On the Belatedness of Psychoanalytic Clinical Writing.

The belatedness of analytic writing and its effects on analytic processes are explored through the concepts of nachträglichkeit and thirdness. The temporal gap between being with and writing about functions as a meaningful pause filled with opportunities for investigating unconscious pathways to the analyst's countertransference. The significance of analytic narration in affecting specific psychoanalytic developments is explored. The theoretical framework utilizes the concept of après coup, which brings to light new meanings in an afterwardness of time. Aspects of analytical writing dynamics are discussed as equivalent to those of nachträglichkeit. Analysts also deploy thirdness in constructing presentations of clinical material. This could be an intrapsychic third or an external figure representing an internal introjected third. A clinical vignette demonstrates the enhanced understanding achieved by writing. It specifically assisted in exploring the analyst's enactment relating to change in the setting, the background for which was a move to online analysis. This evoked infantile anxieties and painful confusions about loss. Historically, the patient had to navigate a path through miasmic ambiguities between reality and phantasy, truths and lies. A conclusion is reached, arguing that analytic processes extend beyond the duration of sessions, and that the processes of clinical writing can provide a significant contribution.

Brain Tumor Imaging without Gadolinium-based Contrast Agents: Feasible or Fantasy?

Gadolinium-based contrast agents (GBCAs) form the cornerstone of current primary brain tumor MRI protocols at all stages of the patient journey. Though an imperfect measure of tumor grade, GBCAs are repeatedly used for diagnosis and monitoring. In practice, however, radiologists will encounter situations where GBCA injection is not needed or of doubtful benefit. Reducing GBCA administration could improve the patient burden of (repeated) imaging (especially in vulnerable patient groups, such as children), minimize risks of putative side effects, and benefit costs, logistics, and the environmental footprint. On the basis of the current literature, imaging strategies to reduce GBCA exposure for pediatric and adult patients with primary brain tumors will be reviewed. Early postoperative MRI and fixed-interval imaging of gliomas are examples of GBCA exposure with uncertain survival benefits. Half-dose GBCAs for gliomas and T2-weighted imaging alone for meningiomas are among options to reduce GBCA use. While most imaging guidelines recommend using GBCAs at all stages of diagnosis and treatment, non-contrast-enhanced sequences, such as the arterial spin labeling, have shown a great potential. Artificial intelligence methods to generate synthetic postcontrast images from decreased-dose or non-GBCA scans have shown promise to replace GBCA-dependent approaches. This review is focused on pediatric and adult gliomas and meningiomas. Special attention is paid to the quality and real-life applicability of the reviewed literature.

Preschoolers negatively evaluate conventional norm violations in pretend play.

A growing body of research demonstrates that children's pretend play is largely influenced by their understanding of reality. The current work took a novel approach to testing children's understanding of pretense by investigating whether children apply and uphold their knowledge of conventional norms in pretend play. In this study, 3- to 5-year-old children (N = 200) were introduced to a series of pretend play scenarios (e.g., pretending to eat breakfast) in which a puppet pretended to follow a norm (e.g., pretended to eat cereal for breakfast) or violate a norm (e.g., pretended to eat a hamburger for breakfast). These pretend play scenarios were presented as either fantastical or realistic in nature. Consistent with our hypotheses, children evaluated pretend norm violation more negatively than pretend norm adherence and reported liking norm violators less than norm followers. Contrary to our hypothesis, the manipulation of play context (fantastical vs. realistic) did not affect children's evaluations. That is, children were just as negative about pretend norm violations (relative to pretend norm adherence) in fantastical pretend play scenarios as they were in realistic pretend play scenarios. Furthermore, individual differences in children's fantasy orientation did not predict their evaluations. This study is the first to establish that children maintain their real-world understanding of conventional norms in pretend play, providing further evidence that children's pretense is largely realistic in nature.

Daydreaming and grandiose delusions: development of the Qualities of Daydreaming Scale.

BACKGROUND: Daydreaming may contribute to the maintenance of grandiose delusions. Repeated, pleasant and vivid daydreams about the content of grandiose delusions may keep the ideas in mind, elaborate the details, and increase the degree of conviction in the delusion. Pleasant daydreams more generally could contribute to elevated mood, which may influence the delusion content. AIMS: We sought to develop a brief questionnaire, suitable for research and clinical practice, to assess daydreaming and test potential associations with grandiosity. METHOD: 798 patients with psychosis (375 with grandiose delusions) and 4518 non-clinical adults (1788 with high grandiosity) were recruited. Participants completed a daydreaming item pool and measures of grandiosity, time spent thinking about the grandiose belief, and grandiose belief conviction. Factor analysis was used to derive the Qualities of Daydreaming Scale (QuOD) and associations were tested using pairwise correlations and structural equation modelling. RESULTS: The questionnaire had three factors: realism, pleasantness, and frequency of daydreams. The measure was invariant across clinical and non-clinical groups. Internal consistency was good (alpha-ordinals: realism=0.86, pleasantness=0.93, frequency=0.82) as was test-retest reliability (intra-class coefficient=0.75). Daydreaming scores were higher in patients with grandiose delusions than in patients without grandiose delusions or in the non-clinical group. Daydreaming was significantly associated with grandiosity, time spent thinking about the grandiose delusion, and grandiose delusion conviction, explaining 19.1, 7.7 and 5.2% of the variance in the clinical group data, respectively. Similar associations were found in the non-clinical group. CONCLUSIONS: The process of daydreaming may be one target in psychological interventions for grandiose delusions.

Links between Aggressive Sexual Fantasies and Sexual Coercion: A Replication and Extension of a Multifactorial Model.

Current research indicates that aggressive sexual fantasies (ASF) are related to sexual aggression, above and beyond other risk factors for this behavior. There have, however, rarely been explicitly considered in multifactor models aiming to explain sexual aggression. One exception is the multifactorial Revised Confluence Model of Sexual Aggression that was replicated in two samples of male individuals who were convicted of sexual offenses and a small sample of men from the general population and evidenced a high relevance of ASF, respectively. There were, however, no further attempts to replicate the model in larger samples from the general population. We, therefore, used a subsample from the Finnish Genetics of Sexuality and Aggression project including 3269 men (age: M = 26.17 years, SD = 4.76) to do so. Cross-sectional latent structural equation models corroborated previous research and the assumption that ASF are a central component in multifactor models that aim to explain sexual aggression: ASF and antisocial behavior/aggression were equally important associates of sexual coercion when also considering adverse childhood experiences, hypersexuality, and callous-unemotional traits. Additionally, ASF mediated the links between hypersexuality, callous-unemotional traits, as well as childhood sexual abuse and sexual coercion. These links held stable when entering further risk factors, that is, distorted perceptions, rape-supportive attitudes, and violent pornography consumption into the model. Contrasting assumptions, alcohol consumption and antisocial behavior/aggression did not interact. These results illustrate the potential importance of ASF for sexual aggression. They indicate that ASF require consideration by research on sexual aggression as well as in the treatment and risk assessment of sexual perpetrators.

The Development and Psychometric Evaluation of the Sexual Fantasy Experience Scale.

Clinicians and researchers consider sexual fantasies to be a central aspect of human sexuality. Although these are subjective experiences, most studies have assessed only their frequency and content. A measure that assesses individuals' subjective experience of sexual fantasies is therefore needed. The aim of this study was to evaluate the psychometric properties of a new measure, the Sexual Fantasy Experience Scale (SFES). In Study 1, the SFES was administered to 391 participants (240 defined themselves as women, 149 as men, and 2 as other). In Study 2, the SFES was administered to 426 participants (255 defined themselves as women, 167 as men, and 4 as other), along with a battery of questionnaires including the New Sexual Satisfaction Scale Short Form and the Global Measure of Sexual Satisfaction, both of which measure sexual satisfaction, as well as the Sexual Fantasy Checklist, which evaluates the content of sexual fantasies and their frequency. Five reliable SFES subscales emerged from Study 1: playfulness, limitlessness, functionality, intrusiveness, and shame. In Study 2, a confirmatory factor analysis confirmed the scale's underlying factor structure, which was obtained in Study 1. The subscales of the SFES contributed to the explained variance of the assessments of sexual satisfaction, beyond the contribution of the fantasies' content and frequency, demonstrating the incremental validity of the subscales. The results of the present analyses suggest that the SFES has good psychometric properties, making it useful as an assessment tool for future research, clinical practice, and sex education.

Deepening Sexual Desire and Erotic Fantasies Research in the ACE Spectrum: Comparing the Experiences of Asexual, Demisexual, Gray-Asexual, and Questioning People.

Over the past 30 years, an increasing number of people have identified within the asexual (ACE) spectrum recognizing an absence/low/situational sexual attraction to individuals of any gender. The current study aims to deepen the knowledge of sexual desire, erotic fantasies, and related emotions within the ACE spectrum. A total of 1072 Italian volunteers were recruited to take part to the present study via social media. Data were collected from October 2021 to January 2022 using the Sexual Desire and Erotic Fantasies questionnaire and the Sexual Desire Inventory-2. Participants were divided into four groups: asexual, demisexual, gray-asexual, and questioning. Focusing on sexual desire, asexual people reported significantly lower scores than the other groups in all the dimensions except for "negative feelings to sexual desire," while demisexual participants showed the higher scores in all the domains except for "negative feelings to sexual desire." The questioning group reported the highest scores in the "negative feelings toward sexual desire" compared to the asexual and demisexual ones. The asexual group reported significantly lower scores than the other groups in fantasies frequency, fantasies importance, negative emotions, and sharing and experiencing. The demisexual group showed higher frequency of romantic fantasies than the asexual and gray-asexual ones. The results showed some specific patterns of desire and fantasies among the asexual, gray-asexual, demisexual, and questioning groups. These data may provide relevant material to clinicians working with asexual patients who need greater awareness about the diversity and heterogeneity of the sexual experience within the ACE spectrum.

The relationship between transliminality, hypnotic and imaginative suggestibility, and other personality traits.

To our knowledge, no study has directly examined the link between hypnotic response and the personality trait of transliminality (which is underpinned, for example, by magical ideation, mystical experience, fantasy proneness, absorption, hyperaesthesia). In order to further understand the correlates of suggestibility, the aim of the current project was to investigate whether transliminality is associated with hypnotic and imaginative suggestibility (considering: objective response, subjective response and involuntariness). Another aim was to assess the contribution of transliminality as a predictor of suggestibility when a range of previously studied personality trait measures were considered. Participants completed: the Revised Transliminality Scale, Tellegen Absorption Scale, Creative Experiences Questionnaire, and the Dissociative Experiences Scale II. To avoid context effects, where knowledge or measurement of one trait or ability might influence measurement of another, a separate standalone study was conducted where hypnotic and imaginative (without hypnosis) suggestibility screenings were carried out in-person in small groups using the modified Carleton University Responsiveness to Suggestion Scale. The merging of these two datasets enabled the analyses. Transliminality was weakly correlated with the imaginative suggestibility subjective response measure (r = 0.19). Likewise, weak correlations were found between transliminality and the hypnotic suggestibility response measures (objective, r = 0.21, subjective, r = 0.23, involuntariness, r = 0.24). The multiple regressions (forward selection) reflected the pattern of correlations, with no model for any of the variables, retaining more than a single significant predictor. In summary, this study combination, avoiding context effects, shows transliminality to be a weak predictor of response to suggestion.

A Content Analysis of Problematic Gambling Prevention Interventions in the United States.

Gambling revenue in the United States is at all-time highs while recent and forthcoming legislation relaxes constraints on casino gaming, sports betting, and fantasy sports betting. Increased gambling will result in increased problematic gambling, highlighting the need to study the impact of our problematic gambling prevention interventions. To address this, we conducted a content analysis of problematic gambling prevention messages in the U.S. Results reveal that although there is overlap between theoretically-based messaging appeals recommended by research and those used in actual prevention interventions, health behavior theory is inconsistently applied and there are numerous examples of potential backfire effects. Results are discussed in terms of their impact on theory development and their noteworthy practical application.

Fantasy Made Flesh - A Network Analysis of the Reciprocal Relationship between Sexual Fantasies, Pornography Usage, and Sexual Behavior.

Based on different theories in media research (3AM, catalyst model of violent crime, reinforcing spirals model), we further explore the relationship between pornography use, sexual fantasy, and behavior. We suggest that pornography use appears so persistent across time and culture because it is related to a human universal, the ability to fantasize. Consequently, pornography use seems to be an opportunity to acquire media-mediated sexual fantasies, and we believe that pornography use interacts with sexual fantasies and, to a much weaker extent, with sexual behavior. To assess our assumptions, we conducted a network analysis with a large and diverse sample of N = 1338 hetero- and bisexual participants from Germany. Analyses were done separately for men and women. Our network analysis clustered parts of the psychological processes around the interaction of sexual fantasies, pornography use, and behavior into communities of especially strong interacting items. We detected meaningful communities (orgasm-centered intercourse, BDSM) consisting of sexual fantasies and behavior, with some containing pornography. However, pornography use was not part of communities we perceive to account for mainstream/everyday sexuality. Instead, our results show that non-mainstream behavior (e.g., BDSM) is affected by pornography use. Our study highlights the interaction between sexual fantasies, sexual behavior, and (parts of) pornography use. It advocates for a more interactionist view of human sexuality and media use.

The correlation between sadomasochists' experience and their sadomasochistic behaviors and fantasies: A qualitative analysis of interviews.

Lacking a comprehensive understanding of sadomasochism makes difficulties in judicial dispositions, clinical interventions, and mental health services. This study explores the correlation between sadomasochists' growth experience and their sadomasochistic behaviors and fantasies. We interviewed 51 sadomasochists from a Chinese subcultural website, coded and analyzed the interview records, conducted correlation and cluster analyses on the reference points of the nodes of impressive experience and sadomasochistic behaviors and fantasies, and constructed the model of Experience-Behaviors and Fantasies. We found that sadomasochists' typical impressive experiences are family parenting and sexual experience; sadomasochistic behaviors and fantasies can be classified into five categories: spirit, punishment, sex, canine, and excretion; and sadomasochistic behaviors and fantasies are partially correlated with sadomasochists' impressive experiences, indicating psychoanalytic theory is the leading theory for the driving processes of sadomasochism, while behaviorist and Gestalt theories also contribute.

Therapy for the Dead: Working Clinically with Jung's Black Books and The Red Book.

With the 2020 publication of the facsimile edition of The Black Books, we have an opportunity to study the layers of C. G. Jung's creative writing process for the first time. In this paper, I explore Jung's practice of active imagination in relation to his fantasy dialogues with the dead during two specific episodes in 1914 and 1916. I discuss Jung's concept of the collective unconscious corresponding to the "mythic land of the dead" and I show how this idea develops in The Black Books and The Red Book, or Liber Novus, culminating in Septem Sermones ad Mortuos. I describe my work with a patient, who, in an early session, said she felt like the "living dead". I recount how the patient's experience of her own internal world began to change as we were able to wonder about the inner world of the patient's late mother and, together, to imagine her mother's lament. I consider the use of imagination when working with the concept of "therapy for the dead" (Hillman & Shamdasani, 2013, p. 164) in the context of intergenerational trauma.

Avec la parution des reproductions des Livres Noirs en 2020, nous avons pour la première fois la possibilité d'étudier les différents niveaux dans le processus d'écriture créative de C.G. Jung. Dans cet article, j'explore la pratique de Jung d'imagination active en lien avec ses dialogues imaginaires avec les morts pendant deux épisodes spécifiques ; en 1914 et 1916. J'étudie le concept de Jung d'inconscient collectif correspondant au 'pays mythique des morts' et je montre comment cette idée est développée dans les Livres Noirs et le Livre Rouge, ou Liber Novus, et culmine dans Septem Sermones ad Mortuos. Je décris mon travail avec une patiente qui, dans une des premières séances, exprima qu'elle se sentait comme un « mort-vivant ¼. Je raconte comment l'expérience que cette patiente avait de son monde interne commença à changer lorsqu'il nous fut possible de nous intéresser au monde intérieur de sa mère décédée et d'imaginer ensemble la lamentation de sa mère. Je réfléchis à l'usage de l'imagination quand on travaille avec le concept de « thérapie pour les morts ¼ (Hillman et Shamdasani, 2013, p.164) dans le contexte de traumatisme intergénérationnel.

Con la publicación de la edición facsímil de Los libros Negros en el año 2020, tenemos la oportunidad de estudiar por primera vez los diversos niveles del proceso creativo de escritura de C. G. Jung. En este artículo, exploro la práctica de la imaginación activa de Jung en relación con sus diálogos con los muertos durante dos episodios específicos en 1914 y 1916. Examino el concepto de inconsciente colectivo de Jung correspondiente a la "tierra mítica de los muertos" y muestro cómo se desarrolla esta idea en Los libros Negros y en El libro Rojo, o Liber Novus, culminando en los Siete Sermones a los Muertos. Describo mi trabajo con una paciente que, en una de las primeras sesiones, dijo sentirse como una "muerta viviente". Cuento cómo la experiencia de la paciente de su propio mundo interno empezó a cambiar cuando pudimos empezar a preguntarnos por el mundo interno de su madre fallecida y, juntas, imaginar el lamento de su madre. Considero el uso de la imaginación cuando se trabaja con el concepto de "terapia para los muertos" (Hillman & Shamdasani, 2013, p. 164) en el contexto del trauma intergeneracional.

The Ubiquity of Psychopathology and the Quandaries this Imposes for Determining "Reality".

In this article, I argue that psychopathology ubiquitously pervades individual and social life. As Freud wrote, each of us finds some way of distorting reality, and as Laing contended, human beings have an almost unlimited capacity for self-deception. History is a chronicle of fantasies, mirages, distortions, and metaphysical consolations believed as apodictic reality, and the bizarre magico-salvific stratagems people adopted to ward off disease, catastrophe, and death. And yet many (even psychoanalysts) maintain the notion (or fantasy) that we perceive reality clearly and sanely. I contend, on the contrary, that we have no epistemologically foolproof way of discerning our own deceptions and defects, and that we find all manner of ingenious excuses not to see ourselves.

Aggressive sexual fantasy frequency outperforms other characteristics in cross-sectionally predicting self-reported sexual aggression in 4 samples.

BACKGROUND: Aggressive sexual fantasies (ASFs) have consistently been associated with sexual aggression measures. ASF frequency has mostly been used to indicate ASF, but other ASF characteristics may be important to explain the apparent gap between alleged high lifetime prevalence rates of ASF and lower sexual aggression rates-that is, why ASFs are only sometimes put into action. AIM: The present study therefore examined whether additional ASF characteristics show associations with sexual aggression measures above and beyond ASF frequency to identify the most relevant ASF characteristics. METHODS: The present study is based on cross-sectional survey data from 4 independent mostly community samples with 448, 131, 758, and 415 participants to examine whether ASF elaboration, intrusion, preoccupation, context, and consent were associated with self-reported sexual aggression measures beyond ASF frequency. OUTCOMES: Self-reported sexual aggression measures included presumably consensual and nonconsensual sexual sadism, self-reports on acting on ASF, sexual harassment, use of coercive strategies, and rape proclivity. RESULTS: The results showed positive correlations among all ASF characteristics. ASF frequency was the most consistent and often strongest predictor of sexual aggression across samples and outcome measures. ASF elaboration and/or its interaction with ASF frequency added to this prediction in study 1 but not in study 2. All other ASF characteristics in studies 1 to 4 either did not add to the predictions or yielded results contrary to expectations, mostly suggesting suppressor effects. CLINICAL IMPLICATIONS: Sexual medicine and forensic sexology researchers may want to consider ASF frequency in diagnostics and develop and refine interventions to reduce it in cases of clearly elevated levels. STRENGTHS AND LIMITATIONS: The strengths of the present study include considering 4 independent samples as well as a large number of ASF characteristics and sexual aggression measures. Its limitations include the reliance on cross-sectional data and not being able to examine the potential influences of all ASF characteristics in a single model. CONCLUSION: ASF frequency seems the most valid and reliable indicator of ASF and the most important associate of sexual aggression. It should be considered the main indicator of ASF by future research and in prevention efforts and risk assessment.

Developmental factors associated with inappropriate coping strategies among sexual aggressors of children.

BACKGROUND: Many studies in the field of sexual offending focus on the presence of inadequate coping strategies prior to sexual offending, and the role these strategies play in the sequence of the offense. However, little is known about the development of strategies-such as substance abuse and, especially, deviant sexual fantasies-to manage daily difficulties. OBJECTIVE: To better understand the antecedents of the development of inadequate coping strategies, we conducted a series of structural equation modeling (SEM) analyses. PARTICIPANTS AND SETTINGS: Based on 274 sexual aggressors of children, these analyses were based on components of Maniglio (2011a) theoretical model, in which victimization before the age of 18 leads to the development of psychological problems and, ultimately, the reliance on deviant sexual fantasies as a coping strategy. METHODS: Two models were created through exploratory factorial analysis: the first model comprised 19 manifest variables, while the second model consisted of 15 manifest variables. All the retained variables were related to Maniglio's (2011a) hypothesis. RESULTS: The analyses not only confirm Maniglio's hypothesis but also produced two statistically significant models (RMSEA = 0.069, CFI = 0.93 and TLI = 0.92 for Model 1 & RMSEA = 0.074, CFI = 0.93 and TLI = 0.91 for Model 2) composed of three indirect trajectories and one direct trajectory on the one hand, and four indirect trajectories and one direct trajectory on the other hand. CONCLUSIONS: These results are consistent with those of studies that have highlighted the heterogeneity of sexual aggressors of children.

Rheumatoid arthritis prevention in arthralgia: fantasy or reality?

The concept of a 'window of opportunity' in treating a disease assumes the existence of a time frame during which the trajectory of the disease can be effectively and permanently modified. In rheumatoid arthritis (RA), optimal timing of this period is presumed to be during the phase before arthritis is clinically apparent and disease is diagnosed. Several proof-of-concept trials of treatment during the 'arthralgia' phase of RA have been completed in the past 4 years, with the underlying notion that temporary treatment at this stage could prevent the development of RA or induce a sustained reduction in the burden of disease. This Review summarizes the results of these trials and reflects on the outcomes in relation to the patients' perspectives. Overall, the majority of symptomatic at-risk individuals could benefit from a fixed period treatment, even if RA does not develop. Various factors must be taken into consideration when translating these findings into clinical practice. More evidence is needed to target the individuals at highest risk, and additional tools are needed to monitor treatment and guide decisions about whether treatment can be discontinued. Without these tools, there is a paradoxical risk of seemingly increasing the incidence of the disease and prolonging disease duration, which is the opposite of what the concept of intervening in the window of opportunity entails.

Measuring sport fantasy proneness and deflated reality in sport and performance: Development and validation of two context-specific instruments.

Fantasy-prone personalities and generalized states of pessimism and hopelessness have been linked to various behavioural, cognitive, and health related outcomes in the general population. Nevertheless, to date, knowledge of sport-specific fantasy proneness and athletes' perception of deflated reality in sport is scarce, possibly due to a lack of appropriate psychometric instruments to examine these two important context-specific constructs. In this research, we developed the Sport Fantasy Proneness Scale (SFPS) and the Deflated Reality in Sport Scale (DRSS), first assessing the content validity of items for the instruments following a rigorous process. Through two cross-sectional samples (Study 1: Sample 1 N = 255, Sample 2 N = 260) and one longitudinal sample (Study 2: Sample 3 N = 118) of competitive athletes in the UK, we then examined factorial, convergent, discriminant, and concurrent validity and measurement invariance (Study 1), as well as internal consistency, and test-retest reliability (Study 2) of the two new scales. Results revealed robust construct validity and reliability of scores on the two instruments and suggested very good invariance when implementing the new scales to athletes from different sports and competitive levels and good invariance for cross-gender comparisons. The new scales fill a gap in the sport psychology literature and provide researchers and practitioners with robust psychometric instruments to examine new research questions and tackle issues relevant to athletes' sport-specific fantasy proneness and perceptions of deflated reality.