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PubMed2005

On aggressiveness and violence in adolescence.

When considering aggressiveness and violence during adolescence, we must take into account multiple senses, which range from the healthy assertion of one's own space before others to the repetition of traumatic violent experiences such as the violation of bodily and spatial-temporal boundaries. The author presents a survey of the views of different authors within psychoanalytical literature which allows us to question these terms, and turn then to the exploration of clinical practice. In studying the latter, acting out is brought to the fore, noting that not every adolescent act connotes a risk. The acts tackled in this case are those that, owing to their characteristics, may often endanger the very life of the adolescent. The author presents clinical material that focuses on adolescent acting out, highlighting the question of how to create, through the transference-countertransference axis, a space within the analytic session where the patient's capacity to think may be incorporated, thus allowing the anticipation of action.

Adolescent↗
PubMed2006

Critical reflections on intersubjectivity in psychoanalysis.

The authors review the philosophical trend known as postmodernism and the way it has influenced a part of psychoanalytic thought, concluding with some comments on the qualities and shortcomings of the new developments. The authors consider the origins and the cultural and aesthetic-philosophical meaning of postmodernism, identifying some key concepts such as deconstructionism, the disappearance of the 'individual subject' and individual identity, and the rejection of 'in-depth' models of psychoanalysis. Then they examine various, wide-ranging developments in psychoanalytic thought and treatment. They review the intersubjective field in psychoanalysis, especially in the USA, and then explore whether the underlying lack of truth to be discovered, stressed by these 'new view' statements, or the fact that the 'truth' only exists in linguistic-narrative constructions is consistent with basic analytic concepts such as the unconscious, phantasy, transference and countertransference, which recall the tri-dimensional nature of inner psychic reality. The psychoanalytic process is a condition activated through a bond that is able to hold and contain the relationship of the analytic couple and the patient's unconscious world and not through hermeneutic or narrative constructions.

Countertransference↗
PubMed2006

Who speaks? Who looks? Who feels? Point of view in autobiographical narratives.

In this paper, the author aims to substantiate Freud's claim that neurotic illness creates gaps in autobiographical narratives in terms of the narrator's stating and inducing perspectives. He sketches out the role of narrative perspective and the joint taking of a shared perspective by analyst and patient in psychoanalytic therapy. He introduces four ways of representing perspectives in narratives. Three degrees of narrative distortion are exemplified by three excerpts from life narratives and explored in terms of narrative perspective representation. The most comprehensive perspective representation is achieved in the first example by explicitly stating the present perspective of the narrator as well as the past perspective of the story's protagonist by use of mental verbs. In the second narrative, exclusive use of linguistic forms for inducing the protagonist's perspective both overwhelms the narrator and gives the listener an incomplete picture of what happened. Inconsistent motives, denial of responsibility and omission of detail render the third narrative even more difficult to follow. The author discusses the clinical significance of this exploratory analysis of perspectives in narratives in terms of claiming responsibility for one's past action and of level of defence mechanisms, and by highlighting the emotional impact on listeners, which the author suggests is the stronger the more perspectives are left out. He discusses analogies to countertransference. The analysis of narrative perspectives offers an approach for systematic research in psychoanalytic practice.

Adult↗
PubMed2006

Cultural function and psychological transformation in psychoanalysis and psychoanalytic psychotherapy.

Cultural experience of silence and individual vicissitudes between talking and being silent influence the way individuals form an alliance and pursue the analytic process. This is of relevance both for the patient and for the psychoanalyst/therapist. The author describes a patient, whose silent phase occurred in the fifth and sixth year of intensive psychoanalytic psychotherapy. She suggests that a) the silence functioned as a protection of a space for the core self and promoted inner transformation and psychological development; b) the silence involved a transference-countertransference matrix with projective identifications of the patient's internalized mother- and father-related objects that caused a tenuous balance between maintaining and erasing the relationship between the patient and the author; c) the silence phase was highly influenced by the author's own cultural background and what she brought into the relationship of tolerance of being silent in the presence of another, and understanding of the many complex functions of silence. During the silent phase the patient moved from simply describing and naming her affects and inner experiences or expressing them as somatic processes, to being able to internally access and verbally convey her own affects and experiences in the therapeutic alliance. This process involved both affect desomatization, affect differentiation, and affect verbalization.

Adult↗
PubMed2006

The impact of words on children with ADHD and DAMP. Consequences for psychoanalytic technique.

Children with attention-deficit/hyperactivity disorder (ADHD) and disorder of attention, motility control, and perception (DAMP) are often sensitive to the analyst's interventions. This is not always due to the literal import of the intervention. The children sometimes react as if the words were dangerous concrete objects, which they must physically fend off. The author traces this phenomenon to the child's unstable internal situation. A bad, un-containing internal object is easily awakened and threatens to expel the analyst's words independently of their content. This results in violent clinical situations. Infant research and psychoanalytic work with infants and mothers evince how a complex semiotic process develops between mother and baby. The prerequisite for this process to get started and maintained is a secure external object, which gradually is internalized. Findings from developmental research and clinical infant work are used to illuminate analytic work with children with ADHD and DAMP. Vignettes demonstrate how important it is for the analyst to phrase interpretations after having gauged the state of the analysand's internal object as well as his/her own countertransference. If this is overlooked, the psychoanalytic dialogue easily capsizes. The author provides some technical recommendations on the psychoanalysis of these children. As part of the theoretical discussion he raises the general question of how the representations, which the baby forms in interaction with the mother, and the analysand forms in interaction with the analyst, should be classified. Rather than dividing them into bipartite thing- or word-presentations (Freud), the author suggests C. S. Peirce's tripartite semiotic classification in that the baby forms representations of icons, indices, and symbols.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Who is 'who' in dissociation?: A plea for psychodynamics in a time of trauma.

Contemporary theories of dissociation and trauma for the most part have evolved outside of psychoanalysis. Psychoanalytic writings have also been regarded as being in opposition to trauma-based notions of human psychopathology. The specific psychoanalytic contribution--the emphasis on unconscious conflict and meaning--is for the most part excluded from the discourse on dissociation, often resulting in a 'mechanic' conceptualisation of trauma. In this paper, based on clinical material, the author argues in favour of including conflict, unconscious intention and personal meaning in understanding the kind of dissociation we see in cases of multiple personality pathology. Textual analysis of letters written to the analyst illustrates how events of abuse are defensively elaborated. The author demonstrates that patterns of affect regulation and dominant object-relational strategies can be captured through analysis of the discourse structure. She focuses on how an organised character pattern, revealed mainly through narrative style and the analyst's countertransference, serves protective purposes as well as wish-fulfillment. She argues that dissociation in the form of multiple personalities may imply an active, strategic agent.

Adult↗
PubMed2004

Incorporation of an invasive object.

The author discusses the experience of 'being invaded' that is sometimes communicated by certain severely disturbed patients. The complaint can sometimes be couched in terms of bodily suffering and such patients may state that they have the experience of a 'foreign body' inside. It is suggested that these patients have suffered severe early failure of containment of their projections, while at the same time they have incorporated primitive characteristics of the object that have been powerfully projected into them. An object that invades in this way, it is suggested, experiences a compulsive need to expel unbearable states of mind using others as a repository. The infant incorporates these violent projections as part of his own mental representational system, and normal identification processes are disrupted. There follows impairment of the development of the sense of self. Clinical examples of how the invasive experience manifests itself in the analytic setting and in the transference and countertransference are presented. It is argued that this highly complex form of early subject-object interaction (prior to the differentiation of psyche-soma) is more likely to be found in severely narcissistically disturbed individuals. Some reflections on the origins of invasive phenomena are given.

Adult↗
PubMed2002

The triadic intersubjective matrix in supervision: the use of disclosure to work through painful affects.

The use of the psychoanalyst's subjective reactions as a tool to better understand his/her patient has been a central feature of clinical thinking in recent decades. While there has been much discussion and debate about the analyst's use of countertransference in individual psychoanalysis, including possible disclosure of his/her feelings to the patient, the literature on supervision has been slower to consider such matters. The attention to parallel processes in supervision has been helpful in appreciating the impact of affects arising in either the analyst/patient or the supervisor/analyst dyads upon the analytic treatment and its supervision. This contribution addresses the ways in which overlapping aspects of the personalities of the supervisor, analyst and patient may intersect and create resistances in the treatment. That three-way intersection, described here as the triadic intersubjective matrix, is considered inevitable in all supervised treatments. A clinical example from the termination phase of a supervised analysis of an adolescent is offered to illustrate these points. Finally, the question of self-disclosure as an aspect of the supervisory alliance is also discussed.

Adolescent↗
PubMed2004

Linguistic styles and complementarities in analyzing character.

This paper discusses and illustrates some technical implications of D. Liberman's contributions to character analysis. Psychoanalysis is an extended conversation, and character structure is expressed linguistically as part of an interactive linguistic field. Liberman's notions of linguistic styles and communicative interaction define a unique analytic surface from which to examine the syntactic, semantic and pragmatic aspects of character. The presence of a rigid and defensive linguistic style reflects resistance and communicative impasse within the transference and countertransference matrix. A fully interactive communicative experience integrates all aspects of the conversation and allows both participants to take part in a shared semantic field, the precondition to the generation of new meanings. Liberman suggests responding to miscommunication by means of a methodical linguistic attitude. Various such complementary responses are explored through several vignettes, with a particular focus on the interplay of the epic and narrative modes.

Character↗
PubMed2001

The therapist's anxiety and resistance to group therapy.

When therapists contemplate starting groups, consider placing an individual patient within an existing group, or respond to the group reconfigurations when members are added or replaced, it raises their anxieties and resistances. Under these circumstances, the therapist must contend with many intersubjective factors: dread, fear, and idealization of groups; contagion and amplification of psychological phenomena; absorption in the group mentality; magnification of the therapist's centrality and importance; exposure and disturbance of existing relationships, and utilization of one's own emerging and evolving thoughts, feelings, and fantasies, along with the group's. Therapists learn about themselves and their groups by reviewing their countertransference, being alert to possible enactments, and listening to their patients, whose anxieties and resistances to group often reflect their own.

Anxiety↗
PubMed2001

The practice of Modern Group Psychotherapy: working with past trauma in the present.

Modern Group Psychotherapy offers specific techniques for aiding the pre-oedipal patient to speak, connect, and achieve emotional growth. This article illustrates the use of such therapeutic group tools as joining, mirroring, bridging, contact functioning, the object-oriented question, the insulation barrier, and transient identification, through case vignettes. It demonstrates how such techniques protect fragile egos and assist them on their journey to maturity. Emphasis is placed on the creative components of countertransference as a valuable supplement in patient treatment. The power of the group as an agent for change is portrayed.

Countertransference↗
PubMed2002

Women, money, and psychodynamic group psychotherapy.

Developmental concerns and sociocultural expectations may keep female patients and therapists from addressing financial issues openly in group psychotherapy. Interpersonal theory provides a different view of nurturing that may help women leaders deal better with financial discussions in group. This paper includes a review of the literature on group psychotherapy and fees; feminist literature relevant to leadership; money management in group therapy; countertransference; and case examples.

Adult↗
PubMed2002

A dualistic model for group treatment of alcohol problems: abstinence-based treatment for alcoholics, moderation training for problem drinkers.

This article provides a clinical framework for a dualistic group treatment model: abstinence-based treatment for alcohol dependent individuals and moderation training for problem drinkers. The major premises of these models are set forth, compared, and contrasted. An integrated approach for synthesizing these models is then detailed along with suggestions for clinical implementation and management of countertransference.

Alcohol Drinking↗
PubMed2002

Passion in group: thinking about loving, hating, and knowing.

In his early work, Bion (1961) established the goal of learning about and getting beyond the basic assumptions to become a work group. Later, in his structural theory of affect, passion became a key concept. Passion describes the necessary and sufficient condition for a psychotherapy group to be a work group. Passion is an intersubjective process of bearing and utilizing one's most basic affects to reach self-conscious emotional awareness. Bion postulated three primary affects: loving, hating, and knowing (LHK). A clinical example illustrates how the therapist may represent, mentally organize, and mobilize the group's potential for passion by attending to the evolution of his or her own affects. Passion transcends transference-countertransference in that an optimal level of personal meaning from LHK is achieved and utilized in emotional participation.

Adult↗
PubMed2002

Changing the guard: new leadership for an established group.

When the leader of an established therapy group decides to leave, the group may wish to continue with a new leader. This decision deserves careful exploration. The transfer of leadership to a new leader is a powerful event in a group. New leaders often experience strong countertransference reactions. Specific recommendations for new leaders include meeting individually with each continuing member, helping the group stabilize and process the meaning of the change, and developing ownership of the leader role. When managed successfully, a leadership transition can strengthen the group cohesion and offer important therapeutic opportunity.

Adult↗
PubMed2004

Group psychotherapy and Parkinson's disease: when members and therapist share the diagnosis.

This report describes a psychosocial therapy group for Parkinson's patients, focusing on the therapeutic processes arising when group members and therapist share the diagnosis of Parkinson's disease. The paper explores the question, "What is the therapeutic effect on the group when the therapist suffers and displays the same illness as members of the group"? Countertransference issues are described.

Countertransference↗
PubMed2005

Saying goodbye: exploring attachments as a therapist leaves a group of chronically ill persons.

This clinical report highlights some of the processes arising in a therapy group of persons with persistent and chronic psychiatric illnesses as they cope with the stress of their long-standing therapist's impending retirement. Members were initially disbelieving that the therapist would leave and were also concerned about their future care, particularly in terms of medications. Gradually they were more able to experience their feelings of loss and their genuine caring for the therapist and the group, using higher level defenses and increasing their ability to tolerate strong affects. They became increasingly able to demonstrate empathy, notably in their ability to consider the therapist's emotions. The clinical material also illustrates the therapist's personal involvement, countertransferences and expressions of concern.

Anxiety, Separation↗
PubMed1979

Analyzability and capacity for change in middle life.

The stimulus for this paper was the analyst's surprise at the capacity for change in a number of middle-aged patients, some of whom would not have been considered good analytic prospects even if young, especially since they had all had extensive, unsuccessful previous psychiatric and psychoanalytic treatment, in two instances with the author herself. Factors of change in what now constitutes "old age," and of analyzability, rigidity, motivation and readiness for change, countertransference factors, and the significance of a late-appearing corrective emotional experience were all considered, along with a brief re-evaluation of what the analytic process really is, and how change comes about.

Adult↗