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PubMed1992

Dreams of anorexic and bulimic women. A research study.

The research paradigms used in this study fit with the content analysis paradigms of Hall and Van de Castle (1966) and Dippel et al. (1987), but differ in the use of descriptive scenarios specific to eating disorders. Anorexic and bulimic patients are often able to share their dreams with their therapists, and this process is sometimes the start of building an analytical relationship. This study compared the dreams of twelve eating-disordered women with eleven 'normal' women. A total of 275 dreams was collected over a four-week period and rated on a 91-item scale (Brink 1991) by eight raters. Significant differences were found between the two groups, with eating-disordered women having more dream scenarios depicting themes of: impending doom at the end of the dream, attitudes of 'whatever I do I won't succeed', and images of the dreamer being attacked, and being watched. Significant differences were also found in dream content portraying the psychological traits of: ineffectiveness, self-hate, negative emotions, an inability to self-nourish, obsession with weight, and anger. The discussion centres around the role of 'inordinate oral rage', the nature of ego defences, how these defences manifest themselves in dream images and in daily living, and how they severely impair positive transformative processes. The implications for clinical practice are that dreams are an amenable way of working with eating-disordered women, and that the therapist is more likely to promote positive transformation through focusing on their dreams than trying to change their behaviour.

Adult↗
PubMed1993

On not knowing beforehand.

This paper starts from recommendations of Freud and Jung on the desirable attitudes of analysts to their patients, and especially open-mindedness which I have named 'not knowing beforehand'. I use the metaphor of a filing cabinet to illustrate how to empty one's mind and, so to speak, lock up one's knowledge, memory, and desires in that filing cabinet. That gives space for the patient to structure his interview. I illustrate how knowing beforehand can disrupt an interview and how 'filing-cabinet material' will get used when tailored to the interview structure. The metaphor is used for the sake of simplicity. It does not include the complexity of the analytical dialectic.

Adult↗
PubMed1993

'In a dark time, the eye begins to see'.

In this paper I discuss a patient whose shadow became his rival, or as Jung put it, 'The shadow is lived'. I describe the beginning of a process of the assimilation of shadow contents, whereby the rupture between ego and shadow can no longer be maintained. I also discuss how it is primarily through the mutual experience and analysis of archetypal images that the unconscious contents become more integrated. In my clinical illustrations I also explore the relationship between my patient's fight with his shadow and his experiences of childhood shame. I consider how fear expressed through a panic attack may open a royal door to the unconscious, and the way in which its mediation through empathy and analysis can lead to unconscious infantile contents becoming more accessible. In addition, I show how, once some of the fear had subsided, it became possible for play to enter into the analysis.

Adult↗
PubMed1995

Trauma and symbol. Instinct and reality perception in therapeutic work with victims of incest.

With the help of the conceptualizations of Amati and Bleger, and of Jung, the loss of instinctual experience and reality sense in the victims of incestuous abuse is described as an extreme regression to a primary undifferentiated stage of development: that of 'ambiguity' and 'identity'. At this stage the identity of the victim is taken over by that of the aggressor and becomes petrified in a form of mimicry. Differentiation processes are partially blocked. Through the therapeutic work with a woman who was sexually abused as a child, and whose daughter was also being incestuously traumatized, it is demonstrated how, through the use of fantasy, the instinctive reaction of thanatosis can be given up, together with the attempt to find meaning through self-sacrifice, which continually places the victim in renewed danger. By means of activating the transcendent function, the positive pole of the archetype can be set up as a counterforce in the internal world which was once feared like an abuser, and thus as a balance to the images of actual historical violation. The positive pole of the archetype then allows the inner world to loosen itself from the tangled aggressive and auto-aggressive layers of identity. This leads to a revival of protective instinctual reactions and to an improvement in reality functioning. It is emphasized that it is not the recall of actual abuse that promotes therapeutic progress but the evolving symbolizations. The analysis of the symbolic experience leads to the following conclusion: the hypothesis that, on the grounds of positive feelings, the children 'have also wanted' the incestuous activity, cannot be upheld.

Adolescent↗
PubMed1995

Archetypal foundations of addiction and recovery.

Addiction recovery takes place at an archetypal level. This is quite visible in the formulation of the twelve steps of AA which refer to forces in illness and recovery, e.g., a take-over by the addictive substances or process that renders one's life unmanageable and often devastated and the strong need to be in relation to a higher power for restoration of one's life. Many people respond to recovery programmes without getting into their individual psychology per se, but a number can benefit from analytic therapy which recognizes the archetypal level of psychic life. For those individuals analysis in conjunction with AA twelve step programmes can facilitate recovery, even as recovery facilitates analysis.

Adult↗
PubMed1995

Alcohol: a drug of dreams.

In this paper I have explored the way in which regressive phantasies of fusion may be brought into being by the heavy consumption of alcohol and the cerebral changes which result, which impair the individual's capacity to digest new information and experience; change therefore has to be resisted and loss and depressive anxiety cannot be experienced and worked through, hindering individuation. Two paradigms, one based on organic brain function and the other on psychodynamic understanding are brought together and shown not to be contradictory.

Alcoholism↗
PubMed1996

Female perversion: scenes and strategies in analysis and culture.

The author presents some ideas derived from observation in analysis about differing positions of Freud and Jung on perversion and about probable differences in perverse structural elements of women in contrast to men. In general perversion is understood as a defence of the self; in particular with women it is seen as a defensive way of achieving a false wholeness, a pseudo-androgyny. A case study describes the unfolding of a perverted transference. The importance of reaching the analyst and being understood by the analyst through projective identification is stressed. Quite often a sexually abusing mother seems to play an important role in generating female perversion; the implications in analysis are discussed as well as some ideas about culture and gender.

Adult↗
PubMed1997

A body with chronic fatigue syndrome as a battleground for the fight to separate from the mother.

I describe the therapy of a 20-year-old women who believed that her difficulties in concentrating and remembering were caused by her "ME' (Myalgic encephalomyelitis, Chronic fatigue syndrome, or CFS). She had been fathered by a man who never left his own wife. Work with her dreams revealed a within-body drama in which she was locked in an unspeakable fight to the death with her mother. Her symptoms improved after parallels between a dream and an accident showed her own self-destructive hand in her story. Another dream, reflecting her first 'incestuous' affair, showed her search for her original father-self as someone separate from mother, and a later affair provided a between-body drama, helping her to own the arrogant and abject traits she had before seen only as her mother's. I show how we worked in the area of Winnicott's first 'primitive agony' as experienced by a somatizing patient, stuck in a too-close destructive relationship with her mother-body. I discuss how analytical work can be done with the primitive affects and conflicts against which the ME symptoms may be defending.

Adult↗
PubMed1997

Fairy-tales in psychotherapy.

Fairy-tales, like mythologies, can be found all over the world containing the same motif and chains of motifs. In this paper I have presented some theories on the occurrence of this archetypal phenomenon ranging from the old migration theory to Sheldrake's theory of morphogenetic fields. I have then tried to show how fairy-tale-motifs can appear in various ways in analytical therapy, often in hidden forms. We find them in patients' dreams as well as in their fantasies and associations. If the therapist is open to them they will also appear in his or her amplifications. He or she might then take note of the fairy-tale or point it out to the patient; in the latter case it might provide better access to the patient's problems and complexes as fairy-tales have an emotional completeness because of their pictorial character. Finally I have described the favourite fairy-tale of one of my patients and related it to his symptoms, his central complex and his personal ways of experiencing and behaving. This survey of how fairy-tales can be used in therapy with children and with adults far from exhaustive.

Adult↗
PubMed1997

Temenos lost: reflections on moving.

This article examines some clinical dilemmas engendered by moving. At such times, certain patients (or the analysts themselves) may lose their sense of containment that the therapeutic space has provided. When such a disruption threatens the course of treatment, this changed condition may be archetypally termed 'temenos lost'. Consideration of this condition has led the author to reconceptualize healing as composed of two distinct components: the healing relationship and the healing space. Together, these components define the healing archetype. Using two historical examples, the King's Evil in Tudor England and healing pilgrimages in Israel, he shows how each component may indeed operate independently. More often, however, they function together. Using an extended published case (Volkan 1984), the author examines various aspects of how patients and analysts cope with 'temenos lost'. He emphasizes the importance of the emotional atmosphere in the physical setting, anticipatory anxiety of losing the temenos, and the basic anxiety that the move will damage the analysis. The importance of the rite of re-entry for the patient is emphasized as a symbolic way of resolving 'temenos loss' that permits a healing move into a 'temenos regained'.

Health Facility Environment↗
PubMed1997

Klein's archaic Oedipus complex and its possible relationship to the myth of the labyrinth: notes on the origin of courage.

The ancient Greek myth linking the images of the labyrinth and the Minotaur provides an allegory for Melanie Klein's conception of the archaic Oedipus complex as well as a vivid illustration of Winnicott's notions of object usage and the 'subjective object'. The labyrinth is suggestive of mother's body as the first area for an infant's exploration and putative sadistic conquest. The Minotaur, in turn, suggests the infant's unconscious phantasies about the content of mother's body, namely such projective identifications onto that body as the paternal penis and the 'internal babies'. Further, the heroic dynamic personified by Theseus in the myth of the labyrinth metaphorically signifies what is here proposed as a developmental line that involves the courage to do a number of things, including to become, to create, to seek, to explore, to do, to challenge, to undertake risks, to accept, to rescue, to initiate, to think, to know and to realize. The Minotaur can thus be thought to serve as a universal subjective signifier for an 'Object of Challenge', which, if not successfully dealt with by the ego-development of the infant, transforms that default into the 'Object of Nemesis'. Ultimately, this myth of mastery speaks to the psychoanalytic process itself as well as casting light on the transformative aspects of sexual intercourse as a personal healing ritual.

Ego↗
PubMed1997

Internal objects--a theoretical analysis of Jungian and Kleinian models.

In this paper I discuss the ways in which experimental and objective research from cognitive science and developmental psychology can help analysts evaluate the theoretical models of mental objects which we use; I indicate the ways in which such evidence tends to support models of internal objects as mental representations or developmental capacities rather than as wish-fulfilling expressions of instinctual drives. This kind of empirical evidence is not just of academic interest but also has direct clinical relevance, particularly with borderline patients; such patients' sense of identity is totally dependent on the analyst's understanding of their internal world and for this to be misunderstood by the analyst can be catastrophic. An accurate theoretical model of mental objects can therefore help analysts to contain their patients more effectively.

Adult↗