[Support groups, preventing violence and dangerousness]. / Groupes de parole, prévenir la violence et la dangerosité.

A support group brings together several people around a common theme. It aims to favour the expression of experiences, suffering, conflicts, problems as well as discussions about potential improvements or solutions. The themes of these supervised exchanges are varied and numerous. They might cover violent acts against oneself or others in order to lessen or prevent such violence and dangerousness. Support groups are often supervised and facilitated by psychologists, frequently accompanied by nurses when they take place within a healthcare setting.

Etiology, pathogenesis, and therapy according to Pierre Janet concerning conversion disorders and dissociative disorders.

Pierre Janet's works on conversion disorders or dissociative disorders has mainly fallen to the wayside in favour of Freud's works. In the first part of this paper, Janet's conception of hysteria is discussed and his place in French psychiatry described. Different aspects of Janet's diathesis-stress approach are presented (particularly the pathogenic concept of fixed ideas), which refer not only to a conception of hysteria but also to traumatic (stress) disorders and other psychological disturbances. The second part of the paper details the varieties of Janetian therapeutic treatments of these disorders: the "liquidation" of fixed ideas by hypnosis and suggestion, confrontation techniques, which resemble contemporary cognitive behavioural approaches, and special cognitive ("logagogic") interventions. Finally, we discuss the various treatment strategies based on psychoeconomic considerations such as physical or psycho-phyical therapies, psychoeducation, treatment through rest, and simplification of life for dealing with basic disturbances of psychic disorders.

Abreaction for conversion disorder: systematic review with meta-analysis.

BACKGROUND: The value of drug interviews in the treatment of conversion disorder is at present unknown. AIMS: To review all the available papers published in English that report on the use of drug interviews for treating conversion/dissociative disorder. METHOD: Databases (including EMBASE, MEDLINE and PsycINFO) were searched from 1920 to 2009. Selected publications had to report on the use of drug interviews in people diagnosed with a conversion/dissociative disorder. Qualitative and quantitative data were extracted. Predictors of a positive response were ascertained using meta-analytic techniques. RESULTS: Fifty-five papers meeting inclusion criteria were identified. No studies compared the intervention with a suitable control group. However, two studies reported high response rates when drug interview was used in individuals with treatment-resistant conversion disorder. In the meta-analysis, the use of suggestion and occurrence of emotional catharsis during the interview were positively associated with recovery. Combining two medications and comorbid psychiatric disorder were negatively associated with recovery. CONCLUSIONS: The evidence for effectiveness of drug interviews is of poor quality but it may be of benefit in the treatment of acute and treatment-resistant conversion disorder. A proactive approach during the interview, making suggestions the individual will respond, could influence outcome. Comorbid psychiatric disorder should be treated conventionally. Experimental studies to determine efficacy are required.

Memory focused interventions (MFI) as a therapeutic strategy in hypnotic psychotherapy.

The prospect of utilizing memory plasticity (the constructive and transitory nature of memory) for therapeutic purposes has not been widely recognized. However, a number of theoretical and clinical venues throughout the last century have shown its potential application. Intensive research conducted during these last decades, pointed out the possibility of influencing human memory in relation to new memories and their specific components. Moreover, the research showed the feasibility of planting alternative early childhood memories and thus altering memories of personal history. Additionally, researchers found that memory is naturally very fallible due to everyday phenomena of forgetfulness, distortion and intrusion of past and present information. Throughout the course of this paper, the integrative overview of these empirical findings with the aforementioned clinical and theoretical foundations serves as a substratum in an attempt to present an integrative therapeutic approach, named Memory Focused Interventions (MFI).

[Indication and therapy of obsessive-compulsive disorder in children and adolescents]. / Indikationsstellung und Therapie der Zwangsstörungen bei Kindern und Jugendlichen.

Based on normal developmental phenomena we describe characteristics of obsessive-compulsive disorder in childhood. The functionalities of OCD symptoms are crucial for the treatment planning. According to the functions of symptoms a treatment of OCD symptoms or a treatment of their underlying problems or even a treatment with the family members of the child with OCD is indicated. Finally the peculiarities of OCD treatment with children and adolescents are described.

A relação entre arte e vida em vigotski: uma análise conceitual / The relationship between art and life in vygotsky: a conceptual analysis / La relación entre arte y vida en vigotski: un análisis conceptual

Este trabalho teve como objetivo analisar a relação entre arte e vida segundo Vigotski. Para isso, foi realizada uma análise conceitual dos capítulos 1, 7, 9, 10 e 11 da Psicologia da Arte, do capítulo 13 da Psicologia Pedagógica e do texto O significado histórico da crise da Psicologia: Uma investigação metodológica. A pesquisa conceitual consiste na análise semântica dos principais conceitos de uma teoria com o intuito de elucidar seus sentidos ocultos ou confusos e desvendar possíveis contradições e ambiguidades no quadro teórico. Podemos observar que a arte é um fenômeno dialético tanto em sua criação como em seus efeitos. A influência da vida, isto é, da realidade sócio-histórica, na criação artística é indireta, pois ela é sempre mediada pelo psiquismo particular do artista. Já o efeito da arte sobre a vida possibilita que o ser humano se conscientize de sua realidade social e se engaje para mudá-la. A arte é, portanto, transformadora, pois reorganiza o psiquismo e possibilita uma mudança nas condições materiais dos seres humanos.(AU)

This study aims to analyze the relationship between art and life according to Vygotsky. Therefore, a conceptual analysis of chapters 1, 7, 9, 10, and 11 of Psychology of Art, chapter 13 of Educational Psychology and the text The Historical meaning of the Crisis of Psychology: A Methodological Investigation was carried out. Conceptual research consists of the semantic analysis of the main concepts of a theory to elucidate its hidden or confused meanings and to reveal possible contradictions and ambiguities in the theoretical framework. Results show that art is a dialectical phenomenon both in its creation and its effects. The influence of life, that is, of socio-historical reality, on artistic creation is indirect since it is always mediated by the artist's particular psyche. The effect of art on life, on the other hand, allows human beings to become aware of their social reality and engage to change it. Art is, therefore, transformative, as it reorganizes the psyche and enables a change in the material conditions of human beings.(AU)

Este proyecto tuve como objetivo analizar la relación entre el arte y la vida, según Vigotski. Para esto, fue realizado un análisis de los capítulos 1, 7, 9, 10 y 11 de Psicología del arte, del capítulo 13 de Psicología Pedagógica y del texto Él significado histórico de la crisis de la Psicología: una investigación metodológica. La pesquisa conceptual consiste en la analice semántica de los conceptos de una teoría, para aclarar sus significados ocultos o confusos y desvendar contradicciones y ambigüedades em el cuadro teórico. Pudimos observar que, el arte es un fenómeno dialéctico en su creación tanto como en sus efectos. La influencia de la vida, esto es, de la realidad socio-histórica, en la creación artística es indirecta, pues es mediada por el psiquismo particular de lo artista. Así, el efecto del arte sobre la vida habilita que lo ser humano adquiera conciencia de su realidad social y que se comprometa a cambiarla. El arte, consiguientemente, transformadora, pues reorganiza lo psiquismo y habilita un cambio en las condiciones materiales de los seres humanos.(AU)

Treating the traumatic memories of patients with dissociative identity disorder.

OBJECTIVE: The author uses clinical experience informed by research findings to suggest approaches to the treatment of the traumatic memories of patients with dissociative identity disorder. METHOD: Recent findings in the treatment of patients with this disorder and current considerations with regard to memories of childhood trauma are used to develop recommended approaches. RESULTS: Treatment of traumatic memories appears crucial in the recovery of patients with dissociative identity disorder, even though the reported memories may not be historically accurate. Criteria are available for determining whether a patient with the disorder is able to undertake such efforts, and methods such as fractionated abreaction have been developed to make the process less unsettling. CONCLUSIONS: Despite the difficulties posed by the vulnerability of patients with dissociative identity disorder to decompensation when working with traumatic material and the vicissitudes of autobiographical memory, modern therapeutic approaches allow the processing of such patients' traumatic material in a manner that reduces the likelihood of disruptive events and the misuse of recovered material.

Annoyance, type and duration of postannoyance activity, and aggression: the "cathartic effect".

A series of experiments was conducted to elucidate the conditions conductive to a decrease in aggression following annoyance. The potential capacity of expression of aggression to bring about a reduction in the amount of subsequent aggression was of particular interest. This empirical concern was supplemented by tests of several influential and competing theoretical concepts dealing with the cathartic aspects of human aggressive behavior. Given the failure of such concepts to account for major portions of the data, an integrative theoretical model was proposed. experiment 1 evaluated the usefulness of the hydraulic, self-arousal, and dissipation of anger concepts in accounting for the earlier demonstrations of the cathartic effect. In a 2 x 3 x 2 design, half of the subjects were annoyed by a confederate, while the other half were treated neutrally. During the next stage (the interpolated period), a third of all subjects gave "shocks" to the confederate, another third simply waited, while the remaining third worked on mathematical problems. Orthogonal to the first two facotrs was the duration of the interpolated period (7 to 13 min). The main dependent measure was the number of shocks administered to the confederate in the final stage of the experiment. It was found that annoyed subjects gave more shocks than nonannoyed ones did, and that only the former were substantially affected by other manipulations. In the case of the annoyed wait and annoyed math subjects, the anger dissipation hypothesis correctly predicted that the mere passage of time would decrease the amount of subsequent aggression, presumably due to the action of homeostatic processes. The self-arousal hypothesis correctly predicted that the annoyed math subjects would give fewer shocks than the annoyed wait ones would. Since the subjects were engaged in an absorbing activity, the likelihood of their arousing themselves by ruminations about the preceding annoying incident was minimized, and the amount of subsequent aggression reduced. Yet, when annoyed subjects had given the confederate a moderate number of shocks in the interpolated period, they subsequently gave him fewer shocks than the 7-min annoyed wait and annoyed math subjects; this was the only outcome predicted correctly by the hydraulic model. In contrast, when a large number of shocks had been administered in the interpolated period, the amount of subsequent aggression was relatively high. The interpretation of the latter result in terms of an "adaption effect" was tested by further experiments.

Catharsis and abreaction in the history of psychological healing.

With roots in ancient religious practices of purification and cleansing and in ancient medicine's purgings, Plato evolved a verbal catharsis for diseases of the soul, and Aristotle developed a catharsis of the passions through tragic drama. Through the centuries, most cultures have had recognized contexts in which emotions were evoked, heightened in intensity, and ultimately released or discharged; and cathartic procedures can be detected in many cultures' healing practices. The late decades of the nineteenth century saw the emergence of numerous psychological healings with a cathartic basis. Catharsis came to mean the lively remembering of a traumatic experience in addition to the emotional release; and the term abreaction frequently was used to refer to the emotional release. Subsequently, the notion that the recovered traumatic memories needed to be integrated with the rest of the patient's mental life became a third significant element. The significance of these three factors has been debated vigorously; but, whether it has been some combination of them or merely the emotional discharge, there has been a cathartic element in many twentieth-century approaches to psychological healing.

Psychotherapy and case management for multiple personality disorder. Synthesis for continuity of care.

Patients with MPD are often difficult to manage in the community. These patients have a chaotic lifestyle with acting out behaviors and traumatic relationships. They have difficulty in managing time, maintaining good function, and being safe. The prognosis is good, however, with intensive psychotherapy. Still, containment of the treatment, which is often stormy, is a difficult task. Clinical case management is a treatment modality that strives to bring order out of chaos, stabilize the patient in the community, and encourage the highest level of function during treatment. It is useful to conceptualize case management as a framework for MPD psychotherapy, both to contain the therapy and to be drawn on for strength and resources. The stages of MPD therapy can be intertwined with the core case management functions of assessing, planning, linking to resources, monitoring, and advocacy to facilitate continuity of care for the patient. The synthesis of psychotherapy and case management can decrease chaos for both the patient and therapist, facilitate the patient's function on a daily basis, and increase connectedness for the patient and needed services. There is an art and a subtlety to the synthesis that grows with awareness and experience of the therapist/case manager. It is a synthesis worthy of development and implementation.

Behavioral psychotherapy for anxiety disorders.

Behavioral psychotherapy is probably the treatment of choice for most phobic and obsessive-compulsive disorders and plays a lesser role in the management of panic disorder without agoraphobia, generalized anxiety disorder, and posttraumatic stress disorder. This article discusses treatment goals and strategies for each disorder.

Post-traumatic stress disorder following myocardial infarction.

The evaluation of Post-Traumatic Stress Disorder (PTSD) following myocardial infarction in four patients is described. The authors outline principles of the therapeutic interventions performed to alter the disorder and alleviate patients' incapacitation. Also discussed are the reasons that may be at the root of the omission of the diagnosis of PTSD for this patient population.

Effects of viewed violence and aggression: stimulation and catharsis.

Tests of the catharsis hypothesis involving viewed violence have led to conflicting results. It was suggested that the inconsistencies were due in part to the use of two different types of response measures, aggressive responses and hostile responses. This study involved a direct comparison of the two types of responses under conditions of instigation versus no instigation and aggressive versus neutral film. It was hypothesized that viewing an aggressive film would lead to a decrease in hostile responses (catharsis) and an increase in aggressive responses (stimulation) when compared with a neutral film condition. It was also hypothesized that both stimulation and catharsis effects would be enhanced under instigation conditions. A main effect of instigation was found with subjects in the instigation condition having higher scores than those in the noninstigated condition. A main effect of film was found with subjects having lower scores in the aggressive film condition than in the neutral film condition. A significant Film times Response Outlet interaction was found which offered support for the predicted catharsis effect on the hostility measure. There was no support for the predicted stimulation effect on the aggression measure. The results of the study offer support for the main thesis that in examining the effects of viewed violence, separation of hostile responses and aggressive responses is necessary for full understanding.

The facilitation of aggression by aggression: evidence against the catharsis hypothesis.

Nnety male subjects were either attacked or treated in a more neutral manner by a male confederate. On a subsequent maze-learning task, one third of the subjects shocked the confederate, one third observed as the experimenter shocked the confederate, and one third waited for a period of time during which the confederate was not shocked. Finally, all subjects shocked the confederate as part of a code-learning task. Subjects who had been attacked and had shocked the confederate during the maze task delivered shocks of greater intensity on the code task did subjects in the other two conditions, and the former subjects also experienced a greater reduction in diastolic blood pressure than did the latter. The results contradict the hypothesis of aggression catharsis and are discussed in terms of feelings of restraint against aggressing that a subject experiences after committing an aggressive act.

An empirical study on the "cathartic effect" of attempted suicide.

A cathartic effect of attempted suicide has been suggested, but few data are available to validate the concept. In this study we report on the relation between presuicidal and postsuicidal mood conditions in a group of 25 hospitalized suicide attempters and 50 control patients who were depressed but not suicidal. A significant decrease in depression was demonstrated to occur in the suicidal patients within a few days of hospitalization. This was not the case in depressed patients without prior suicide attempts. The drop in depression ratings can, therefore, be attributed to the suicide attempt. Possible explanatory factors are discussed. These findings indicate that the diagnosis of a suicide attempt in the absence of depression can only be reliably made on the basis of data pertaining to the presuicidal mood condition.

Treatment implications of past trauma in borderline personality disorder.

Recent research and clinical experience have shown childhood trauma to be common in the histories of patients with borderline personality disorder. This article reviews the association between borderline personality disorder and early trauma, and how an awareness of the role of trauma may improve the treatment of patients with this disorder. Particularly when early trauma is in the form of childhood abuse, clinicians may be better able to understand the difficulties these patients experience in relational skills, affect tolerance, behavioral control, self-identity, and self-worth. Clinicians may be able to facilitate a stronger therapeutic alliance through acknowledgement of the patient's victimization and empathy with the effects of early trauma on the patient's life. Reframing the patient's experience as a consequence of childhood trauma is essential, especially when making traditional interventions such as interpretation and confrontation. The role of trauma in the development of borderline personality disorder suggests the need for modification of models of individual, family, and group psychotherapies that may allow more productive and successful treatment.

Epileptic seizures induced by sexual abuse. Pathogenic and pathoplastic factors.

Previous sexual abuse is now thought to be a common cause of non-epileptic seizures (pseudoseizures). However, since sexual abuse is common, a previous history of sexual abuse may also occur in people with actual epilepsy. We present six patients in all of whom sexual abuse may, by acting as a stressor in the already predisposed, have precipitated epilepsy and in some of whom the abuse may have affected the actual experiences of the epilepsy itself: all but one of the patients had partial seizures.

Gender-related differences in non-epileptic attacks: a study of patients' cases in the literature.

Gender-related differences for disorders of consciousness other than true epilepsy usually point to a larger number of women suffering especially from non-epileptic attacks or pseudoseizures. Recently, sexual abuse has been suggested as a possible cause for this increased prevalence in women. It has, however, not been very clear if women have a different phenomenology of these type of seizures from men. In the present study, patients' cases as published in the literature are analysed in a detailed way, using a working classification by Betts et al to look for gender-specificity. Of the 62 cases, 76% concern women and 24% men; a percentage comparable to those published elsewhere. Ages range from 14 to 77 years-of-age, but 89% of patients are younger than 40. Sexual abuse was proven in 18 cases, all women. The phenomenology of the attacks was divided into tonic-clonic type and complex partial type of attack, or a combination of the two. Also, special types of attacks (swoons, tantrums, abreactive attacks and forthright simulation) were looked for. Males tended to suffer especially from tonic-clonic type seizures (80% of cases), while in women as many tonic-clonic type as complex partial type attacks were observed. Special types of attacks were observed at the same frequency in both sexes. The group of sexual abuse victims did not differ from the total group of women in this respect. The clinically more impressive nature of a tonic-clonic-type attack, that is more easily suspected to be 'real', might make this type of seizure a more male form of acting out. A prospective study on the incidence and phenomenology of pseudo-epileptic seizures in the general population is suggested to answer the new questions raised in this survey.