Obsessive-compulsive symptoms have long held interest for psychoanalysts. Currently, pharmacological and behavioral treatments are commonly viewed as the standard of care, and psychoanalytic clinicians are often uncertain of how best to approach these patients. The successful two-year psychoanalytic treatment of a ten-year-old boy with obsessivecompulsive disorder, who remained symptom-free eight years after termination, is reported. While this is but a single case, its outcome implies that for some patients psychoanalysis may be the treatment of choice.
Rebecca was a 2 1/2 ‐year‐old Caucasian female who was brought to the Infant Psychiatry Clinic by her 28‐year‐old widowed mother. Her mother's chief concern was around parenting issues as well as how to explain to Rebecca the death of her father. This loss occurred when Rebecca was 6 months old and was a source of great pain and unresolved grief to her mother. Central to this case was the chaotic history of Rebecca's mother, who was a victim of incest from the time she was 13 until she was 23 years old. Both of her parents struggled with chronic alcoholism during much of her childhood. It appeared that a factor precipitating the mother's request for help was her struggle to move out of her own mother's home. This outpatient Infant Clinic case involved two primary goals: (1) the assessment of the parent‐child relationship and (2) the development of confidence in this “good enough” mother. Vitally important to the process of treatment was the mother's modulation of timing and frequency of sessions. The issue of pacing was carefully monitored as this mother could have been overwhelmed by delving precipitously into her incestuous history. The use of a structured videotape interview to address mother‐child interaction and parenting issues was particularly helpful. Referral to an AlAnon group provided the mother with social support as she separated herself from her alcoholic mother and moved toward autonomy in her own parenting role.
W ith the publication of Manual of Regulation-Focused Psychotherapy for Children with Externalizing Behaviors: A Psychodynamic Approach, Leon Hoffman, Timothy Rice, and Tracy Prout have given us something to think about. They have written a treatment manual accessible to most therapists for a short-term, psychodynamically derived therapy (RFP-C) to help children struggling with externalizing behaviors. As a child analyst practicing for thirty years, I can read this book only through the eyes of my experience; doubtless, then, this essay will convey the bias with which I have approached the treatment of such children. I will first describe what the authors have attempted in this manual, after which I will discuss what I found most useful in their approach and what might be problematic in it.The book begins with a foreword by Nick Midgley. After placing the manual in context, Midgley notes that RFP-C is designed for the most common referral for outpatient treatment of children, that of externalizing disorders. This would include diagnoses such as Attention Deficit Disorder, Oppositional Defiant Disorder, Conduct Disorder, and the more recently described Dysregulation Disorder. These disorders, understood to be heterogeneous, are often difficult to treat. These children are understood as having "deficits in implicit emotional regulation" (p. xviii), doubtless the result of both genetic and environmental factors. What makes this manual unusual is its insistence that externalizing behaviors are not just to be managed, but to be understood. Symptom resolution will require attending to the function and meaning of the symptom. Thus, 821092A PAXXX10.
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