20; cited by MacDonald, 2001, ¶ 3) serves as poignant pointed prompt. While conducting this study, holding the view that a patient's internal world reflects their external world and that "there is a constant interaction," this researcher regularly recounts the fact that understanding one of the patient's world mandates that this researcher understands the other. During the next chapter of this clinical case study dissertation, the Literature Review section, this researcher relates accessed information that contributes a sampling of previous research to begin to enhance the understanding needed to help a patient "grow" not only in therapy, but also in life.CHAPTER II

LITERATURE REVIEW

The theories and techniques used in psychoanalysis are very diverse; Freudian analysis is only one approach."

Thomas and McGinnis, 1991, ¶ 1)

Diverse Contentions

One recent University of New Hampshire study indicated that 63% of more than 3,000 surveyed American parents surveyed reported experiences of one or more instances of verbal aggression toward children in their homes. A Child Protective Services study, albeit reported that only 6% of child abuse cases involved "emotional maltreatment," form of abuse in which verbal abuse constitutes the most common form of maltreatment. The apparent low number of "official" verbal abuse cases likely relates to the fact verbal abuse signs prove more difficult to recognize and prove than the more obvious signs of physical abuse. (Vardiganm, 2008)

During this clinical case study dissertation's Literature Review chapter, this researcher presents information, as well as diverse contentions accessed from a barrage, more than 25, of credible sources, including books, journals and websites. Themes explored during this study's segment include emotional abuse/maltreatment, along with theories and techniques other than Freudian, specifically those relating to Object Relation, Attachment Theories, and Self-Psychology.

2.2 Emotional Abuse/Maltreatment

According to Vardiganm (2008) in his web post article, reviewed by Bruce Linton, PhD, a psychoanalyst specializing in marriage and family counseling in Berkeley, California, the following denote signs that a child is or has been verbally abuse.

Negative self-image: This sign denotes "the most common and pervasive effect of verbal abuse." child may verbalize statements such as "I'm stupid," or, "Nobody likes me."

He/she may appear withdrawn, sullen, or depressed, other signs a person possesses a poor self-image. The National Committee for the Prevention of Child Abuse defines emotional abuse by explaining that "attacks a child's... sense of self-worth." (Vardiganm, 2008)

Self-destructive acts: "Cutting," using razor blades or knives to cut oneself, and numerous other forms of self-injury, as well as a number of reckless activities that put a child in danger indicate a problem exists.

Antisocial behavior. According to the New Hampshire study, verbally abused children exhibited more physical aggression, delinquency, and interpersonal problems than children who were not verbally abused. Verbally abused children may hit their siblings and friends. They may quarrel regularly with their classmates, and/or abuse/torture animals.

Delayed development.

A verbally abused child may display delayed development signs in his/her physical, academic, social, and/or emotional development. he/she may experience problems making/keeping friends. he/she may also fall behind in his/her schoolwork, and/or engage in regressive acts as bed-wetting, rocking, and thumb-sucking. (Vardiganm, 2008)

Discipline vs. Abuse

May (2008) points out a number of differences between discipline of a child and abuse, as the following figure (1) portrays. He also stresses, albeit, that both discipline and abuse are taught by example.

Figure 1: Differences Between Discipline and Abuse (adapted from May, 2008)

The following table (1) depicts numerous physical and behavioral indicators of abuse.

Table 1: Physical and Behavioral Indicators of Abuse (May, 2008)

Type of Abuse

Physical Indicators

Behavioral Indicators

Physical Abuse

Unexplained bruises (in various stages of healing)

Unexplained burns, especially cigarette burns or immersion burns

Unexplained fractures, lacerations or abrasions

Swollen areas

Evidence of delayed or inappropriate treatment for injuries

Self-destructive

Withdrawn and/or aggressive - behavioral extremes

Arrives at school early or stays late as if afraid to be at home

Chronic runaway (adolescents)

Complains of soreness or moves uncomfortably

Wears clothing inappropriate to weather, to cover body

Bizarre explanation of injuries

Wary of adult contact

Physical Neglect

Abandonment

Unattended medical needs

Consistent lack of supervision

Consistent hunger, inappropriate dress, poor hygiene

Lice, distended stomach,...
...

Winnicott's contributions to psychoanalytic theory provide positive groundwork in this area. His idea of a time-limited therapeutic consultation proves particularly useful for the brief nature of crisis work. When individuals experience suicidal ideations involving the use of a gun, according to Kohut (1971; cited by Romano, 2004), this type scenario portrays an idealizing self-object transference. The use of a gun permits the person to feel in control and exert dominance over other individuals in his/her life. (Feldman & Johnson; cited by Romano, 2004) Often within suicide attempts or other crises' contexts, the present crisis depicts only one of numerous unconscious expectations and reactions to external events perpetuating the situation. Change at a dynamic level can negate the necessity of repeating crisis-precipitating behaviors in the future. (Jerry, 1998)
May (2008) notes the following acronym proves helpful for parents, verbally abused as children, who may struggle with the possibility they too may verbally abuse their child/ren.

A ecognize your feelings.

A mpathize with your child.

A hink of the situation differently. (Try using humor.) ear what your child is saying.

A ntegrate your love with your angry thoughts.

A otice your body's reactions to feeling anger and to calming down.

A eep your attention on the present problem. (May, 2008)

Winnicott's Relational Model Theory

Donald Winnicott, a British psychoanalyst, pediatrician, and child psychiatrist who lived from 1896 to 1971, worked at the Paddington Green Children's Hospital in London for more than 40 years. In 1923, Winnicott became interested in child psychoanalysis and during his professional pursuit in psycholanalysis, Melanie Klein's work significantly influenced him. Winnicott, in turn impacted object relations theory, particularly with his 1951 essay "Transitional Objects and Transitional Phenomena," which focused on familiar, inanimate objects children utilize during times of stress to stave off anxiety. ("Donald Winnicott," 2008, ¶ 1) the following figure (2) relates a photo of Winnicott.

A figure in file Mark is to send

Figure 2: Donald Winnicott (Robbins, 1999)

Winnicott purported that the success or failure of therapy ultimately evolved from the therapist:

every failed analysis is a failure not of the patient but of the analyst." (from "Clinical Varieties of Transference," 1955-56; cited by Robbins, 1999))

Along with emphasizing the psychoanalysts' responsibility in the therapy process, Winnicott stressed that "play" proved to be a prominent part in psychotherapy, not only when treating children, but also adults, in therapy.

Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist. Psychotherapy has to do with two people playing together. The corollary of this is that where playing is not possible then the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play." (from "Playing: Its Theoretical Status in the Clinical Situation," 1971; cited by Robbins, 1999)

In treating children, Winnicott noted, children possess…