CLINICAL
AND
RESEARCH
Am
REPORTS
promptly to ECT. Retrospective analysis of the mother’s case history revealed two abrupt and otherwise unexplained 48-hour episodes of feeling active, confident, and enthusiastic while on imipramine. These episodes disappeared as suddenly as they had started.
treatment and antidepressant.
with
tricyclic
Discussion
rated
out
whose only characteristics
ium,
Ms. A had a postpartum depression that was phenotypically unremarkable. She met the Research Diagnostic Criteria (5) for a simple primary endogenous recurrent major unipolar depression. For 3 weeks her course had been well established. However, after starting
imipramine,
changes hypomania such
Ms.
between over
a cyclic
depressed
viously,
although
in response
15 major
and period.
either euthymia To our knowledge,
depression a 10-week
response
unipolar
A underwent
to
imipramine
patient clear
switches
to imipramine
(6, 7). It is also in bipolar
patients
that
being
with
which have been switch’ process ‘ ‘
similar
cases
or
(8).
910,
mania
attacks
with
or the of
mechanisms
‘ ‘
rapid-cyclers’
according
‘
to
criterion
of
ofTraining
BY THEODORE
WEISS,
Schedule M.D.,
LINDA
Masseter muscle electromyographic back reportedly improves speech
Received Weiss
Chairman,
Philadelphia, Baltimore,
Nov.
13, 1978;
accepted
Dec.
and
27:304-309,
4 or
on
M.D.,
FK,
Murphy illness: and drugs.
DL, et al: The “switch II. Relationship to cateArch Gen Psychiatry
1972
try 32:1357-1361,
10. Dunner DL, sive patients.
AND
Speech
JOHN
PAUL
frequency of manic1978 Arch Gen Psychia-
1975
Patrick Compr
V. Fieve RR: Rapid cycling manic Psychiatry 18:561-566, 1977
depres-
Dysfluency BRADY,
M.D.
(1). We examined the efficacy of this method and the effects of training session frequency in an older patient with speech dysfluency.
(EMG) biofeedfluency in stutterers
Case
8, 1978.
©
Report
The patient was a 64-year-old woman with mild congenital choreoathetoid encephalopathy (cerebral palsy). The cerebral palsy had not impaired her functioning, but at age 62 her speech had worsened, and her jaws started clamping shut when she spoke. She had to compress her cheeks inward with both hands to facilitate speech flow. Inpatient evaluation revealed no clear reason for her deterioration, and several medications (haloperidol , perphenazine , amantadine,
is Assistant Professor and Dr. Brady is Professor and Department of Psychiatry, University of Pennsylvania, Pa. 19104. Dr. Carson is an intern at Sinai Hospital, Md.
0002-953X/79103/0342/03/$00.40
Never-
us to identify
trial.
Wehr 1, Goodwin FK: Tricyclics modulate depressive cycles. Chronobiologia 4:161, 9. Mass 1W: Biogenic amines and depression.
This work was supported by Alcohol, Drug Abuse, and Mental Health Administration Research Scientist Development Award MH70906 to Dr. Weiss from the National Institute ofMental Health, and by National Institutes of Health grant RR-00040 from the Division of Research Services.
342
a lithium
8.
Biofeedback
F. CARSON,
inconclusive.
encourage
sepa-
to lith-
1973
Bunney WE Jr. Goodwin process” in manic-depressive cholamines, REM sleep,
7.
affective episodes per year. As a group these pawere observed to benefit less from lithium than bipolar patients. However, this represented a of patients who were known to be bipolar before
Effects
Dr.
their
been
1967
29:420-425,
linking imipramine administration and the clinical syndrome exhibited by Ms. A is not implausible. Dunner and associates (10) examined the case records of 390 bipolar patients and found that 13% were more tients other group
would
yet
response
Jones FD, Maas 1W, Dekirmenjian H, et al: Urinary catecholamine metabolites during behavioral changes in a patient with manic-depressive cycles. Science 179:300-302, 1973 4. Post RM, Stoddard FJ, Gillin JC, et al: Alterations in motor activity, sleep, and biochemistry in a cycling manic-depressive patient. Arch Gen Psychiatry 34:470-477, 1977 5. Spitzer RL, Endicott I, Robins E: Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders, 2nd ed. New York, Biometrics Research, New York State Psychiatric Institute, 1977 6. Pnien RK, Klett Ci, Caffey EM: Lithium carbonate and imipramine in prevention of affective episodes. Arch Gen Psychiatry
implicated in the manic-depressive (7, 9), so that a causal relationship
‘
is ofcourse
attempt
not
favorable
3.
occur
may be shortened Imipramine,
amine
case,
has
A’s
or manic treatment
I. Bunney WE Jr. Hartmann EL: Study ofa patient with 48-hour manic-depressive cycles. Arch Gen Psychiatry 12:611-618, 1965 2. Jenner FA, Gjessing LR, Cox JR. et al: A manic depressive psychotic with a persistent 48 hour cycle. Br J Psychiatry I 13:895-
well-documented
patients
Ms.
experience and
1979
REFERENCES
pre-
persistent
prophylactically
biogenic
our
otherwise
described
manic
a single
theless,
March
of hypomanic they are under
antidepressants
for study.
136:3,
not being treated with a tnicyclic subset of affectively ill patients
manifestations occur while
mood
being treated with lithium evidence suggests that
cycle time of some bipolar by tricyclic antidepressants
interacts
been
more
treated
imipramine than in those placebo (6), and preliminary
course,
into
have
known
in an
has not been
as
were The
J Psychiatry
I 979
American
Psychiatric
Association
Am
J Psychiatry
TABLE
136:3,
March
/979
CLINICAL
Speech
Biofeedback
REPORTS
Performance
Training
Words in 5 Minutes
Number of Recordings
Schedule’
Baseline Daily Weekly Biweekly Weekly Weekly (no biofeedback) LThere were 10 sessions
-
-
1
in each
training
activity
(100-1,000
2
439.0
10 8 10 10
361.6 341.8 375.5 395.8
Hz)
from
the
right
or left
recorded using a The maso that
the patient
when
on a green
---
or yellow
light
she
relaxed her masseter muscle and a red light when she tensed it. She practiced this several times during the Ihour training session. The rest of the time she spoke with a technician and was drilled in pronouncing problematic words or syllables while attempting to keep the yellow or green lights lit. Performance was assessed by a 10-minute recording during which the same experimenter had the patient talk about a subject that interested her. Five minutes of her speech was analyzed for numbers of words and dysfluencies defined as clearly discernible instances of words or syllables the patient had difficulty emit,
sequence
was
as follows:
1) 10 twice-
daily biofeedback sessions over 5 days, 2) 10 weekly biofeedback sessions, 3) 10 biweekly biofeedback sessions, 4) 10 weekly biofeedback sessions, and 5) 10 weekly sessions without biofeedback. In no-biofeedback sessions, after the initial recording, the patient and technician talked for 50 minutes, with no biofeedback or drill on problematic words and syllables. The tape recording was done at the beginning of every ses-
except
during
the daily
-________
SD
Mean
SD
Mean
SD 26.5
88 55.2 50.5 61.6 38.1 45.0
35.2
21.2 14.5 22.5 11.1
7.9 8.9 15.0 9.6
5.8 3.6 7.7 3.5
34.3
7.9
8.8
2.5
33.0 32.6
48.6
Results During daily biofeedback training, the patient’s speech fluency improved markedly. Dysfluencies/lOO words fell from 26.5 before training to 3.8 at the beginning of session 9. Speech data generally were best during
biofeedback
phase,
when
it was done only before sessions I (baseline, see table I), 5, and 9. Between biofeedback sessions the patient was instructed to practice relaxing and clenching her
jaw several times daily at home green or yellow lights when she ing. For the no-biofeedback sessions instructions about home practice. consent to participate in the study.
and to imagine the had difficulty speakshe was given no She gave informed
period.
this
phase was
speech decreased
ened.
Her
In the
following
remained to every
weekly
good, but 2 weeks,
performance
during
when her
biweekly
biofeedback biofeedback speech wors-
training
was
worse than any otherpeniod. Of8 sessions, 4 (numbers 2, 3, 4, and 9) showed dysfluency rates over 18.0, a high level not seen in any other sessions (except the prestudy baseline). During this biweekly biofeedback phase doxepin was discontinued after session 4 because the patient no longer seemed depressed. Speech fluency worsened dramatically in the next 2 sessions (5 and 6), with data in almost every category by far the worst seen (e.g., dysfluency rates of 53.3 and 43.9).
We
felt
these
sessions
reflected
drug’s discontinuation data analysis. (These our argument regarding cy.)
In the subsequent again
improved.
back,
we
feedback was
ting.
training
Dysfluencies/ 100 Words
phase.
(in alternate sessions) masseter muscle was with surface electrodes (silver/silver chloride) commercially available biofeedback device. chine’s threshold criterion was set empirically
turned
-
332
Method
EMG
Dysfluencies in 5 Minutes
Mean
diazepam, and doxepin) were administered without benefit. She was taking doxepin, 75 mg/day, for mild depression at the beginning of the study. Because her speech problem involved masseter muscle contraction, we trained her with EMG biofeedback from this area. After 20 informal training sessions, at varying intervals, we initiated the present study to examine our impression that improved speech occurred with more frequent biofeedback.
sion,
RESEARCH
1
Patient’s
The
AND
quite
training
and data the
weekly To assess
then
gave
as
described
similar phases.
to
aftereffects
of
the
dropped them from the would have strengthened effect of session frequen-
biofeedback the importance
phase speech of biofeed-
10 weekly
sessions
without
above.
Speech
performance
that
in
the
weekly
bio-
biofeedback
Discussion
Weekly
training
sessions
were
more
beneficial
than
less frequent ones for this dysfluent patient. However, we found no evidence that EMG biofeedback from masseter muscles was necessary for this improvement. Masseter biofeedback improved fluency in stutterers
when
the
feedback-on
and
feedback-off
con-
ditions followed one another within a few minutes (1). Our data on a related but different issue-the persistence of benefit from masseter biofeedback during a
1-week
period
that weekly therapeutic
We speech sistence
cannot
between
training
practice speaking with as weekly biofeedback.
exclude
the
possibility
sessions-indicate a technician
that
was
as
improved
during the no-biofeedback phase reflected of an over-learned response from many
perprior
343
CLINICAL
AND
biofeedback ing in speech
RESEARCH
sessions. during
REPORTS
Am
However, the patient’s worsenbiweekly biofeedback followed 40
prior biofeedback sessions, performance in the weekly
pressures sessions our data
whereas persistently good no-biofeedback phase fol-
than a similar number spread over several in the no-biofeedback
that an appropriate relaxation training, out with the same
Unconscious BY
JESSE
0.
CAVENAR,
JR.,
M.D.,
AND
RI, Barrington CC, Newman AC: Modification of stutthrough EMG biofeedback: a preliminary study. Behav Ther 7:96-103, 1976 2. Elder ST, Eustis NK: Instrumental blood pressure conditioning in out-patient hypertensives. Behav Res Ther 13:185-188, 1975 3. Weiss T: Biofeedback training for cardiovascular dysfunctions. Med Clin North Am 61:913-928, 1977 tening
Father
NANCY
T.
and
BUT1S,
or psychotherapy
ofthe
child
has
been
lieved that the parent or parents unconsciously derived pleasure from the child’s antisocial acts and subtly encouraged them. At the same time, the parents could discharge their unconscious hostility, sadism, and destructiveness toward the child. Child psychoanalysts observe the intensity of unconscious parental forces when they undertake simultaneous analysis of both parent and child. Such simultaneous analysis is occasionally necessary when a parent and child are locked in a severe neurotic pattern. There are several case reports in the literature that de-
ap-
preciated since at least 1909, when Freud capitalized on his patient’s relationship with his father in ‘The Analysis of a Phobia in a Five-year-old Boy” (1). Freud conducted the entire treatment of the boy through the father. The importance of unconscious conflicts in the parents as a cause of conflicts in the child gained more acceptance as more experience was gathered in child psychoanalysis. By 1935, Burlingham (2) stated that ‘the power of unconscious forces is especially marked ‘
scribe
and
uncanny
between
that
parent
it seems
and
at times
child.
It is so subtle
to approach
the
supernatural.”
Johnson and Szurek (3) suggested that unconscious communication between the child and the parents, particularly the mother, was instrumental in the development of antisocial personality disorders. It was be-
Case Received
Oct.
27, 1978; revised
Dec.
4, 1978; accepted
Dec.
or policies
344
are those ofthe authors and do not represent of the Veterans Administration.
0002-953X/79/03/0344/02/$00.35
had
iety,
psychoanalysis
of mother
and
Report sought
Mr. A, is a 38-year-old psychoanalysis
self-defeating
10 years
behavior,
sessive-compulsive choanalysis of6
and
professional earlier
a fear
because
of success.
man
who
of anx-
An ob-
personality structure had led to a psyyears’ duration. There was excellent nesolution of his anxiety and other symptoms. The psychoanalysis had terminated 4 years previously;
the views
©
simultaneous
The father,
8, 1978.
Dr. Cavenar is Associate Professor of Psychiatry, Duke University School of Medicine, and Chief of Psychiatry, Veterans Administration Hospital, Fulton Street and Erwin Road, Durham, N.C. 27705. Dr. Butts is in private practice in Chapel Hill, N.C.
The opinions
the
child (4, 5); we are aware of only one article (6) on the simultaneous psychoanalysis of a father and son. None of these case reports refers to specific dreams of either parent or child during the treatment. The purpose of this paper is 1) to report a case in which unconscious communication between father and son resulted in both having dreams that used the same symbols and 2) to demonstrate the degree to which the father’s conflicts influenced his son.
‘
in its interplay
Son
M.D.
The influence of parents and their neuroses on the developing child has long been recognized. The importance ofthe neurotic conflicts ofthe parents in the psychoanalysis
1979
1. Lanyon
control procedure in their studynapping, sitting quietly-carried frequency as blood pressure bio-
Between
March
REFERENCES
of biofeedback months. Howphase suggest
Communication
136:3,
feedback might have been as effective in lowering patients’ pressures. The issue of nonspecific or placebo factors in biofeedback training (3) is relevant. An opportunity to speak with a familiar person was beneficial to our dysfluent patient’s speech. Biofeedback was merely the mechanism by which this interaction occurred rather than an important therapeutic ingredient.
lowed 60 prior biofeedback sessions. It seems unlikely that the 20 biofeedback sessions between the first weekly biofeedback phase and the final weekly no-biofeedback phase-during a number of which the patient was quite dysfluent-were critical in her acquiring persistently improved speech. Elder and Eustis (2) found that daily blood pressure biofeedback was more effective in lowering hypertensives’ training ever,
J Psychiatry
1979
American
Psychiatric
Association
AND
RESEARCH
Am
REPORTS
promptly to ECT. Retrospective analysis of the mother’s case history revealed two abrupt and otherwise unexplained 48-hour episodes of feeling active, confident, and enthusiastic while on imipramine. These episodes disappeared as suddenly as they had started.
treatment and antidepressant.
with
tricyclic
Discussion
rated
out
whose only characteristics
ium,
Ms. A had a postpartum depression that was phenotypically unremarkable. She met the Research Diagnostic Criteria (5) for a simple primary endogenous recurrent major unipolar depression. For 3 weeks her course had been well established. However, after starting
imipramine,
changes hypomania such
Ms.
between over
a cyclic
depressed
viously,
although
in response
15 major
and period.
either euthymia To our knowledge,
depression a 10-week
response
unipolar
A underwent
to
imipramine
patient clear
switches
to imipramine
(6, 7). It is also in bipolar
patients
that
being
with
which have been switch’ process ‘ ‘
similar
cases
or
(8).
910,
mania
attacks
with
or the of
mechanisms
‘ ‘
rapid-cyclers’
according
‘
to
criterion
of
ofTraining
BY THEODORE
WEISS,
Schedule M.D.,
LINDA
Masseter muscle electromyographic back reportedly improves speech
Received Weiss
Chairman,
Philadelphia, Baltimore,
Nov.
13, 1978;
accepted
Dec.
and
27:304-309,
4 or
on
M.D.,
FK,
Murphy illness: and drugs.
DL, et al: The “switch II. Relationship to cateArch Gen Psychiatry
1972
try 32:1357-1361,
10. Dunner DL, sive patients.
AND
Speech
JOHN
PAUL
frequency of manic1978 Arch Gen Psychia-
1975
Patrick Compr
V. Fieve RR: Rapid cycling manic Psychiatry 18:561-566, 1977
depres-
Dysfluency BRADY,
M.D.
(1). We examined the efficacy of this method and the effects of training session frequency in an older patient with speech dysfluency.
(EMG) biofeedfluency in stutterers
Case
8, 1978.
©
Report
The patient was a 64-year-old woman with mild congenital choreoathetoid encephalopathy (cerebral palsy). The cerebral palsy had not impaired her functioning, but at age 62 her speech had worsened, and her jaws started clamping shut when she spoke. She had to compress her cheeks inward with both hands to facilitate speech flow. Inpatient evaluation revealed no clear reason for her deterioration, and several medications (haloperidol , perphenazine , amantadine,
is Assistant Professor and Dr. Brady is Professor and Department of Psychiatry, University of Pennsylvania, Pa. 19104. Dr. Carson is an intern at Sinai Hospital, Md.
0002-953X/79103/0342/03/$00.40
Never-
us to identify
trial.
Wehr 1, Goodwin FK: Tricyclics modulate depressive cycles. Chronobiologia 4:161, 9. Mass 1W: Biogenic amines and depression.
This work was supported by Alcohol, Drug Abuse, and Mental Health Administration Research Scientist Development Award MH70906 to Dr. Weiss from the National Institute ofMental Health, and by National Institutes of Health grant RR-00040 from the Division of Research Services.
342
a lithium
8.
Biofeedback
F. CARSON,
inconclusive.
encourage
sepa-
to lith-
1973
Bunney WE Jr. Goodwin process” in manic-depressive cholamines, REM sleep,
7.
affective episodes per year. As a group these pawere observed to benefit less from lithium than bipolar patients. However, this represented a of patients who were known to be bipolar before
Effects
Dr.
their
been
1967
29:420-425,
linking imipramine administration and the clinical syndrome exhibited by Ms. A is not implausible. Dunner and associates (10) examined the case records of 390 bipolar patients and found that 13% were more tients other group
would
yet
response
Jones FD, Maas 1W, Dekirmenjian H, et al: Urinary catecholamine metabolites during behavioral changes in a patient with manic-depressive cycles. Science 179:300-302, 1973 4. Post RM, Stoddard FJ, Gillin JC, et al: Alterations in motor activity, sleep, and biochemistry in a cycling manic-depressive patient. Arch Gen Psychiatry 34:470-477, 1977 5. Spitzer RL, Endicott I, Robins E: Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders, 2nd ed. New York, Biometrics Research, New York State Psychiatric Institute, 1977 6. Pnien RK, Klett Ci, Caffey EM: Lithium carbonate and imipramine in prevention of affective episodes. Arch Gen Psychiatry
implicated in the manic-depressive (7, 9), so that a causal relationship
‘
is ofcourse
attempt
not
favorable
3.
occur
may be shortened Imipramine,
amine
case,
has
A’s
or manic treatment
I. Bunney WE Jr. Hartmann EL: Study ofa patient with 48-hour manic-depressive cycles. Arch Gen Psychiatry 12:611-618, 1965 2. Jenner FA, Gjessing LR, Cox JR. et al: A manic depressive psychotic with a persistent 48 hour cycle. Br J Psychiatry I 13:895-
well-documented
patients
Ms.
experience and
1979
REFERENCES
pre-
persistent
prophylactically
biogenic
our
otherwise
described
manic
a single
theless,
March
of hypomanic they are under
antidepressants
for study.
136:3,
not being treated with a tnicyclic subset of affectively ill patients
manifestations occur while
mood
being treated with lithium evidence suggests that
cycle time of some bipolar by tricyclic antidepressants
interacts
been
more
treated
imipramine than in those placebo (6), and preliminary
course,
into
have
known
in an
has not been
as
were The
J Psychiatry
I 979
American
Psychiatric
Association
Am
J Psychiatry
TABLE
136:3,
March
/979
CLINICAL
Speech
Biofeedback
REPORTS
Performance
Training
Words in 5 Minutes
Number of Recordings
Schedule’
Baseline Daily Weekly Biweekly Weekly Weekly (no biofeedback) LThere were 10 sessions
-
-
1
in each
training
activity
(100-1,000
2
439.0
10 8 10 10
361.6 341.8 375.5 395.8
Hz)
from
the
right
or left
recorded using a The maso that
the patient
when
on a green
---
or yellow
light
she
relaxed her masseter muscle and a red light when she tensed it. She practiced this several times during the Ihour training session. The rest of the time she spoke with a technician and was drilled in pronouncing problematic words or syllables while attempting to keep the yellow or green lights lit. Performance was assessed by a 10-minute recording during which the same experimenter had the patient talk about a subject that interested her. Five minutes of her speech was analyzed for numbers of words and dysfluencies defined as clearly discernible instances of words or syllables the patient had difficulty emit,
sequence
was
as follows:
1) 10 twice-
daily biofeedback sessions over 5 days, 2) 10 weekly biofeedback sessions, 3) 10 biweekly biofeedback sessions, 4) 10 weekly biofeedback sessions, and 5) 10 weekly sessions without biofeedback. In no-biofeedback sessions, after the initial recording, the patient and technician talked for 50 minutes, with no biofeedback or drill on problematic words and syllables. The tape recording was done at the beginning of every ses-
except
during
the daily
-________
SD
Mean
SD
Mean
SD 26.5
88 55.2 50.5 61.6 38.1 45.0
35.2
21.2 14.5 22.5 11.1
7.9 8.9 15.0 9.6
5.8 3.6 7.7 3.5
34.3
7.9
8.8
2.5
33.0 32.6
48.6
Results During daily biofeedback training, the patient’s speech fluency improved markedly. Dysfluencies/lOO words fell from 26.5 before training to 3.8 at the beginning of session 9. Speech data generally were best during
biofeedback
phase,
when
it was done only before sessions I (baseline, see table I), 5, and 9. Between biofeedback sessions the patient was instructed to practice relaxing and clenching her
jaw several times daily at home green or yellow lights when she ing. For the no-biofeedback sessions instructions about home practice. consent to participate in the study.
and to imagine the had difficulty speakshe was given no She gave informed
period.
this
phase was
speech decreased
ened.
Her
In the
following
remained to every
weekly
good, but 2 weeks,
performance
during
when her
biweekly
biofeedback biofeedback speech wors-
training
was
worse than any otherpeniod. Of8 sessions, 4 (numbers 2, 3, 4, and 9) showed dysfluency rates over 18.0, a high level not seen in any other sessions (except the prestudy baseline). During this biweekly biofeedback phase doxepin was discontinued after session 4 because the patient no longer seemed depressed. Speech fluency worsened dramatically in the next 2 sessions (5 and 6), with data in almost every category by far the worst seen (e.g., dysfluency rates of 53.3 and 43.9).
We
felt
these
sessions
reflected
drug’s discontinuation data analysis. (These our argument regarding cy.)
In the subsequent again
improved.
back,
we
feedback was
ting.
training
Dysfluencies/ 100 Words
phase.
(in alternate sessions) masseter muscle was with surface electrodes (silver/silver chloride) commercially available biofeedback device. chine’s threshold criterion was set empirically
turned
-
332
Method
EMG
Dysfluencies in 5 Minutes
Mean
diazepam, and doxepin) were administered without benefit. She was taking doxepin, 75 mg/day, for mild depression at the beginning of the study. Because her speech problem involved masseter muscle contraction, we trained her with EMG biofeedback from this area. After 20 informal training sessions, at varying intervals, we initiated the present study to examine our impression that improved speech occurred with more frequent biofeedback.
sion,
RESEARCH
1
Patient’s
The
AND
quite
training
and data the
weekly To assess
then
gave
as
described
similar phases.
to
aftereffects
of
the
dropped them from the would have strengthened effect of session frequen-
biofeedback the importance
phase speech of biofeed-
10 weekly
sessions
without
above.
Speech
performance
that
in
the
weekly
bio-
biofeedback
Discussion
Weekly
training
sessions
were
more
beneficial
than
less frequent ones for this dysfluent patient. However, we found no evidence that EMG biofeedback from masseter muscles was necessary for this improvement. Masseter biofeedback improved fluency in stutterers
when
the
feedback-on
and
feedback-off
con-
ditions followed one another within a few minutes (1). Our data on a related but different issue-the persistence of benefit from masseter biofeedback during a
1-week
period
that weekly therapeutic
We speech sistence
cannot
between
training
practice speaking with as weekly biofeedback.
exclude
the
possibility
sessions-indicate a technician
that
was
as
improved
during the no-biofeedback phase reflected of an over-learned response from many
perprior
343
CLINICAL
AND
biofeedback ing in speech
RESEARCH
sessions. during
REPORTS
Am
However, the patient’s worsenbiweekly biofeedback followed 40
prior biofeedback sessions, performance in the weekly
pressures sessions our data
whereas persistently good no-biofeedback phase fol-
than a similar number spread over several in the no-biofeedback
that an appropriate relaxation training, out with the same
Unconscious BY
JESSE
0.
CAVENAR,
JR.,
M.D.,
AND
RI, Barrington CC, Newman AC: Modification of stutthrough EMG biofeedback: a preliminary study. Behav Ther 7:96-103, 1976 2. Elder ST, Eustis NK: Instrumental blood pressure conditioning in out-patient hypertensives. Behav Res Ther 13:185-188, 1975 3. Weiss T: Biofeedback training for cardiovascular dysfunctions. Med Clin North Am 61:913-928, 1977 tening
Father
NANCY
T.
and
BUT1S,
or psychotherapy
ofthe
child
has
been
lieved that the parent or parents unconsciously derived pleasure from the child’s antisocial acts and subtly encouraged them. At the same time, the parents could discharge their unconscious hostility, sadism, and destructiveness toward the child. Child psychoanalysts observe the intensity of unconscious parental forces when they undertake simultaneous analysis of both parent and child. Such simultaneous analysis is occasionally necessary when a parent and child are locked in a severe neurotic pattern. There are several case reports in the literature that de-
ap-
preciated since at least 1909, when Freud capitalized on his patient’s relationship with his father in ‘The Analysis of a Phobia in a Five-year-old Boy” (1). Freud conducted the entire treatment of the boy through the father. The importance of unconscious conflicts in the parents as a cause of conflicts in the child gained more acceptance as more experience was gathered in child psychoanalysis. By 1935, Burlingham (2) stated that ‘the power of unconscious forces is especially marked ‘
scribe
and
uncanny
between
that
parent
it seems
and
at times
child.
It is so subtle
to approach
the
supernatural.”
Johnson and Szurek (3) suggested that unconscious communication between the child and the parents, particularly the mother, was instrumental in the development of antisocial personality disorders. It was be-
Case Received
Oct.
27, 1978; revised
Dec.
4, 1978; accepted
Dec.
or policies
344
are those ofthe authors and do not represent of the Veterans Administration.
0002-953X/79/03/0344/02/$00.35
had
iety,
psychoanalysis
of mother
and
Report sought
Mr. A, is a 38-year-old psychoanalysis
self-defeating
10 years
behavior,
sessive-compulsive choanalysis of6
and
professional earlier
a fear
because
of success.
man
who
of anx-
An ob-
personality structure had led to a psyyears’ duration. There was excellent nesolution of his anxiety and other symptoms. The psychoanalysis had terminated 4 years previously;
the views
©
simultaneous
The father,
8, 1978.
Dr. Cavenar is Associate Professor of Psychiatry, Duke University School of Medicine, and Chief of Psychiatry, Veterans Administration Hospital, Fulton Street and Erwin Road, Durham, N.C. 27705. Dr. Butts is in private practice in Chapel Hill, N.C.
The opinions
the
child (4, 5); we are aware of only one article (6) on the simultaneous psychoanalysis of a father and son. None of these case reports refers to specific dreams of either parent or child during the treatment. The purpose of this paper is 1) to report a case in which unconscious communication between father and son resulted in both having dreams that used the same symbols and 2) to demonstrate the degree to which the father’s conflicts influenced his son.
‘
in its interplay
Son
M.D.
The influence of parents and their neuroses on the developing child has long been recognized. The importance ofthe neurotic conflicts ofthe parents in the psychoanalysis
1979
1. Lanyon
control procedure in their studynapping, sitting quietly-carried frequency as blood pressure bio-
Between
March
REFERENCES
of biofeedback months. Howphase suggest
Communication
136:3,
feedback might have been as effective in lowering patients’ pressures. The issue of nonspecific or placebo factors in biofeedback training (3) is relevant. An opportunity to speak with a familiar person was beneficial to our dysfluent patient’s speech. Biofeedback was merely the mechanism by which this interaction occurred rather than an important therapeutic ingredient.
lowed 60 prior biofeedback sessions. It seems unlikely that the 20 biofeedback sessions between the first weekly biofeedback phase and the final weekly no-biofeedback phase-during a number of which the patient was quite dysfluent-were critical in her acquiring persistently improved speech. Elder and Eustis (2) found that daily blood pressure biofeedback was more effective in lowering hypertensives’ training ever,
J Psychiatry
1979
American
Psychiatric
Association
