: reflections on an adolescent's journey.

In this second article about work at a refugee centre for unaccompanied minors in Berlin, the author discusses his encounter with Syrian and Afghani adolescents who were enrolled in the program. Issues around adaptation to a new culture are explored with attention to the dynamics of conformity and marginalization. The questions of what happens to adolescent refugees separated from their families, and how their identity formation is shaped by this burden is explored in relation to the author's meeting with a Syrian adolescent living in Berlin. To illustrate the long reach of a missing father who has been left behind, characters from Virgil's Aeneid are discussed to amplify heroic and spiritual aspects within father-son relationships. The interplay between needing help and allowing for resilience is explored as an important aspect of refugees' transitions, while also considering variables such as dependence and independence, foreign and familiar, being with or without family, and adjusting to the present and/whilst relating to the past; tensions between these alternatives can create various psychosocial challenges for adolescent refugees.

Dans ce deuxième article sur le travail dans un centre pour réfugiés mineurs et non-accompagnés à Berlin, l'auteur évoque sa rencontre avec les adolescents Syriens et Afghans qui suivent le programme de ce centre. Les problèmes dus à l'adaptation à une nouvelle culture sont examinés, en prêtant une attention particulière aux dynamiques liées à la conformité et la marginalisation. La question de ce qui arrive aux réfugiés adolescents séparés de leurs familles, et de comment la formation de leur identité est façonnée par ce fardeau, sont examinées en s'appuyant sur la rencontre de l'auteur avec un adolescent Syrien vivant à Berlin. Pour illustrer la portée d'un père absent et qui a été laissé en arrière, des personnages de l'Enéide de Virgile sont discutés afin d'amplifier les aspects héroïques et spirituels des relations père-fils. L'interaction entre avoir besoin d'aide et donner de la place à la résilience est étudiée comme un aspect important des transitions des réfugiés. En même temps d'autres variables sont également prises en compte: la dépendance et l'indépendance, l'étranger et le familier, être avec sa famille ou sans famille, ainsi que l'ajustement au présent tout en restant en contact avec le passé. Les tensions entre ces alternatives peuvent créer divers défis sociologiques et psychologiques pour les réfugiés adolescents.

En este segundo artículo sobre el trabajo en un centro de refugiados para menores no acompañados en Berlín, el autor discute su encuentro con adolescentes Sirios y Afganos enrolados en el programa. Se exploran temas vinculados a la adaptación a una nueva cultura con especial atención a las dinámicas de conformidad y marginalización. Las preguntas acerca de lo que sucede a los adolescentes refugiados separados de sus familias, y cómo la formación de su identidad es determinada por este peso, son exploradas a partir del encuentro del autor con un adolescente Sirio viviendo en Berlín. Para ilustrar el largo alcance del padre perdido quien ha sido dejado atrás, se presentan caracteres de La Eneida de Virgilio, para amplificar aspectos espirituales y heroicos, dentro de la relación padre-hijo. Se explora el inter juego entre la necesidad de ayuda y el permitir la resiliencia, como un aspecto importante en las transiciones del refugiado, considerando al mismo tiempo variables como dependencia e independencia, extranjero y familiar, estar con o sin familia, y ajustarse al presente y/mientras relacionarse con el pasado; tensiones entre estas alternativas pueden crear varios desafíos psicosociales a los adolescentes refugiados.

The Psychology of Shoplifting: Development of a New Typology for Repeated Shoplifting.

Despite the damaging effects of shoplifting on individuals, the current literature offers little guidance for changing shoplifting behavior. One limitation in this area of research has been the failure to use empirically and theoretically sound methodologies to identify individuals' diverse characteristics and motivations. The present study addressed these limitations by developing an empirically and theoretically supported typology of the varied individuals who shoplift. Participants included 202 community individuals who reported repeated shoplifting and provided information about their shoplifting behavior, motivations, mental health, ethical attitudes, personal histories, and life circumstances. Cluster analyses revealed that the sample could be divided into six discrete groups. These clusters comprise a typology of shoplifting, including Loss-Reactive (28% of the sample), Impulsive (20%), Depressed (18%), Hobbyist (18%), Addictive-Compulsive (9%), and Economically Disadvantaged (7%) types. Each type comprises a unique pattern of shoplifting with unique needs. This research establishes a promising foundation for treating the diverse individuals who shoplift.

'Just black sometimes': analytic tools applied at the frontlines of social upheaval, part 1.

Analysts are increasingly grappling with making space for the discussion of turbulent and disturbing current events in their practices. This social disorder raises questions about the role of social activism and advocacy for groups suffering discrimination, persecution, violence, and displacement. Jung too commented on the immediacy of political happenings that show up in our practices with 'violence'. The author discusses an organizational consultation he did in Berlin in 2017 to consult for an NGO that handles placements for unaccompanied minors who are refugees. Such consultation can employ analytic ideas and concepts to the benefit of the organization and its staff. This process, though, requires some translation of these ideas so as not to burden consultees with theoretical terminology with which they may have little or no familiarity. The role of vicarious trauma is discussed, including how it is passed along, and its implications for frontline helpers are considered. Developmental aspects of adolescence figured prominently in the consultation. This is the first of two papers addressing this topic; the second will focus on interactions that the author had with young refugees.

Lost in (cyber)space: finding two adolescent boys hiding from their own humanity.

This article explores the intense psychological effects of compulsive Internet use, which has become increasingly common among adolescent boys and young men. Two cases are presented and discussed to illustrate some of the psychic distortions around thinking and feeling, as these occurred in the analysis of a mid-adolescent boy and of another patient in later adolescence. A kind of narcissistic omnipotence grounded in magical thinking appeared to take root in their minds, and it led to an avoidant pattern in relationships because of such strong wishes for both distance and control. A short review of the conceptual origins of magical thinking underscores its continued relevance because so many now engage with the Internet. In addition, Anzieu's idea of the 'skin ego' is applied to the clinical case material to provide a theoretical framework for the developmental challenges that can appear in adolescent boys who seek to use the Internet as a form of psychic container. Emerging problems that immersion in the Internet might bring into our practices, for example the depleting effects of massive projective identification, are considered and discussed, along with the obvious ways in which using the Internet can be beneficial for connecting with others, for creating new platforms of expression, and for education.

The impact of group psychotherapy on social development in children with pervasive developmental disorders.

Thirty-nine children with a diagnosed pervasive developmental disorder (PDD) participated in homogeneous psychotherapy groups. Their social development was assessed at home and at school both before and after treatment. Significant improvements in social functioning were observed in both settings, and these gains were not attributable to demographic variables or cognitive development. This research provides psychometric validation for the Vineland Adaptive Behavior Scale (VABS; Sparrow, Balla, & Cicchetti, 1984) and the Tyminski Social Skills Checklist (SSC), a new index designed to assess children's social functioning in educational settings. The results suggest that group therapy may be an important modality for better understanding and developing crucial social skills among the growing number of children diagnosed with a pervasive developmental disorder.

The week the couch arrived.

Changes in the therapeutic environment can elicit intense and unpredictable responses from patients, who then react to the new elements with their own unique thoughts, fantasies, emotions and behaviours. When the change is very specific, and when it entails implications for the treatment itself, these patient responses can coalesce around more profound experiences of the transference as well as of the countertransference. The author, as a candidate or analyst-in-training, purchased an analytic couch for his office and observed the unfolding of what this new couch meant for existing treatments. Using clinical examples, he describes the three most common patient responses that occurred: rejecting, ambivalent, and embracing. The richly variant ideas and fantasies related to the analytic couch are described, and the couch's history within Freudian and Jungian contexts is reviewed. Personal determinants that could lead to the decision of whether to use a couch as part of analysis are considered from the standpoint of the analyst's preferences and own experience with the couch. The couch is discussed as a signifier of the analytic process with cultural meanings alluding not only to familiar stereotypes, but also to psychological healing and self-development.

Long-term group psychotherapy for children with pervasive developmental disorders: evidence for group development.

This article highlights the clinical progress of three long-term psychotherapy groups for children with pervasive developmental disorders. Unique aspects of working with such children are addressed as well as their movement through the phases of group development. Clinical observations suggested that these groups did in fact pass through observable phases of cohesion, differentiation, and intimacy. Further, these children demonstrated noticeable social development both inside and outside the groups. They identified strongly with their groups, and after the settling-in period, there was remarkably little resistance to participation, especially given the children's tendencies for social avoidance. Vignettes are provided to illustrate both group developmental phases and noteworthy psychological experiences of the clinical process with children who have been diagnosed with pervasive developmental disorders.