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PubMed1991

[Familial reality construction. On dealing with intrafamilial realization processes in psychodiagnostic and psychotherapeutic contexts].

Psychodynamic processes are connected to relationship-psychological and family dynamic phenomena in varied ways. Especially the processes of forming judgments and coming to realizations in the family influence the individual psychodynamics greatly. In these processes characteristics, purposes, roles and pathologies are ascribed to the individual family member. In this article these processes will be clearly shown with casuistic material. After this the author will clarify the theoretical relationship between the various levels of description which are the result of examining intrapsychic and family dynamic questions.

Child↗
PubMed2006

Sense of reality, reality testing and reality processing in borderline patients.

Although borderline patients are suitable for it, they often undergo repeated testing of fantasies against objective reality without success. A reason for these partial failures is that subjects have not been able to build a solid sense of reality and have found many difficulties for processing reality demands and possibilities. The author puts forward some thoughts on this question, such as the importance of working through the depressive position and the Oedipus complex in the process of building up a solid sense of reality. A sense of reality also favours continuous reality processing. When reality processing becomes as continuous as life itself, the repetition of individual reality tests becomes less frequent and necessary, and more satisfying. The author also presents some recommendations for the psychoanalytic treatment of such patients, stressing the importance and the difficulties of the introduction of the borderline patient into the triangular situation because primitive defences--such as disavowal and denial--are mobilized.

Adult↗
PubMed1995

Schizophrenia and oxymorons.

From the viewpoint of character structure, patients with schizophrenia can be seen as the diametric opposite of persons with a nonpsychotic organization. They construct adaptations and defenses to deal with an externalized primitive mental orientation, whereas nonpsychotic persons tend to develop defensive mechanisms to render these primitive parts inactive. Patients with schizophrenia do not have a continuum between primary process id levels and secondary process reality operations. Thus polarities are not differentiated, leading to a series of paradoxes and oxymorons. These patients may view themselves as omnipotent and grandiose, yet at the same time lead a miserable, drab existence. Primitive parts of the personality may feel alive and powerful, whereas the ego is viewed as dead--the fundamental oxymoron of the living dead. The author presents several illustrative case vignettes of these features.

Adult↗
PubMed1993

Truth and reality in psychoanalytic discourse.

In this paper, I examine the influences of two philosophical theories of truth--coherence and correspondence--on the current debate on the search for 'common ground' and on specific aspects of clinical practice. Results from a previous empirical study of analysts' approaches to transference interpretation are described in order to illustrate the way in which a network of clinical concepts is held together by explicit and implicit beliefs concerning the nature of subjectivity, truth and reality. Excerpts from interviews of psychoanalysts of varying orientations practising in different geographical locations indicate the complex interrelationships between concepts of analytic neutrality, extra-transference, the real relationship, countertransference, the death instinct and the therapeutic alliance. These findings suggest that the coherence versus correspondence theories of truth may constrain rather than enhance the investigation of the differences and commonality between varying analytic theories, schools and clinical practices.

Attitude to Death↗
PubMed1998

[Obsessive-compulsive disorders in childhood and adolescence--recent psychoanalytic views and treatment approaches].

Based on neurobiological and development-psychological findings psychodynamic concepts for understanding compulsive disorders are supplemented and extended. A stimulus barrier impaired during development which in the early mother-child system normally develops into an autonomous and self-regulating ability has the consequence in compulsive disorders that the ability of drawing limits between reality and phantasy has only poor success. Based on case examples the function of the situation triggering the compulsive symptoms and the foreseeable relationship quality are examined on the different levels of development. Then it becomes clear how complex the originating conditions for compulsive disorders are, and under which conditions a primary object fails as original external psycho-neurobiological regulator in the development of autonomous self-regulation.

Adolescent↗
PubMed1985

[Psychosocial rehabilitation in advanced age].

The psychosocial rehabilitation of older persons is one of the main problems in health policy. About one quarter of the over 65-year-olds face psychic problems, without, to a large extent, receiving adequate treatment and rehabilitative care. Substantial deficits exist above all in the out-patient and non-residential service sectors. In in-patient care, existing methods for psychosocial intervention (such as psychoanalysis, behavioural, client-centered, family, Gestalt, milieu, or music and dance therapy, psychodrama, reality orientation training, or resensitization techniques) are hardly ever used. This absence of applied geronto-psychology is attributable to the shortcomings of available assessment methods, multiple methodical problems of intervention research, and--above all--to insufficient staff positions for psychosocial professions in the gerontological sector. Provision of further permanent posts for psychosocial workers; development of age-specific assessment methods; interdisciplinary and systematic interventional research; the development of ambulatory, community-based services as well as intensive support for existing self-help efforts are therefore called for.

Aged↗
PubMed1980

The closing phase of the psychoanalytic treatment of adults and the goals of psychoanalysis 'The myth of perfectibility'.

The goal of analysis in the transference neuroses is achieved with establishment of internalized autonomy. A central focus of the analytic process is the epigenesis of reality thinking. Freud's early ideas about reality testing and the more recent contributions to the development and organization of the mental apparatus are reviewed. Recent postanalytic follow-up studies and panel discussions relating to these studies suggest that the analyst's task is completed when the best possible psychological conditions for the ego's functioning has been reached including the development of the self-analytic function. The attainment of the latter provides the analysand with the potential for continued analytic monitoring and further development.

Follow-Up Studies↗
PubMed1995

Transferences of deception.

Three characteristic transference configurations are identified that frequently emerge in the analyses of patients for whom deception and inauthenticity are central themes. These configurations are labeled (1) imposturous, (2) psychopathic-paranoid, and (3) psychopathic-unreal. Patients who develop these transferences have actively split the object world along two distinct axes. The first split has occurred along the lines of pleasure and unpleasure. The second divides objects along the lines of the experience of reality, with some objects felt to be charged with exaggerated, painful meaning, and others felt to be devoid of meaning and affect. This split, which arises as a way of managing painful object relations, is then woven into fantasy and defense at many developmental levels. Material from the analyses of two patients is presented to demonstrate the interplay of the three transference configurations, the fantasies that underlie them, and the clinical importance of analyzing the second split.

Adult↗
PubMed1994

Interpretation and creationism.

This paper is an attempt to raise questions about certain underlying and implicit assumptions in some hermeneutic and narrative approaches to psychoanalysis. Starting from the view that Freud saw interpretation in the clinical setting as an attempt to unveil the analysand's psychic reality, it is argued that he envisaged that psychoanalysis aims to interpret what is real in the analysand's inner world--an empirical line of thought underpinned by the idea of analytic neutrality and an emphasis on the analysand's capacity to judge reality. By contrast, the tendency within the hermeneutic-narrative tradition is to demote psychic reality in favour of an emphasis on the analyst's capacity to interpret in order to help his analysand construct meaning. This approach may be said to put the analyst's words in the place of those of the Creator; in other words, it amounts to a 'verbal creationism', which the author argues is rooted in the idealistic philosophy of Hegel, Vico and Descartes and, further back, can be traced to the Book of Genesis--a conclusion causing the author to express some reservations.

Creativity↗
PubMed1995

Psychological vicissitudes of theory in clinical work.

The author discusses the ways in which psychoanalytic theories, like other theories, attempt to systematise the understanding of observations. Freud remarked that systems also have unconscious meanings. The author discusses these unconscious vicissitudes of psychoanalytic theories of both clinical and more abstract kinds, at various levels of psychological function. Learning psychoanalysis repeats in some respects the developmental processes of learning about 'reality'. The role of authority and superego function in learning and utilising theories is emphasised. The enduring unconscious relationship of theory to authority contributes to adherence to, misapplications of, and rejection of theories, as well as to anti-theoretical attitudes. The concept of an 'analysing instrument' illustrates the way in which a useful exploratory idea may acquire prescriptive and constrictive implications. Analysis of the analyst's attitudes towards theory and its applications is an aspect of countertransference analysis.

Authoritarianism↗
PubMed1997

Psychic reality and unconscious belief: a reconsideration.

In a recent paper Britton attempted to distinguish between a phantasy that has achieved the status of a belief and one that has not, and between a belief and knowledge. The author argues that, in the light of the seventeenth-century controversy between Descartes and Spinoza, both of these distinctions are untenable. Descartes argued, as Britton does, and as Freud did, that phantasies or ideas are not accepted as beliefs until they are tested against reality. Furthermore, Britton maintains that for a belief to acquire the status of knowledge, it must be supported by incontrovertible evidence. Spinoza, on the other hand, proposed the seemingly preposterous notion that a comprehended proposition is automatically believed. Doubt may subsequently be engendered by disconfirming evidence. As it turns out, research in a number of domains suggests that Spinoza was correct and Descartes was wrong. This evidence and its clinical implications are discussed. As suggested by Bion, instilling doubt regarding deeply ingrained (Spinozan-formed) phantasies is a principal goal of treatment.

Freudian Theory↗
PubMed2006

Dreams that mirror the session.

Dreams in which the analyst appears undisguised almost always depict violations of the setting. Often experienced as special, epiphanic moments, they give a glimpse of an intense, emotional reaction to traumatogenic or otherwise significant events that have occurred during the session or in the most recent previous ones. Probably, the essential aspect of these dreams can be found in the 'form of their content'. This may be paralleled by the narrative technique of mise en abyme or mirror-text. The dream appears as a story within the main story and the scene of the analysis is reflected anti-illusionistically. The fictional structure of the setting is emphasized. Its theatrical self-consciousness quality is revealed at its best. The author postulates that the transformative therapeutic value of these dreams derives from denouncing the referential illusion of 'concrete reality' and of 'what really happened'. For the analysand, they are an effective (i.e. emotionally intense) opportunity to discover the spatial articulations and the staggering refractions of the inside/outside, the textual/extra-textual, the psychic reality/material reality. In the continual comings and goings from one term to another, the work of symbolization is reactivated and the subject is constructed. Dreams that mirror the session, from this point of view, provide a model for conceptualizing the analytic work, and their significance goes beyond the specific phenomena referred to. A clinical case is given, in which some of one patient's dreams are considered as they occurred over a short period. In one of them, the dream-within-a-dream phenomenon is present.

Adult↗
PubMed2005

Reminiscence therapy for dementia.

BACKGROUND: Reminiscence Therapy (RT) involves the discussion of past activities, events and experiences with another person or group of people, usually with the aid of tangible prompts such as photographs, household and other familiar items from the past, music and archive sound recordings. Reminiscence groups typically involve group meetings in which participants are encouraged to talk about past events at least once a week. Life review typically involves individual sessions, in which the person is guided chronologically through life experiences, encouraged to evaluate them, and may produce a life story book. Family care-givers are increasingly involved in reminiscence therapy. Reminiscence therapy is one of the most popular psychosocial interventions in dementia care, and is highly rated by staff and participants. There is some evidence to suggest it is effective in improving mood in older people without dementia. Its effects on mood, cognition and well-being in dementia are less well understood. OBJECTIVES: The objective of the review is to assess the effects of reminiscence therapy for older people with dementia and their care-givers. SEARCH STRATEGY: The trials were identified from a search of the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group on 4 May 2004 using the term "reminiscence". The CDCIG Specialized Register contains records from all major health care databases (MEDLINE, EMBASE, PsycLIT, CINAHL) and many ongoing trials databases and is regularly updated. We contacted specialists in the field and also searched relevant Internet sites. We hand-searched Aging and Mental Health, the Gerontologist, Journal of Gerontology, Current Opinion in Psychiatry, Current Research in Britain: Social Sciences, British Psychological Society conference proceedings and Reminiscence database. SELECTION CRITERIA: Randomised controlled trials and quasi-randomized trials of reminiscence therapy for dementia. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. MAIN RESULTS: Five trials are included in the review, but only four trials with a total of 144 participants had extractable data. The results were statistically significant for cognition (at follow-up), mood (at follow-up) and on a measure of general behavioural function (at the end of the intervention period). The improvement on cognition was evident in comparison with both no treatment and social contact control conditions. Care-giver strain showed a significant decrease for care-givers participating in groups with their relative with dementia, and staff knowledge of group members' backgrounds improved significantly. No harmful effects were identified on the outcome measures reported. AUTHORS' CONCLUSIONS: Whilst four suitable randomized controlled trials looking at reminiscence therapy for dementia were found, several were very small studies, or were of relatively low quality, and each examined different types of reminiscence work. Although there are a number of promising indications, in view of the limited number and quality of studies, the variation in types of reminiscence work reported and the variation in results between studies, the review highlights the urgent need for more and better designed trials so that more robust conclusions may be drawn.

Aged↗
PubMed1997

Psychic reality and the interpretation of transference.

Beginning with Freud's concept of psychic reality as the product of external events and the patient's unconscious fantasies, the author suggests that projective identification, as described by Klein, gives an account of how these two elements combine to produce one's psychic reality. The transference is an aspect of psychic reality that represents a confusion between the patient and one of his or her objects--the analyst--brought about by projective identification. A clinical example illustrates how the patient's transformation of the analyst's interpretations through projective identification contributes to the transference. Analysis of the transference in the analytic relationship allows patients to experience their role in the formation of their experience of the world, "live" and as it happens. This promotes the integration of the patient's personality. The author compares this approach with other approaches to the transference.

Adult↗
PubMed2000

Manipulations of exposure-based therapy to reduce return of fear: a replication.

Using exposure-based treatment for fear of heights, we tested two different manipulations, namely administering blocks of exposure trials on an expanding spaced schedule and varying the nature of the exposure, both of which have been shown to reduce return of fear [Rowe, M. K., & Craske, M. G. (1998a). Effects of an expanding-spaced versus massed exposure schedule on fear reduction and return of fear. Behaviour Research and Therapy, 36, 701-718; Rowe, M. K., & Craske, M. G. (1998b). Effects of varied-stimulus exposure training on fear reduction and return of fear. Behaviour Research and Therapy, 36, 719-734.]. The samples for these two studies included 23 and 34 undergraduates, respectively. Fear was assessed before, immediately after and one month after treatment using self-report and physiological measures. Study hypotheses were not strongly supported, but the manipulations did lead to different responses during treatment. The data suggest that physiological habituation is not necessary for fear reduction. Expanding spaced treatment may have increased generalization, and those in the constant and varied conditions responded to different aspects of the exposure. Reasons for the failure to replicate previous research and ideas for future research are discussed.

Adult↗
PubMed1994

What is a clinical fact?

As a preliminary to the question, 'What is a clinical fact?', the author asks the wider question, 'What is a fact?', answering that facts are double in aspect: they both say how the world is, and they also depend on our species, our language, theory, etc. A claim of fact in any empirical discipline--in the natural sciences or in human studies with their different methods--is a truth claim which is not infallible or unique to the fact, and also a claim that must offer itself for verification. Using the clinical record of three sessions, she then tries to answer the question, 'What is a clinical fact?', offering the starting formulation that clinical facts, under the unusual conditions of an analytic hour which give an analyst access to a patient's inner world, manifests themselves in the form of immediate psychological realities between patient and analyst. On the way, the author discusses the analyst's anxieties about making a claim of clinical fact; further striking features emerge about clinical facts in the three sessions, and some unsolved problems, i.e. the variety of analytic theories, subjectivity and objectivity, are noted. Even while they bear the perplexities of their problems, clinical facts are of great significance to the study of the mind. They extend the domain of psychology to the area of the mind's interiority, with its human experiences of subjective meaning, conscious, and especially unconscious.

Adolescent↗
PubMed1994

[The structure and psychodynamics of delusion].

Discussing classical psycho-analytic interpretations of delusion the authors show that neither the notion of "projection" nor the theory of regression to very early stages of ego-formation provide a satisfying explanation for the difficulty of those patients to discern inner world from external reality. An approach to this crucial question rather has to consider the underlying structural differences in order to differentiate between neurotic and psychotic symptom formation. The basis for psychotic symptoms is identified in a deficient mode of symbol-formation impeding certain structural patterns or spheres of conflict from being integrated into the whole of the subject's existence. If required under certain circumstances those "excluded" parts of the personality overwhelm the subjective experience arising as something radically strange and uncanny. A psychotic phenomenon like delusion bears witness of this break down, but at the same time is an attempt to cope with this threatening experience.

Adult↗
PubMed2006

The emotional experience of K.

The author raises the question of the emotional experience of K in Bion's schema of affective links, L, H, and K, suggesting that it is the emotional experience of feeling curious. He explores the central role curiosity has in 'On arrogance' and 'Attacks on linking' and hypothesizes that in Learning from experience the more complex notion of K is introduced in its place. Thus, Bion's affective schema is taken to be a version of Freud's account of experience in terms of instinctual impulses recast in terms of emotional experience. Freud's primary developmental dichotomy, the tensions between the pleasure principle and the reality principle, can be seen as the dichotomy of tensions between the emotional experience of L/H and the emotional experience of K. This suggests that the potential tension between K and L/H is critical to what happens in the consulting room. Finally the author argues that containing as a developmental dynamic is an expression of a K-state-of-mind and thus the container is thus a container-in-K. It concludes that one important aspect of what Bion called -K is an attack on a K-state-of-mind by an intrusion of L/H which has the effect of contaminating and dominating the urge to know.

Drive↗