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• W1570800302 abstract "The author of this thought-provoking and evocative book is a well-established and respected child and adolescent psychiatrist and psychoanalyst. Efrain Bleiberg was born in Monterrey, Mexico and is a graduate of the School of Medicine of the University of Neuvo Leon, the School of Psychology of the University of Monterrey and the Psychiatry and Child Psychiatry programmes of the Karl Menninger School of Psychiatry and Mental Health Sciences. He also completed training in adult and child psychoanalysis at the Topeka Institute for Psychoanalysis. This unique background informs and colours the wealth of clinical cases that are offered and dissected throughout the text.Bleiberg begins his Preface by stating simply “This book represents an effort to make sense of the plight of children and adolescents who are in the process of structuring a severe personality disorder.” He continues later by setting out the task before him. “While they are often strikingly arrogant, defiant, manipulative, they also convey a touching determination to survive and connect with others. Yet they excel at defeating the efforts to help them break the grip that anxiety, anger, and vulnerability have fastened on their loneliness.”The book explores panoply of theories from basic science, psychology and neurobiology. It begins by evoking the classic 1975 paper ‘Ghosts in the Nursery’ by Fraiberg, Adelson and Shapiro and paints an eloquent picture of the infant origins and antecedents that affect attachment and reflective function. The infant text is complicated but rewarding. Daniel Stern’s work on the infant’s subjective experience is a key element. Also cited is Peter Fonagy and his colleagues work on parents with high reflective capacity before the birth of their child which demonstrated that they were 3 to 4 times more likely to have a securely attached infant than were parents with a low reflective capacity.The text follows a developmental approach to severe personality disorders interweaving current genetic and neuroimaging research but in a holistic psychological framework. The area of behavioral genetics is discussed with mention of the role of the D2 dopamine receptor gene, which may interact with early environmental stressors. As well there is a discussion of recent research on the D2A1 allele and its relationship to a person’s maladaptive response to stress.Pharmacological management strategies include a number of drug algorithms for such clinical cluster issues as affective dysregulation, bipolar disorder, intermittent explosive disorder and depression. Another cluster group identified were the patients with impulsivity, behavioral dyscontrol and ADHD.However, it is the honest, self-effacing clinical discussions of the author’s therapeutic relationship and counter-transference issues with these patients that are at the heart of this life work’s book. These are the type of patients that constantly challenge the child and adolescent psychiatrist’s hubris and temper. They bring the psychiatrist into many ‘hearts of darkness’, but, as explained in the section ‘Yogi, Commissar and Alchemist’, they also encapsulate the interaction between genetic predisposition, neurobiological vulnerability and environmental factors. Finally, the clinical challenge of these children and adolescents may be daunting, but as this book shows the rewards and insights are life lasting." @default.
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• W1570800302 date "2005-05-01" @default.
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• W1570800302 title "Treating Personality Disorders in Children and Adolescents: A Relational Approach" @default.
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