Graham Music

This paper outlines ways in which more traditional psychoanalytic technique has been challenged by new findings about trauma and the optimal ways in which it can be worked with. In particular it outlines how therapists need to become much more knowledgeable about the risks of retriggering PTSD symptoms, and about dissociative symptomatology. In addition, in some cases it is suggested that psychoanalytic therapists might become braver in helping victims of trauma to feel anger about what happened to them, and that often for optimal recovery anger and rage needs to precede remorse, reparation and a bearing of depressive anxieties

This article examines some of the challenges of working with trauma. It looks at how more recent understandings of trauma, linked with neurobiology and atttachment theory, have challenged some more traditional ways of working with trauma. The author uses their own learning and mistakes from earlier in their career to think about how we need to change our therapeutic approach to one more appropriate in such cases. In particular, the article emphasizes the dangers of retraumatization and the risks of triggering dissociative states when insufficient attention is paid to the development of a sense of safeness.

Summary: We argue that current debates about attention-deficit hyperactivity disorder (ADHD) can be considered afresh using an evolutionary lens. We show how the symptoms of ADHD can often be considered adaptive to their specific environment. We suggest that, from an evolutionary point of view, ADHD symptoms might be understood to result from an ‘evolutionary mismatch’, in which current environmental demands do not fit with what evolution has prepared us to cope with. For example, in our ancestral environment of evolutionary adaptedness (EEA), children were not expected to sit still and concentrate on academic tasks for many hours a day. Understanding ADHD in terms of such a ‘mismatch’ raises significant issues regarding the management of childhood ADHD, including ethical ones. An approach based on the concept of mismatch could provide an alternative to current debates on whether ADHD results from nature or nurture and whether it is under- or over-diagnosed. It would allow clinicians and policy makers to take both the child and the environment into account and consider what might be desirable and feasible, both in society and for specific children, to lessen the mismatch.LEARNING OBJECTIVES: •Grasp the concept of ADHD as an ‘evolutionary mismatch’ •Understand the issues raised by this perspective, including ethical ones •Appreciate how a transparent discussion of these issues might inform decisions about management, medication and schooling

This paper looks at violence and sadism in child and adolescent patients. Psychoanalytic and developmental ideas are brought together to make sense of these children’s presentations and the clinical challenges of therapeutic work with them. Differences are outlined between cold and hotter forms of aggression. The contribution of Glasser and his concept of the core complex is central to the paper, as is an understanding of addictive processes often seen in aggression, including sexual aggression.

This paper looks at how difficult early experiences can give rise to defences in which patients rely excessively on their minds, or on bodily activity, having little faith in good reliable objects, internal or external, and little capacity for relaxation and just being. Links are made between Winnicott's theories about mind and psyche–soma and Porges' more recent ideas about vagal tone and the parasympathetic nervous system. These ideas are illustrated with a number of clinical examples of patients who were distrustful of others and who were out of touch with their bodily states. Attention is paid to the need to become more ‘body aware’ in our clinical technique, and questions are asked as to how we might manage this.

(2012). Childhood depression: A place for psychotherapy. Psychoanalytic Psychotherapy: Vol. 26, No. 4, pp. 343-346.