Therapeutic Framework Research Articles

Histrionic personality disorder: Definition, clinical profiles, differential diagnosis and therapeutic framework

Starting from the general concept of “histrionic personality”, the present work focuses on the essential aspects of personality disorder that defi ne the clinical and diagnostic contexts, laying the foundations for a correct differential diagnosis, without neglecting the neural characteristics developed by the scientific community. The discussion ends with the best suggested therapeutic approaches.

Working with Autistic Children and their Families from a Mentalization Based Therapy for Children (MBT-C) Approach

Work with children on the autistic spectrum and their families is described and illustrated from a mentalization-based therapy lens. Focus on the importance of working with parents from a therapeutic stance that models an interactive style and on the capacity to “find and be with” a child on the autistic spectrum is described. The MBT intervention seeks to offer an alternative model of relationship which fits both the child’s “regulation profile” and his caregiver’s capacity to learn and generalize a new way of connecting and communicating. These aims are achieved through the application of a scaffolding approach, one that seeks to provide a developmental experience within a secure and predictable, yet flexible, therapeutic framework with the central aim of improving psycho-social functioning and increased emotional regulation skills for this population.

Expressions cliniques et projectives de la distorsion et de la répression de l’affect chez les femmes victimes d’inceste

ObjectivesThe originality of our work lies in the fate of affects in adult women who have been repeatedly sexually abused by their fathers during their childhood and/or adolescence. We are particularly interested in the effects of their emotional life trauma. MethodsA qualitative methodology was chosen, combining clinical research interviews and a projective Rorschach test for three women followed in a victim support association. After they had given their consent, we made sure they were followed by a therapist because the research could reactivate dramatic memories and cause them to feel unwell. ResultsFrom the Rorschach, we can identify the lack of connection between affect and representation in our patients. For two patients, the affect is volatile, which can be of a pleasant nature and then quickly switch to displeasure or generate anxiety. In the third patient, it is repressed. This repression prevents the expression of affects, which would fail to be taken care of by the psyche because of their disorganizing character. DiscussionWomen who have lived through a traumatic experience such as incest, seem to have their emotional life affected. At the end of this research, the term distortion is discussed, referring on the one hand to deformation and on the other hand to imposed movement. It thus cumulates the idea of constraint by the other and discontinuity (touching on the mode of quality). We can put forward the hypothesis that the affect would be distorted, due to an early impossibility of the environment to give meaning to the experiences of the young child. The latter was caught early in the desire of the incestuous parent, leading him to submit to the expectations of the aggressor and to forget himself. In addition to distortion, another way may be possible, that of repression where the affect is repressed, the subject withdrawing from his psychic and emotional life in order to no longer feel. Emotional distortion and repression seem to be associated with the self clivage as the subject cuts himself off from a part of himself by refusing to recognize parts of his emotional life (repression), or to identify affects as if he had lost his ability to discriminate (the good/bad). Can’t this be seen as an effect of identification with the aggressor? ConclusionRecognizing the fates of affect (distortion and repression) in women who have suffered from incest encourages us to question the classic therapeutic accompaniment modalities based on free association. Initially, this call for associativity could resemble a threat to which the subject would respond either by withdrawing or withdrawing (affective anaesthesia), or by a feeling of dilution of limits. In order to arrange the therapeutic framework, the clinician, relying on transference and counter-transference, could offer words to qualify the incest emotional experience abused by incest. Indeed, the latter could redouble the difficulty in identifying and recognizing what is good, bad, pleasant, or on the contrary unpleasant in relation to primary experiences, which have hindered the reflexive function.

New Challenges for Psycho-Oncology during COVID-19 Pandemic. Urgent Implementation of Telepsychology

Introduction: The health and assistance crisis generated by the SARS-CoV2 pandemic has been a serious health problem and a major disruption to the general population, specifically to the most vulnerable groups as cancer patients. This situation is forcing health professionals to face and take on major challenges to maintain the necessary care. Aim: The main objective of this study is to maintain specialized psychological care for oncology patients, and in addition, to describe the principal psychological difficulties of our series of cases. Methods: Before the alarm state in Spain, the therapy was changed from face-to-face to telephone attendance and an e-mail account was opened for specific consultations in which a psycho-oncologist was present in GenesisCare Spain. The psychological interventions carried out during this time have had two characteristics: 1) Cognitive-behavioral therapeutic framework 2) Targeted and specific interventions on issues associated with the COVID-19 pandemic. Results: From March 10 to April 30 (8 weeks), patients and families have been attended to by 2.5 senior psycho-oncologists. A total of 369 psychological services have been attended in Spain in 142 patients. The number of services per patient has ranged from 1 to 4. The median of the long consultation has been 45 minutes. A qualitative analysis, based on a psychological interview, was conducted on the areas of intervention and concerns of the patients served. All patients presented with difficulties in more than one area and the main concerns were related to quarantine (emotional distress associated overload of information) and on aspects specific to the oncological disease (fear of death and disease recurrence). Conclusion: A field is opening up to improve psychological care for cancer patients thanks to Telepsychology, which can remain as a model of comprehensive care and improve access to a wide range of users. Oncological patients have shown highly structured negative emotional responses to COVID-19, but 20% have shown a resilient response to this stressful situation.

An Investigation of the Effectiveness of Arts Therapies Interventions on Measures of Quality of Life and Wellbeing: A Pilot Randomized Controlled Study in Primary Schools.

BackgroundOver the last decades there has been a change in the way schooling is perceived recognizing that children’s learning is closely linked to children’s health. Children spend most of their time at school, which is often the place where problems are identified and interventions are offered, not only for treatment but also prevention. Embedding arts therapies into the educational system may help address children’s emerging needs and have a positive impact on their wellbeing.MethodsA pilot cross-over randomized controlled design was employed to investigate the effectiveness of an arts therapies intervention on a series of child- and teacher-reported outcome measures, specifically, health related quality of life (assessed using a HRQOL scale; EQ-5D-Y), wellbeing and life functioning (assessed using the child outcome rating scale; CORS), emotional and behavioral difficulties (assessed using the strengths and difficulties questionnaire; SDQ), as well as duration of sleep (assessed using Fitbits). Sample size calculations for future large-scale studies were also performed, and the sustained impact of the intervention was evaluated at 3, 6, and 12 months follow-up. The pluralistic theoretical and therapeutic framework of this intervention was informed by a systematic review on school-based arts therapies interventions and is presented in detail in the study protocol. Participants were 62 children with mild emotional and behavioral difficulties.ResultsImprovements in HRQOL and CORS were greater in those engaged in the arts therapies intervention than the control groups and were maintained at the follow-up stages. Significant improvements were only found for duration of sleep (P = 0.002) and SDQ (P = 0.008). Minimal clinically important differences (MCIDs) as defined in the published protocol were found for CORS, SDQ and duration of sleep, but not HRQOL.DiscussionFindings indicate that the arts therapies interventions were having a clinically significant effect on life functioning, duration of sleep, emotional and behavioral difficulties. Findings also indicate a small effect size for health related quality of life, suggesting the intervention was having a small positive effect on this outcome measure. The study indicates that all outcome measures assessed here would be suitable for inclusion in a larger randomized controlled study utilizing these arts therapies interventions, and that a sample size of 225 participants would be required if these outcome measures were used.

Clinical and genetic risk factors define two risk groups of extracranial malignant rhabdoid tumours (eMRT/RTK).

Extracranial rhabdoid tumours are rare, highly aggressive malignancies primarily affecting young children. The EU-RHAB registry was initiated in 2009 to prospectively collect data of rhabdoid tumour patients treated according to the EU-RHAB therapeutic framework. We evaluated 100 patients recruited within EU-RHAB (2009-2018). Tumours and matching blood samples were examined for SMARCB1 mutations by sequencing and cytogenetics. A total of 70 patients presented with extracranial, extrarenal tumours (eMRT) and 30 with renal rhabdoid tumours (RTK). Nine patients demonstrated synchronous tumours. Distant metastases at diagnosis (M+) were present in 35% (35/100), localised disease (M0) with(LN+) and without (LN-) loco-regional lymph node involvement in 65% (65/100). SMARCB1 germline mutations (GLM) were detected in 21% (17/81 evaluable) of patients. The 5-year overallsurvival (OS) and event-free survival (EFS) rates were 45.8±5.4% and 35.2±5.1%, respectively. On univariate analyses, age at diagnosis (≥12 months), M0-stage, absence of synchronous tumours, absence of a GLM, gross total resection (GTR), radiotherapy and achieving a CR were significantly associated with favourable outcomes. In an adjusted multivariate model presence of a GLM, M+ and lack of a GTR were the strongest significant negative predictors of outcome. We suggest to stratify patients with localised disease (M0), GTR+ and without proof of a GLM (5-year OS 72.2±9.9%) as 'standard risk'. Patients presenting with one of the features M+ and/or GTR- and/or GLM+ belong to a high risk group (5-year, OS 32.5±6.2%). These patients need novel therapeutic strategies such as combinations of targeted agents with conventional chemotherapy or novel experimental approaches ideally within international phase I/II trials.

Apport de l’attachement dans le travail d’élaboration de la mort d’un sujet âgé en établissement d’hébergement. Le cas de Pierre, 90 ans

ObjectiveFrom a psychological point of view, this article aims to understand the attachment theory's contribution to the psychical elaboration of death for ‘resident elderly’ in nursing homes. Physical, cognitive and social losses make people to be aware of death. A psychical elaboration–the ability to attribute subjective meanings to events - permits to integrate death. Psychical elaboration depends on mentalization, but proximity of death alters mentalization: individuals are no longer able to use appropriate emotional strategies to express a request for social support. These strategies are highlighted by attachment. Social support can help individuals to understand their state of mind. So, social support can ease mentalization and psychical elaboration. We assume that difficulties in finding social support, due to alteration of mentalization and inter relational strategies, complicate psychical elaboration of death. MethodWe report a clinical case of Pierre, 90 years old, who lives in a French nursing home. This case comes from a qualitative study carried out with thirty-three nursing homes’ residents in Switzerland and France. In-depth interview – inspired by Adult Attachment Interview – investigated the participants’ life stories through their relationship experiences, the entry in nursing home, their views on their present and their future, and the meaning of their life. The Relation Scales Questionnaire measured attachment and the Mini Geriatric Depression Scale measured depression. ResultsTo understand the psychical elaboration of death, mentalization and the way how individuals seek social support - underlined by attachment - must be investigated. The proximity of death alters mentalization. The difficulties of mentalization influence attachment: the individuals use emotional regulation strategies which do not allow them to benefit from social support. However, this support could help them to understand their internal state and indirectly support difficulties of mentalization and favour the psychical elaboration. Social support is therefore essential in the psychical elaboration of death. The other's place in old age is also questioned and raises a paradox. Get closer to the other to benefit from social support allows to overcome difficulties of mentalization. But the comparison of oneself with the other as different reinforces the self-esteem. ConclusionFor professionals in nursing homes, providing social support to people who do not seek help and do not appear to need social support is essential. Adopting the therapeutic framework (art therapy, the use of a media) to each person's personality seems to be important.

Encéphalopathie anoxo-ischémique et hypothermie thérapeutique : quels principaux impacts psychologiques pour les parents et les bébés présentant une IRM normale à la sortie de la maternité ?

Objectifs : Réaliser une première étude préliminaire française qui évalue la santé psychologique des parents de nourrissons traités par hypothermie thérapeutique pour encéphalopathie anoxo-ischémique et sortis de l’hôpital avec une évolution initiale normale (IRM et examens cliniques de sortie normaux). Matériels et méthode : Sept enfants de moins de 2 ans traités par hypothermie thérapeutique pour encéphalopathie anoxo-ischémique à la naissance et leurs parents ont été rencontrés pour l’étude. Tous les enfants étaient sortis de la maternité avec une IRM normale et un examen clinique satisfaisant. L’échelle Brunet-Lézine a été utilisée pour mesurer le quotient de développement psychomoteur des enfants (QD). La santé psychologique des parents a été évaluée à l’aide de deux échelles adaptées : l’EPDS ( Edinburgh Postnatal Depression Scale ), et le PPQ ( Perinatal Posttraumatic Stress Disorder Questionnaire ). Le vécu parental a été recueilli à l’aide d’un entretien semi-directif. Résultats : À l’échelle Brunet-Lézine, les enfants ne présentaient pas de retard significatif (QD entre 98 et 97). Cependant, huit à dix-huit mois après l’événement : 50 % des mères et 25 % des pères présentaient des scores pathologiques de stress post-traumatique. L’autre moitié des mères et 25 % des pères présentaient des critères de dépression postnatale. Les entretiens ont révélé des expériences traumatisantes de l’accouchement ; des difficultés de lien dans les premiers temps suivant l’accouchement ; une forte exposition des pères ; des projections extrêmes et oscillantes sur la vie et la mort pendant le traitement de l’hypothermie ; les résultats de l’IRM et le séjour à l’état unité Kangourou comme étapes majeures de réassurance et de « parentalisation ». Des préoccupations persistaient chez les parents six mois à un an plus tard. Conclusion : l’encéphalopathie anoxo-ischémique et l’hypothermie thérapeutique sont des facteurs potentiels de déstabilisation psychique pour les parents, même en l’absence de complications. Cette étude confirme l’importance d’un cadre thérapeutique de confiance durant l’hospitalisation et souligne la nécessité d’un suivi posthospitalisation préventif et multidisciplinaire, quel que soit l’état de santé du nouveau-né à la sortie de la maternité. D’autres recherches multicentriques sont souhaitables en France pour mieux comprendre et soutenir ces familles.

Modifications of the therapeutic setting during the Covid-19 pandemic: thoughts based on the Greek experience with latency children and adolescents

ABSTRACT The paper reflects on the authors’ observations regarding the handling of the Covid-19 pandemic within the context of child and adolescent psychoanalytic psychotherapy in Greece. The specific conditions in Greece during the first general lockdown are described, and the necessary modifications to the therapeutic framework with latency children and adolescents are discussed. During the lockdown, the authors continued to meet with their patients online, a framework that had both advantages and limitations. The authors share their thoughts about the ways they tried to keep the connection with their patients alive, in the face of the first wave of the coronavirus crisis.

Ethics: supporting the sexuality of people with a mental disability in an institution

The question of the sexuality of people with a disability in an institution touches on two sensitive aspects: sexuality, between taboo and unknown, and disability-related particularities. Within the microsociety of an institution, the protocols, daily living rules and therapeutic framework guide institutional life, and caregivers are sometimes helpless. An ethical perspective can help professionals support people with a mental disability with regard to their emotional and sexual life.

Implementation of a nationwide universal ultrasound screening programme for developmental dysplasia of the neonatal hip in Mongolia.

PurposeMongolia is the first Asian country to launch universal ultrasound screening for newborns with developmental dysplasia of the hip (DDH). The aims of this study were to determine the coverage and treatment rate of this programme.MethodsData from birth statistics and ultrasound hip screening from 29 hospitals were retrospectively reviewed (2010 to 2016, pre-nationwide phase; and 2017 to 2019, nationwide programme). DDH was diagnosed using the Graf-technique and treated according to ‘ABCD’, a modified Graf classification (Group A: Graf Type 1, mature; B: 2a, physiologically immature; C: 2c to 3, early DDH; D: 4, dislocated). Group B children were followed with monthly ultrasound. Group C and D children were treated with a flexion and abduction orthosis (Tübingen). Screeners used a web-based platform to upload images for quality surveillance.ResultsBetween 2017 and 2019, 230 079 live births were registered and 176 388 newborns screened. The nationwide screening coverage rate in newborns increased from 73.6% in 2017 to 82.1% in 2019. Group A (148 510 children, 84.2%) was discharged, while Group B (25 820, 14.6%) was followed. Among children in Group B, 284 cases worsened to Group C and were, therefore, treated with a Tübingen orthosis. The remaining 2058 (1.2%) of newborns with DDH were treated with a Tübingen orthosis, including 1999 newborns in Group C and 59 in Group D. Since 2017, a total of 142 860 (81.0%) hip sonograms were uploaded to the platform.ConclusionA simplified diagnostic and therapeutic framework for ultrasound DDH screening for newborns was successfully deployed in Mongolia, a developing country, providing high surveillance coverage and appropriate treatment.Level of evidence: IV

Morfoanalitica Therapy as a therapeutic resource post breast cancer surgery for women

Introduction: Women with breast cancer may present, in addition to physical limitations, changes in emotional aspects. In physical therapy, it is unusual to consider the mind-body dialogue, even when it comes to diseases with great impact on bio-psychosocial aspects, such as breast cancer. However, therapies are emerging with a psychosomatic nature, such as morphonalitic therapy, which includes bodily, sensory, emotional and verbal aspects. Objective: To verify the effects of morphonalitic therapy on the treatment of anxiety, depression and self-esteem in women after breast cancer. Furthermore, it presents some verbal reports of sessions in order to include the feelings and sensations of these women and recognize, in addition to objective factors, the subjective factors that are an integral part of human stories. Method: Ten women participated in the study, undergoing 16 individual morphonalitic therapy sessions, once a week, lasting 60 minutes. They completed a scale on anxiety and depression and the Rosenberg self-esteem scale. The sessions were arranged through a structured therapeutic framework, which varied according to the therapeutic process of each participant. This included bodywork, empathetic touching contact, eye contact, stimulation of body awareness, and analysis of the patient’s body structure; during the session, the patients verbalized their feelings. Results: Depressive symptoms decreased (p = 0.0418) and self-esteem increased (p = 0.0020) after treatment. Conclusions: During the sessions, these women experienced various feelings, beyond the awakening of body awareness. It is hoped that morphonalitic therapy be applied on a larger scale as an adjunct therapy for women with breast cancer, as well as in other populations.

The development of the Early Intervention in Psychosis (EIP) outpatient unit of Eginition University Hospital into an EIP Network.

Over the past 25 years, in the field of psychosis there is an increased interest in early detection of symptoms and treatment provision for people who are either at Ultra High Risk (UHR) of developing psychosis or with First Episode Psychosis (FEP). Extensive research has proved, that by engaging quickly into treatment and addressing the needs of each case individually, clinical outcomes could be improved substantially. The above evidence-based argument has resulted in the establishment of specialized Early Intervention in Psychosis (EIP) services worldwide. Eginition University Hospital (EUH) in Athens has been providing care for Early Psychosis through a specialized outpatient EIP service since 2012, which receives all early psychosis cases. Initially clinical focus was mainly directed towards UHR cases, since EUH had long been providing standard care for FEP. However, over the last 4 years, the EIP Unit has evolved incrementally into a network of directly linked services, involving the EIP outpatient service, an Inpatient Unit for prompt hospitalization and a Day Clinic for partial hospitalization, to address acute treatment, follow-up and recovery/relapse prevention phases. Diagnostic evaluation is made through specialized instruments along with the typical psychiatric interview. The therapeutic approach follows the international guidelines for EIP, namely symptom-based and phase-specific treatment, which includes supportive counselling, coping strategies and psychoeducation both for subjects and family members, as well as pharmacotherapy when needed and preferably in low doses. Regarding our results, in the first 3 years (3/2012-3/2015) the EIP unit received 26 (60%) UHR subjects and 17 (40%) FEP patients. Over the last 4 years (3/2015-3/2019) the referrals rose to 167 with 35 (21%) UHR and 132 (79%) FEP cases. All of the UHR subjects were from the outset followed by the specialized outpatient EIP service for up to 3 years. As to the FEP patients, seventy-seven (60%) were acutely hospitalized for less than a month, and 10 (8%) attended the Day Clinic for 6 - 12 months, before being referred to the outpatient service. Concluding, the development of the EIP network of specialized services has cohesively enabled a broader therapeutic framework, shifting the clinical focus towards FEP, although UHR subjects are still being assessed systematically. However, there is still considerable work to be done, in order to enhance the full potential of all units and promote the interconnection with potential community settings.

Synaptic RTP801 contributes to motor-learning dysfunction in Huntington\u2019s disease

RTP801/REDD1 is a stress-responsive protein that mediates mutant huntingtin (mhtt) toxicity in cellular models and is up regulated in Huntington’s disease (HD) patients’ putamen. Here, we investigated whether RTP801 is involved in motor impairment in HD by affecting striatal synaptic plasticity. To explore this hypothesis, ectopic mhtt was over expressed in cultured rat primary neurons. Moreover, the protein levels of RTP801 were assessed in homogenates and crude synaptic fractions from human postmortem HD brains and mouse models of HD. Finally, striatal RTP801 expression was knocked down with adeno-associated viral particles containing a shRNA in the R6/1 mouse model of HD and motor learning was then tested. Ectopic mhtt elevated RTP801 in synapses of cultured neurons. RTP801 was also up regulated in striatal synapses from HD patients and mouse models. Knocking down RTP801 in the R6/1 mouse striatum prevented motor-learning impairment. RTP801 silencing normalized the Ser473 Akt hyperphosphorylation by downregulating Rictor and it induced synaptic elevation of calcium permeable GluA1 subunit and TrkB receptor levels, suggesting an enhancement in synaptic plasticity. These results indicate that mhtt-induced RTP801 mediates motor dysfunction in a HD murine model, revealing a potential role in the human disease. These findings open a new therapeutic framework focused on the RTP801/Akt/mTOR axis.

Prise en charge pluridisciplinaire des liens d’attachement chez l’enfant : cas clinique

Bowlby's theory of attachment (1958) helps to understand the relationship between parent and child. Attachment refers to an affective bond between infant and caregiver. The child identifies as principal attachment figure the person bringing comfort and security. Other people are considered as subsidiary attachment figures whom the child mobilizes in the absence of the principal attachment figure. When distressed, the child seeks proximity and physical contact with specific and innate behaviors. Once the needs are met, the security base allows exploration of the environment. The repetition of these experiences leads to the development of internal working models which concern the representations of oneself and others. They serve as filters to understand the environment and to help the child assess, predict and choose the behavior to be realized. The type of attachment developed by infants depends on the quality of care they have received. There are four identified attachment types: secure, insecure avoidant, insecure ambivalent and insecure disorganized. The quality of the tie of attachment has repercussions on the development of the child (mental, physical, intellectual, emotional and social). It is also associated with certain psychological difficulties (anxiety, depression, psychotrauma). In practice, we meet regularly with children and their parents whose follow-up needs to refocus on the bonds of attachment. However, there are few articles or research presenting the way and the particularities of taking care of the insecure attachment style. In this article, we present a clinical case of a multidisciplinary therapeutic follow-up of a mother-child relationship with ambivalent attachment ties. We describe the evolution of the follow-up according to the significant moments, the stages of development of the child and the therapeutic spaces proposed (psychomotor, educational and psychological). Therapy includes sensorimotricity, internal working models, early schemas, trauma desensitization, narrative and parenting support. We expose the specificity of the therapeutic framework and the interest of acting jointly to allow the establishment of a secure attachment link. This framework is container and protection for everyone. It influences the therapeutic follow-up and adapts to the symptoms and development stage expressed. This device has enabled the creation of the therapeutic alliance and moves from an insecure attachment style to a secure attachment style. It is an evolutionary and singular therapy with each relation.

A New Therapeutic Framework for Atrial Fibrillation Drug Development

Atrial fibrillation (AF) is a highly prevalent cardiac arrhythmia and cause of significant morbidity and mortality. Its increasing prevalence in aging societies constitutes a growing challenge to global healthcare systems. Despite substantial unmet needs in AF prevention and treatment, drug developments hitherto have been challenging, and the current pharmaceutical pipeline is nearly empty. In this review, we argue that current drugs for AF are inadequate because of an oversimplified system for patient classification and the development of drugs that do not interdict underlying disease mechanisms. We posit that an improved understanding of AF molecular pathophysiology related to the continuous identification of novel disease-modifying drug targets and an increased appreciation of patient heterogeneity provide a new framework to personalize AF drug development. Together with recent innovations in diagnostics, remote rhythm monitoring, and big data capabilities, we anticipate that adoption of a new framework for patient subsegmentation based on pathophysiological, genetic, and molecular subsets will improve success rates of clinical trials and advance drugs that reduce the individual patient and public health burden of AF.

Erectile dysfunction: How to help patients & partners

This guide and helpful list of key questions can provide a therapeutic framework for addressing the relationship side of ED.

Collaborative Assessment and Management of Suicidality (CAMS) compared to enhanced treatment as usual (E-TAU) for suicidal patients in an inpatient setting: study protocol for a randomized controlled trial

BackgroundThe Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic framework that has been shown to reduce suicidal ideation and overall symptom distress. CAMS has not been previously evaluated in a standard acute inpatient mental health care setting with only short treatment times for suicidal patients. In this randomized controlled trial (RCT) we are investigating whether CAMS is more effective than Enhanced-Treatment as Usual (E-TAU) in reducing suicidal thoughts as primary outcome variable. We are also investigating depressive symptoms, general symptom relief, and the quality of the therapeutic alliance as secondary outcomes.Methods/DesignThis RCT is designed as a single-center, two-armed, parallel group observer-blinded clinical effectiveness investigation. We are recruiting and randomizing 60 participants with different diagnoses, who are admitted as inpatients because of acute suicidal thoughts or behaviors into the Clinic for Psychiatry and Psychotherapy, Ev. Hospital Bethel in Bielefeld, Germany. The duration of treatment will vary depending on patients’ needs and clinical assessments ranging between 10 and 40 days. Patients are assessed four times, at admission, discharge, 1 month, and 5 months post-discharge. The primary outcome measure is the Beck Scale for Suicide Ideation. Other outcome measures are administered as assessment timepoints including severity of psychiatric symptoms, depression, reasons for living, and therapeutic relationship.DiscussionThis effectiveness study is being conducted on an acute ward in a psychiatric clinic where patients have multiple problems and diagnoses. Treatment is somewhat limited, and therapists have a large caseloads. The results of this study can thus be generalizable to a typical inpatient psychiatric hospital settings.Trial registrationThis clinical trial has been retrospectively registered with the German Clinical Trials Register; registration code/ DRKS-ID: DRKS00013727 (on January 12, 2018). In addition, the study was also registered with the International Clinical Trials Registry Platform of the World Health Organization (identical registration code). Registry Name: „Evaluation von CAMS versus TAU bei suizidalen Patienten – Ein stationärer RCT“.

Encountering the Shadow

The interacting unconscious in the contact between therapist and client, the (self) sabotage and destructiveness observed as resistance in the contact to oneself and to others, is explained conceptually and illustrated with case studies. Therapeutic techniques will be presented which allow a creative and energizing, vocally expressive handling of the hostility bound up in the introject, in which the patient «embraces” their own shadow. The bases for the practical work are the well-known concepts and interventions of Bioenergetic Analysis, and this perspective is extended by reference to the anatomical-functional and the neurovegetative contexts of vocal expression. The tongue is of particular importance as it is a universal organ of expression for rejection, contempt, aversion as well as for desire. The familiar and the new are placed within a specific therapeutic framework.

Gastro-emotivism: How MasterChef Israel produces therapeutic collective belongings

Although there is burgeoning research on the impact of therapeutic culture in the construction of the individual Self, the ways in which emotional discourse and therapeutic style shape the collective Self have been overlooked. Focusing on the popular reality-television cooking show MasterChef Israel, this article explores the emergence of gastro-emotivism – an interlacing of food with emotions and therapy and a materialization of emotions in the form of food. In MasterChef Israel, gastro-emotivism is used to articulate emotional-therapeutic selves as well as collective belongings and social categories. While recent literature understood the appearance of therapeutic culture in popular media as geared to reshape the individual neoliberal Self, we suggest that gastro-emotivism indicates the expansion of the emotional therapeutic framework in the depiction and construction of collective identities and identifications. We elaborate on the global phenomena of gastro-emotivism and explain its particular Israeli appearance. Emerging from this account is the proliferation of emotional-therapeutic discourse in the Israeli public sphere and its predominance in the ways in which Israelis ‘cook, taste and feel’ their collective affiliations.