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This presentation of excerpts from the literature synthesizes many suggestions by various therapists concerning the treatment methods of borderline psychotic children. The importance of providing a stable, auxiliary ego for the child to introject emerges clearly and is clinically demonstrated. Comments on the author's own experiences are included.
This paper attempts to indicate some of the strengths and weakenesses of primal therapy, some of the ways it is changing and how it can be incorporated within more traditional psychodynamic frames of reference.
Drug abuse is an attempt to resolve through the use of chemicals the psychic disequilibrium caused by intrapersonal (narcissistic) losses. The chemical equilibrium creates a false sense of quiet which retards the completion of the process of mourning for these losses. Due to the unconscious need to express these losses, addicts pick up clothing styles, behavior patterns, and grooming habits from the Judeo-Christian mourning and black ghetto rituals. In order to successfully give up the drug, the addict must resolve his grief by completing the stages of mourning in the process of group therapy.
Seven current critical areas in intensive psychotherapy are discussed. (1) Social polemics, centering around the conflict between the humanistic and individualizing thrust of intensive psychotherapy, and the dehumanization of our current dark age; (2) training, where the resident is caught in a dilemma between techniques stressing fast relief and the possibilities of longer intensive therapy that stand in stark contrast to these techniques; (3) fundamental philosophical choices on the part of every practitioner that various types of therapy require; (4) delineation of intensive psychotherapy primarily defined as a modified form of psychoanalysis; (5) establishing the methodology of psychoanalysis and its derivative discipline, intensive psychotherapy; (6) use of intensive psychotherapy as the treatment of choice for pre-Oedipal disorders, severe character disorders, borderline patients, and certain others, such as some schizophrenic patients; (7) the collision between certain irreconcilable views such as those of Kohut and Kernberg that forces further choices on the therapist. This latter unresolved area could be placed in perspective by appeal to ego psychology which, as in the work of Blanck and Blanck, and others, is still a viable alternative and forms a critical area of investigation.
A large number of cases in analytically oriented psychotherapy and psychoanalysis were studied to determine the developmental consequences of parent loss by death or continuous separation in childhood. The cumulative evidence from this data is that the meaning, impact, and consequences of parent loss on emotional development are determined both by the phase-sensitive issues impacted, as well as the unique interpretation by the child of the fantasied cause and effect of the loss event. Specific issues arising in treatment as a derivative of earlier parent loss are presented as they relate to developmental diagnosis, therapeutic alliance, transference, countertransference, mourning, and termination.
In this paper an overview of the status of individual short-term dynamic psychotherapy in Europe and in North America is presented. Special emphasis is placed on the criteria for selection of suitable patients, on the technical interventions that are being utilized by various workers in this field, and on the follow-up results.
The unique and remarkable impact of the opera Elektra is explored. This opera rests not only on its dramatic portrayal of the oedipal theme, but also on an inspired expression of archaic emotions, prelogical thought, and preoedipal concerns. This accounts for its unique impact, and serves as a warning to clinicians confronted with manifest oedipal material to be sensitive to the diagnostic implications when oedipal material is permeated with more primitive expressions, producing a curious and eerie ambience and much disquiet in the therapist.
A search of the literature of children in disasters showed no case of individual therapy with such a child. The absence may be related to a specific countertransference. In the case of the preschooler presented here, the child's particular situation and developmental stage were significant aspects of his reaction and therapy.
A developmental model forms the framework for the transtheoretical practice of psychotherapy. Major preoedipal and oedipal events, interfaced with significant two-person (mother-child) and three-person (father-mother-child) influences--dyadic deficit, dyadic conflict, triadic deficit, triadic conflict--are instrumental in the formation of different relationship patterns in treatment that transcend classical versus selfobject transferences. Therapeutic as well as countertherapeutic stances and strategies are elucidated.
This paper highlights dynamics that may interfere with the therapist's identifying and addressing the erotic transference: (1) deficient training; (2) theoretical orientations that devalue the transference while espousing a "real" relationship including self-disclosure; (3) countertransference responses to the erotic transference; and (4) clinical errors of focusing on the manifest erotic transference while overlooking significant but latent pre-oedipal, oedipal, aggressive, or selfobject issues. Inattention to these dynamics may render the therapist vulnerable to sexual acting out with his patient.
Proceeding from a critical discussion of positions adopted in object-relations theory and of recent approaches to the understanding of shame (exemplified with reference to Wurmser's concept of shame), the paper demonstrates that intrapsychic structures should not be regarded as preconditions for shame but as themselves evolving in the first place from contact with experiential forms of the shame affect. The paper takes its theoretical bearings from object-relations theory and the theory of psychic structure, expanding the purview of these approaches by incorporating the reciprocity aspect and thus outlining a comprehensive "alterity theory." "Shame" is presented as an "interface affect," manifesting itself initially in the external interactional dimension and constituting the relational structure of "self-consciousness" via the internalization of the reciprocal relation between subject and object. From the angle of developmental psychology, three characteristic forms of such stages of internalization (identified by mythological figures) are described. (1) Narcissus, characterized by the absence of any reciprocal relation and accordingly termed "unreflected," (2) Tiresias, with a capacity for taking up the position of the vis-à-vis temporarily and looking critically at one's own self from that perspective, yet lacking the faculty of self-objectification without the help of the vis-à-vis. Self-objectification is therefore taking place in the interactional dimension. This stage is thus designated as "externally reflected." (3) Oedipus, who has reached the stage to be termed "self-reflected" or "self-referential." The gaze is directed initially toward the outside in search of external sources of guilt but then falls back upon the subject itself. The gaze "turns inward" (to use an experientially suggestive image) and in the mythology this is represented by Oedipus' self-blinding. The subject is capable of "critical," dissociating functions, in the sense of self-objectification, thus attaining to a capacity for self-recognition, self-criticism and self-judgement. These three stages are seen to be progressive, not mutually exclusive. Self-referentiality in the broadest sense is regarded as being hierarchically stratified.
Traditionally, visual cues (that is, seeing the difference between one's own genitals and those of the opposite sex) and the fantasies that they prompt were thought to be the central determinants in the organization of gender identity. More recently attention has been focused on mother-infant interaction patterns, on the construction of the body itself, on its kinesthetic sensations, and on the fantasies that these evoke. These matters are now thought to be equal in importance to the traditional considerations. The resulting concept of a core gender identity has suggested the possibility of various forms of preoedipal genital anxiety. This paper discusses how two experiences common to childhood as well as adulthood--the tumescence of erectile tissue and the involuntary vaginal secretions of sexual arousal--may contribute to the organization of feminine gender identity. Case material, including a close examination of an analytic hour, is presented to show how this process may manifest itself in adult neurotic conflict.
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The psychodynamic relationship between homosexual sons, their mothers, and other women in their lives is reexamined. The limitations of earlier writings on the topic are discussed, and a reconceptualized psychoanalytic model is presented for understanding some aspects of the relationships between these sons and their mothers during childhood. In particular, the oedipal stage of development is reformulated to coincide with the sexual orientation of the developing boy. This stage is then examined in the context of the discordant psychosocial environment in which it is often played out. The usefulness of this construct for understanding aspects of the psychosocial development of gay men throughout their lives, particularly their relationships with women, is explored through the examination of clinical data from a number of sources. Finally, the implications of this model for psychotherapeutic endeavors with homosexual men are considered.
The history of ideas about perversion is considered, along with an examination of whether the concept is clinically useful. Three cases of varying degrees of severity are presented, illustrating the clinical value of the concept in the analytic situation. All three cases are women, and the particular usefulness of the concept of perversion for women is noted. The place of aggression and the pleasure resulting from its expression are highlighted.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.