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P Fonagy

Publications and source records attributed to P Fonagy.

At least 19 recordsLinked to original sources
PubMed1995

Understanding the violent patient: the use of the body and the role of the father.

We offer some thoughts about the roots of habitual violence in patients who are not part of the 'cycle of abuse'. We suggest that both self-harm and mindless assaults on others may reflect inadequate capacity to mentalise. Poor functioning of this capacity tends to lead to mental states being experienced as physical, in both the self and others, and the violence is seen as an attempt to obliterate intolerable psychic experience. This experience is felt to belong to somebody else, originally to mother or father. The problem can be traced back to a crucial stage of the development of the self when the child searches the face of his primary object for a representation of his own states of mind. Failure to find this forces him into pathological solutions to achieve an containing organisation. We explore the meaning of the gender difference in the direction of aggression, and the way in which the child has a second chance to foster a secure psychological self through his relation to the father, even when the mother has been unable to support this and to separate successfully. These issues and others of technique are explored in the treatment of a violent young man.

Anxiety, Castration↗
PubMed1994

The efficacy of psychoanalysis for children with disruptive disorders.

OBJECTIVE: This paper describes a chart review of 763 cases of child psychoanalysis and psychotherapy at the Anna Freud Centre, and illustrates its usefulness by examining predictors of treatment outcome in children with disruptive disorders. METHOD: 135 children and adolescents with a principal diagnosis of disruptive disorder were individually matched with others suffering from emotional disorders. Outcome was indicated by diagnostic change and change in overall adaptation (clinically significant improvement or return to normal functioning). RESULTS: Improvement rates were significantly higher for the emotional than for the disruptive group. Within the disruptive group, significant improvement was more frequent among children with oppositional defiant disorder (56%) than those with attention deficit hyperactivity disorder (36%) or conduct disorder (23%). However, 31% of the children terminated treatment within 1 year. Of those disruptive children who remained in treatment more than 1 year, 69% were no longer diagnosable on termination. Fifty-eight percent of the variance in outcome ratings could be accounted for within this group. The crucial variables in predicting attrition and symptomatic improvement were found to be quite different in the disruptive and emotional groups. CONCLUSION: Although the study has several methodological limitations, it does suggest demographic, clinical, and diagnostic characteristics of those disruptive children most likely to benefit from intensive and nonintensive psychodynamic treatment.

Adolescent↗
PubMed1994

The efficacy of psychoanalysis for children: prediction of outcome in a developmental context.

OBJECTIVE: This is the third report from a chart review of 763 cases of child psychoanalysis and psychotherapy at the Anna Freud Centre. This paper examines the way in which the age of a child or adolescent at the time of treatment in psychoanalytic psychotherapy relates to the outcome of that treatment. METHOD: One hundred twenty-seven children were selected from each of three age bands (younger than 6 years, 6 to 12 years, and adolescents); they were matched on broad diagnostic grouping, gender, socioeconomic status, global adaptation (Children's Global Assessment Scale), and frequency of sessions. Outcome was indicated by diagnostic change and clinically significant change in adaptation. RESULTS: Younger children were more likely to show significant improvement. Children younger than 12 benefited from intensive (four or five times weekly) treatment more than from nonintensive (one or two times weekly) treatment; this was not true of adolescents. There were interactions between certain diagnostic categories, age, and outcome. Predictors of good and poor outcome were different for the three age groups, further highlighting the importance of a developmental perspective. CONCLUSIONS: Within the limitations of a retrospective design, this study suggests that in psychodynamic treatment, younger age is an advantage and developmental factors considerably affect the outcome of this form of therapy.

Adolescent↗
PubMed1994

The Emanuel Miller Memorial Lecture 1992. The theory and practice of resilience.

The aim of this paper is to identify a theoretical framework which may provide a meaningful context for developing practical interventions to build upon the concept of resilience. In so doing I shall briefly consider the importance of the concept, what is known about it, and then focus on a specific facet of the problem: intergenerational transmission of maladaptive relationship patterns and resilience to such a threat.

Adaptation, Psychological↗
PubMed1993

The roles of mental representations and mental processes in therapeutic action.

In this paper we describe two models of the psychoanalytic treatment of mental disturbance. The first describes the mechanism by which the patient is helped to recover threatening ideas and feelings which have been repudiated or distorted as a result of conflict and defense. The second points to the therapeutic effects of engaging previously inhibited mental processes within the psychoanalytic encounter. The two forms of therapeutic action imply two distinct means available to the individual to deal with psychological conflict. They highlight different aspects of the psychoanalytic process and technique in child and adult psychoanalysis.

Adult↗
PubMed1993

Measuring the ghost in the nursery: an empirical study of the relation between parents' mental representations of childhood experiences and their infants' security of attachment.

This paper presents a summary of the Anna Freud Centre-University College London, Parent-Child Project. Its most important finding was that the security of the infants' relationship with both parents at 12 and 18 months could be predicted on the basis of qualitative aspects of the parents' accounts of their own childhoods collected before the birth of the child. This confirmed Selma Fraiberg's observations concerning the reemergence of childhood conflicts at early stages of childbearing. Possible mechanisms mediating this link are explored with particular reference to the role of the parents' accurate mental representations of the infants' mental world.

Adult↗
PubMed1993

Aggression and the psychological self.

In this paper we explore the idea of aggression as a defence against threats to the psychological self. This aspect of the self allows reflection about people in psychological terms and develops, in the first three years of life, through appreciation of mental states in the other. When the object is unpredictable or hostile, recognition of this is painful to the child, and his reflective function will not be adequately established. The defences of aggression or avoidance will be invoked very frequently. In time, aggression may become an organising influence in the construction of the self; pathological destructiveness then takes the place of emotional relatedness and concern for the other. Psychoanalytic treatment no longer works primarily by addressing conflict. Instead, particularly through interpretations of transference and countertransference, the analyst recreates an intersubjective process which enhances the patient's reflective self, this time in the safety of a benign relationship.

Adult↗
PubMed1992

Psychotherapy in borderline and narcissistic personality disorder.

Psychodynamic concepts about borderline personality disorder are reviewed and the literature concerning psychotherapeutic treatment of this group is examined. The treatment contexts considered include: psychoanalysis and intensive (expressive) psychoanalytic psychotherapy, supportive psychotherapy, group psychotherapy, family therapy, in-patient treatment, the therapeutic community, cognitive-behavioural approaches, and combinations of drugs and psychotherapy. The practical implications of recent follow-up studies for intervention strategies are considered.

Borderline Personality Disorder↗
PubMed1991

A controlled study of psychoanalytic treatment of brittle diabetes.

The study compared two equivalent groups of 11 diabetic children with grossly abnormal blood glucose profiles necessitating repeated admissions to a hospital. Patients in the treatment group were offered an intensive inpatient treatment program including psychoanalytic psychotherapy three to four times a week, which took place on the hospital ward and lasted an average of 15 weeks. The intervention was highly effective in improving the diabetic control of the children, and this was maintained at a 1 year follow-up. Patients in the comparison group, who were offered only inpatient medical intervention, returned to their prehospitalization level of metabolic control within a period of 3 months from discharge.

Adolescent↗
PubMed1991

Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age.

While strong retrospective and concurrent associations between maternal and infant patterns of attachment have been noted, this is one of the first reports of a prospective investigation of such associations. The Adult Attachment Interview was administered to 100 mothers expecting their first child, and, at 1-year follow-up, 96 of these were seen with their infants at 12 months in the Strange Situation. Maternal representations of attachment (autonomous vs. dismissing or preoccupied) predicted subsequent infant-mother attachment patterns (secure vs. insecure) 75% of the time. These observed concordances, as well as the discordances, are discussed in terms of the uniquely powerful contribution the Adult Attachment Interview makes to the study of representational and intergenerational influences on the development of the infant-mother attachment.

Adult↗
PubMed1991

Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient.

This paper addresses a specific aspect of pathological mental functioning in so-called borderline patients. Analytic work with a borderline man is presented to show that an inhibition of, and defences against, the contemplation of one's own and others' mental states may be a hallmark of the resistance encountered in a number of such patients. It is claimed that the analysis of transference and countertransference is a crucial therapeutic factor in tackling this source of resistance. In doing this, the paper draws upon a topical notion from philosophy of mind and recent ideas from child development studies which help to clarify psychoanalytic ideas concerning the nature of the pathology of internal object relations underlying feelings of emptiness and social alienation in borderline functioning.

Adult↗
PubMed1990

Studies on the efficacy of child psychoanalysis.

This article summarizes 3 studies that evaluated the psychoanalytic psychotherapeutic treatment of diabetic children and adolescents with grossly abnormal blood glucose profiles necessitating repeated admissions to hospital. Study 1 used time series analysis to demonstrate that improvements in control were predicted by unconscious themes emerging in the analytic material. Study 2 compared the effect of psychotherapeutic treatment with that of minimal psychological intervention in two well-matched groups (n = 11). Patients in the treatment group were offered psychoanalytic psychotherapy 3-4 times per week on the hospital ward. The intervention was highly effective in improving the diabetic control of the children, and this improvement was maintained at 1-year follow-up. Study 3 used single-case experimental design to demonstrate the marked effect of psychotherapeutic help on growth in diabetic children with short stature.

Adaptation, Psychological↗
PubMed1990

The prolonged benzodiazepine withdrawal syndrome: anxiety or hysteria?

In an attempt to establish whether prolonged withdrawal symptoms after stopping intake of benzodiazepines is caused by return of anxiety, hysteria, abnormal illness behaviour or the dependence process itself producing perhaps a prolonged neurotransmitter imbalance, a group of such patients suffering prolonged withdrawal symptoms (PWS) was compared on a range of psychophysiological measures with matched groups of anxious and conversion hysteria patients and normal controls. It was found that the psychophysiological markers of anxiety were not marked in the PWS group; nor were the averaged evoked response abnormalities found to be associated with cases of hysterical conversion in evidence. The PWS group were hard to distinguish from normal controls on the basis of psychophysiological measures and thus it was felt to be unlikely to be an affective disturbance. It was concluded that PWS is likely to be a genuine iatrogenic condition, a complication of long-term benzodiazepine treatment.

Adolescent↗
PubMed1990

Adaptive probit estimation and body size: the evaluation of a new psychophysical technique.

Studies of body size estimation are frequently used to identify body-image disturbances in clinical populations. No clear pattern of results has, however, so far emerged. One reason for this may be that studies confound non-sensory influences on performance deriving from motivational components with the observer's discriminative sensitivity. This study introduces an adaptive version of the method of constant stimuli and probit analysis (APE) to determine independently bias and threshold in the estimation of four body parts for two samples of undergraduate students. In the first study, test-retest reliability coefficients were obtained for body-size estimates, using the traditional technique and the new method. Estimates of subjective body size obtained by the new method were shown to have higher test-retest reliabilities than those obtained using traditional techniques. The stability of sensitivity estimates was in the .8-.9 range. In a second study we attempted to validate the new technique by comparing the body-size estimates of male and female observers. Independent bias and sensitivity estimates were found to be significantly different. Female observers were more likely to overestimate the size of their chest and waist whilst underestimating face size. There was no difference overall between the accuracy of male and female observers. Perceptual sensitivity did not differ significantly overall, but whilst female subjects showed a particularly low threshold for waist size, male observers showed the same specific sensitivity for thigh width. The extension of this method of measuring body-image distortions to relevant clinical populations is recommended.

Adolescent↗
PubMed1988

The natural history of tolerance to the benzodiazepines.

Dependence on benzodiazepines following continued use is by now a well-documented clinical phenomenon. Benzodiazepines differ in their dependence potential. The present studies were aimed at examining the possibility that differential rates of tolerance development might account for differences in dependence risk. Four studies are reported. The first three studies concerned normal subjects. The development of tolerance over a fifteen day period was demonstrated for three different benzodiazepines (ketazolam, lorazepam and triazolam) using two paradigms. Tolerance in terms of a reduction in effectiveness of a repeated given dose was most notable for the benzodiazepine with a medium elimination half-life (lorazepam) for physiological, behavioural and subjective measures. In the case of the drug with the longest elimination half-life (ketazolam) reduction in effectiveness could only be assumed to be occurring if account was taken of the steady increase in plasma concentrations of active metabolites. For this drug it seemed that the physiological measures were those most likely to demonstrate the development of tolerance. Although triazolam showed few significant drug effects on this paradigm (testing being 12 hours after ingestion of this short half-life benzodiazepine), tolerance was seen to develop on some subjective measures. Using an alternative method of testing tolerance, assessing responses to a diazepam challenge dose, a high degree of tolerance on two-thirds of the measures was observed in subjects when pretreated with the benzodiazepine with the most marked accumulation of active metabolites (ketazolam). The other two drugs also led to tolerance development on a range of measures; this was more marked for lorazepam than triazolam. Blunting of the growth hormone response to diazepam was the most sensitive and reliable method of detecting tolerance to the benzodiazepines. Symptoms on discontinuation of the two weeks' intake of the benzodiazepines were marked for all the drugs but unrelated to either the tolerance induced or the elimination half-life of the particular drug. A further clinical study revealed that tolerance persisted in a group of long-term benzodiazepine users for between four months and two years following complete abstinence from the drug. These patients appeared to be less affected by diazepam in terms of its commonly observed subjective effects, regardless of their original medication. These ex-long-term users of benzodiazepines were, however, more likely to manifest two specific types of effects--immediate 'symptom' reduction and exacerbation of 'withdrawal symptoms' over the subsequent week.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗