Abordajes psicoterapéuticos de los casos difíciles (I parte) / Psychotherapeutic approaches in difficult cases

En este articulo planteamos el problema de la psicoterapia en los casos difíciles entendiendo como tales lo contrario de los casos de indicaciones de consulta terapéuticas o de psicoterapias breves (padres-hijos o de tipo ``focal``) se dan ejemplos clínicos para ilustrar la hipótesis de que las intervenciones psicoterapéuticas breves pueden realizar sobre todo en las organizaciones de personalidad de tipo neurótico o paradepresivo. En las organizaciones borderline más o menos regresivas las posibilidades de construir un ´´foco psicoterapéutico central´´ se reducen y con ello la posibilidad de realizar una acción psicoterapéutica breve, aunque se puede intentar. En las organizaciones de la personalidad más regresivas con rasgos psicóticos infantiles autísticos o simbióticos, incluso la psicoterapia convencional encuentra graves obstáculos, en particular reacciones terapéuticas negativas (AU)

In this paper we pose the problem of psychotherapy in difficult cases in contrast with those cases indicated for therapeutic interviews or brief psychotherapies( parents-child or ´´ focal´´).Several clinical examples with illustrate the hypothesis that brief psychotherapeutic interventions are attainable, above all, in neurotic or ´´para-depresive´´ personality organizations are give. In more or less regressive borderline organizations the possibilities of constructing a ´´central psychotherapeutic focus´´ and therefore of obtaining a brief psychotherapeutic action are reduced, though this may be attempted. In more regressive personality organizations, with infant psychotic autistic or symbiotic. Traits, even psychotherapies interventions, neurotic personality, psychosis (AU)

Los trastornos de personalidad en el adolescente, el niño e incluso en el bebé / Personality disorders in adolescents, children and even in babies

En este artículo el autor propone un recorrido por los trastornos de la personalidad desde el niño pequeño hasta el adolescente. Va describiendo cada uno de ellos, destacando, a su vez, las principales características desde diferentes ángulos: relaciones con el examinador, funciones del yo, concepto del self e identificaciones. Termina con descripción de elementos clínicos y terapéuticos a tener presente en los trastornos del humor del bebé y del niño pequeño (AU)

In this paper the author proposes a journey thorugh personality disorders from te smaller child up o the adolescent. To achieve this, the author describes each of them and highlights their main characteristics from different angles: relationship with the interviewer, ego functions, self concept and identifications. The paper finally ends with an account of clinical and therapeutic elements to be considered in affective disorders of the baby and toddler (AU)

[Prevention of preterm delivery: new interventions]. / Prévention de l'accouchement prématuré: nouvelles approches.

Prematurity is an important cause of perinatal mortality and morbidity. The incidence is not decreasing, despite the efforts of prevention. Few interventions were demonstrated effective to decrease the risk of preterm birth. We are currently conducting two randomized trials including women with preterm labor. The objective of one trial is to evaluate a psychotherapeutic intervention. The other trial is multicentric to evaluate vaginal progesterone. We hope that these two trials will provide us with valid evidence on the effectiveness of these interventions to decrease the risk of preterm delivery and of neonatal consequences.

Early behavioral development in autistic children: the first 2 years of life through home movies.

OBJECTIVE: The main aim of the research is to study the early behavioral development in autistic children through home movies. METHODS: fifteen home movies, regarding the first 2 years of life of autistic children are compared with the home movies of 15 normal children. The films of the two groups were mixed and rated by blind ratings with the Grid for the Assessment of Normal Behavior in Infants and Toddlers. The grid is composed of 17 items grouped into three developmental areas: social competence, intersubjectivity and symbolic activity. For every area, we have identified specific children's behaviors. RESULTS: Significant differences between the two groups are found both in the range of age 0-6 for intersubjectivity, and in the ranges of age 6-12 and 18-24 for symbolic activity. CONCLUSIONS: The authors pose some hypotheses about an early-appearing impairment of intersubjectivity, the ability to represent other's state of mind, in subjects with autistic disorder.

Young children with Velo-Cardio-Facial syndrome (CATCH-22). Psychological and language phenotypes.

This is the first clinical description of a detailed psychological, speech, and language phenotype of four young children (< 5 years) with Velo-Cardio-Facial syndrome (VCFS) due to a deletion on chromosome 22 (22q11.2). The reported elevated risk of developing schizophrenia or bipolar disorder in adolescence for individuals with this chromosomal deletion led us to examine the psychiatric and cognitive status of young children with VCFS. Our observations suggest a phenotype comprised of a borderline to mildly retarded level of intellectual functioning, a language delay, a general deficit in social initiation, difficulties with attention/concentration, and a perturbed train of thought.

Study of the onset of autism through home movies.

The authors describe the natural history and the beginning of pervasive developmental disorders (PDD) by the observation of home movies. The sample is composed of 26 children aged 18 months to 5 or 6 years at the first consultation. The methodology used in the observation of home movies includes: (1) application of the ERC-A-III scale for recognizing the precocious symptoms of autism; (2) analysis of the coming out and coming off of social, emotional and cognitive competences. The authors, starting from the analysis of these data, describe three kinds of onset and courses of PDD: progressive, regressive and fluctuating. The authors present some conclusive considerations on the different age of PDD onset in home movies, in anamnestic reconstruction and in recall for diagnosis.

The narcissistic scenarios of parenthood.

The authors begin by pointing out that Freud always considered parent-child relations in terms of the child's psychic development and took little account of the parents' experience of the relationship and its psychic effects on them. They recall Freud's distinction between the anaclitic and narcissistic modes of relationship and show how these are unconsciously embodied and enacted in varying proportions in the cases observed in their own clinical practice of therapeutic consultations with parents and young children. After a review of the relevant psychoanalytic literature, the authors present their concept of the narcissistic scenarios of parenthood, which include parental projection on to the child, parental counter-identification, a specific aim and a relational dynamic that is acted out. Depending on the individual situation, the effects may help to structure the developing psyche or, if the narcissistic element is excessive, they may be pathological. The authors consider the literature on the application of psychoanalysis to therapeutic interventions with parents and children, stressing the technical importance of establishing a therapeutic focus. These ideas are illustrated by a detailed case history showing the interaction between a mother and a 4-year-old girl and how it was modified by a short therapy. The differences between interpretation in this situation and in the classical psychoanalytic setting are explained, and the paper ends with some comments on the transmission of psychic elements from generation to generation.

["Para-neurotic" organization in the young child]. / L'organisation "para-névrotique" chez le jeune enfant.

We define the term "para-neurotic organization" as a particular form of the mental organization of the young child, intermediate between a neurotic structure and a personality disorder. The para-neurosis has little chance of spontaneous improvement, but there is good indication for psychotherapeutic treatment for these children and its results are satisfactory. Although the fantasmatic life of this type of children is often related to oedipal problems and their capacity to symbolise is rich, there are nevertheless frequent regressive mouvements leading to blocking (inhibitions of symbolisation) or to manic behaviors (flight of ideas). The persistance of this functioning could prevent the establishment of a true neurotic organization. We shall present this clinical entity on the basis of clinical examples (dynamic profiles). In order to illustrate the principal caracteristics, a standard-scale has been constructed. Psychodynamic considerations support our various findings.

[Therapeutic indications in child psychiatry and involvement of the family]. / Les indications thérapeutiques en psychiatrie infantile et l'implication de la famille.

On the basis of clinical cases in which brief therapeutic parent-child interventions were indicated, the author treats the problem of the involvement of the parents and of the family in child psychiatry. The clinical and dynamic characteristics of the parent-child interaction (that of the mother with her child in particular) as well as the relation with the examiner (positive pre-transference) are studied. Cases of counter-indication of this type of approach are also taken up. The author suggests using these clinical-dynamic criteria and the pre-transference in order to determine which members of the family could lend themselves to the most efficient, and economical preventive and therapeutic approaches.