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PubMed2002

[Gaining insight and structural capability as goals of psychodynamic psychotherapy].

Psychodynamic psychotherapy in the sense of German psychotherapy guidelines is currently the most frequently used treatment in outpatient psychotherapy. This report summarizes the psychodynamic fundaments of this method and distinguishes the conflict exposure and the structure formation as significant therapeutic aims. The subject of personality structure is dealt with according to the OPD (operationalized psychodynamic diagnosis) system which allows an operationalization and empirical investigation of structural aspects. The treatment techniques used to achieve structure-related therapy aims (e.g. the ability to differentiate affects, impulse control, empathy, emotional expression, attachment, separation, etc.) are described in detail.

Ambulatory Care↗
PubMed2006

The child's active role in mother-child, father-child psychotherapy: a psychodynamic approach to the treatment of relational disturbances.

The short-term mother-child and father-child psychoanalytic psychotherapy assumes that children develop specific types of relationships with each parent, as well as with the parenting couple. The model integrates an intra-psychic, object-relational view with an interpersonal perspective to the treatment of relational disturbances in childhood. The same therapist meets with the mother-child, father-child dyads on a weekly basis, along with regular meetings with the parental dyad. The model focuses on the developmentally prelatency child's need for the active participation of both parents in the here-and-now shared experiences of the therapeutic process. The participants express, in interactions and in enactments, various contents and meanings of their specific patterns of relations. The therapist addresses the behaviours as well as the meanings of relations, thus promoting reflective understanding and experiential changes in self, other, and self-other relations. The child's active and different participation with each parent is the main change-promoting factor. The child uses mainly the medium of play to express his/her needs and to mobilize the therapist's help. The therapist's access to the different dyads is utilized to better understand the explicit and implicit relational themes. The therapist supports the co-construction of new and different behaviour patterns and the co-creation of additional meanings to representations. The setup fosters the child's active participation in each dyad's growth-promoting changes.

Adult↗
PubMed2006

Resolving threats to the therapeutic alliance in cognitive analytic therapy of borderline personality disorder: a task analysis.

BACKGROUND: Alliance ruptures and premature drop out from psychotherapy are very common with patients who have a diagnosis of borderline personality disorder, limiting the clinical effectiveness of treatment. AIM: To test and refine a model of how therapists successfully resolve threats to the therapeutic alliance involving enactment of problematic relationship patterns in the cognitive analytic therapy of borderline personality disorder. METHOD: Task analysis (Greenberg, 1984a) of 107 enactments from 66 sessions in four good outcome cases, compared with 35 enactments from 16 sessions in two poor outcome cases. This systematically compares a rational model of process with empirically coded transcripts of therapy sessions where independent raters have identified an alliance threat event. RESULTS: The process stages of the rational model were observed, and 20 refinements were made, including a new process stage, heuristic principles and 'when-then' steps. Therapists were found to cycle between stages. Therapists in good outcome cases recognized the majority of these enactments and focused attention to them in contrast to poor outcome cases where therapists usually failed to notice or draw attention to the alliance threat and did not adhere to the model. CONCLUSION: Competent resolution of alliance-threatening events is crucially dependent on therapists' ability to recognize them, and secondarily on their adherence to the principles in the refined model. The model is consistent with prior research and can be used in supervision and quality improvement strategies.

Adolescent↗
PubMed2000

A concerned critique of psychoanalytic education.

The author explores some central problems in contemporary psychoanalytic education. He compares strengths and limitations of the two dominant models of psychoanalytic training, the traditional Eitingon model and the French model, and reviews current efforts to modify these models in order to overcome their limitations. In examining problems common to both educational systems, the author highlights the following issues: a tendency to infantilise psychoanalytic candidates, a persisting trend towards isolation from the scientific community, a lack of consistent concern for the total educational experience of candidates, authoritarian management and a denial of the effects of external, social reality on psychoanalytic education. Proposed solutions to these problems include: a stress on 'step-by-step' evaluation of candidates' progression, a greater emphasis on the cognitive aspects of seminars and supervision, particularly, a systematic exploration of the psychoanalytic method and its applications, a re-examination of the usefulness of the function of the training analyst status, an integration of teaching and practical experience in systematic research, and the incorporation of contemporary educational methods as part of the strengthening of the academic ambience of psychoanalytic institutes. The author concludes with a list of fifteen questions that may provide a quick indication of how for a psychoanalytic institute has progressed with the work of educational innovation.

Curriculum↗
PubMed2000

Teaching Freud to undergraduates: a case report.

The authors describe their experience teaching 'The Writings of Sigmund Freud' to undergraduates at Columbia College over a three-year period. The course focused on Freud's developing theory of the mind, his application of psychoanalytic theory to the study of culture, and the autobiographical and historical context in which the texts were written. The students entered the course intrigued by the controversy surrounding Freud. They immersed themselves in the intellectual task of understanding Freud's work while at the same time discovering its power to speak directly to their personal concerns. The students found in Freud a companion in the search for personal meaning in the 'great books' of the western canon. At a deeper level, they found in Freud an ally in the drama of coming-of-age, experienced in terms of separation and loss, concerns about normality and sexuality, the quest for autonomy and the search for identity. While interested in Freud's ideas about infantile sexuality, for the most part, they rejected the concept of the Oedipus complex. The authors present excerpts from the students' written work and classroom discussion. Their responses are explored in relation to the developmental tasks of adolescence.

Attitude↗
PubMed2000

A father's abdication: Lear's retreat from 'aesthetic conflict'.

The author explores the potential contribution of Shakespeare's 'King Lear' to psychoanalytic thinking, linking a reading of the play focused on the emotional tensions inherent in the parental function of endowing ('heriting') the next generation with the developmental struggle characterised by Donald Meltzer as the 'aesthetic conflict'. Following Meltzer's definition of passion as the 'consortium' of Bion's emotional links, love, hate and the urge to know (L, H and K), the author develops an understanding of 'aesthetic conflict' linked with the tension inherent in that constellation. It is suggested that L and H split off from each other and from K become attempts to possess and control, while K split off from L and H becomes an attack on dreaded emotional links, oscillating between attempting to ignore them and attempting to overcome them. The author suggests an affinity between Bion's K link and what in 'King Lear' is pictured as a capacity to 'see feelingly' in the context of the struggle to give the object its freedom. This way of characterising 'aesthetic conflict' is linked with a fresh look at weaning as a lifelong developmental process, which in turn leads to a reconsideration of the psychoanalytic models of the dynamics of mourning.

Conflict, Psychological↗
PubMed2001

Hermeneutics.

Explore the source record for details and available documents.

Humans↗
PubMed2001

The countertransference: erotic, erotised and perverse.

The author begins by drawing attention to the dearth of psychoanalytic theory on the sexual countertransference, which he attributes largely to embarrassment associated with the personal superego and to fear of censure by the psychoanalytic community. After a review of the relevant literature, he points out that the term 'countertransference' arose in the context of misbehaviour by the early analysts and that the countertransference was originally seen as something to be controlled and suppressed, partly for the sake of the reputation of psychoanalysis. Theoretical and normative reasons are adduced for the disappearance of sexuality from psychoanalytic scenarios, and the wish for sexual contact with patients is discussed. While it may be deemed perfectly normal for an analyst to have erotic feelings towards patients of either sex, psychopathology is, in the author's view, involved only if he acts out. Clinical illustrations are given of manifestations of the sexual countertransference in its erotic, erotised and perverse forms, which the author considers it important to distinguish. He concludes that the relative absence of theory on the subject means that not enough clinical use is made of the sexual countertransference, which he sees as of great potential value to therapist and patient alike.

Adult↗
PubMed2001

The dream's navel between chaos and thought.

The authors begin by drawing attention to the problem of the transition from the biological to the psychic, noting that Freud himself, with his background in the neurosciences, grappled with it throughout his career. Certain recent paradigms more commonly applied to the natural sciences, such as in particular chaos and complexity theory, can in their view prove fruitful in psychoanalysis too, and it is shown how these notions are inherent in some of Freud's conceptions. The unconscious is stated to operate like a neural network, performing the kind of parallel processing used in the computing of highly complex situations, whereas the conscious mind is sequential. Dreams, in the authors' opinion, are organisers of the mind, imparting order to the turbulence of the underlying wishes and unconscious fantasies and structuring them through the dream work. Through dreams, the structured linearity of conscious thought can emerge out of the non-linear chaos of the drives. The dream's navel can be seen as the chaotic link, or interface, between the unconscious wish, which constitutes an attractor, and the conscious thought. The attractor may be visualised as having an hourglass or clepsydra shape, the narrow section being the dream's navel, and, being the same at any scale of observation, has the property of fractality.

Dreams↗
PubMed2001

Distinguishing the drama from the histrionics in a case of hysteria with multiple tics.

The author describes a clinical experience with a hysterical patient with multiple tics, an upper-middle class, married woman, who when she started analysis at the age of 30 was in a state of profound tension and anxiety. The first eight years of this analysis are presented in order to describe how the analyst came to identify the dynamics of unconscious phantasies in a situation where analyst and patient found themselves involved in several roles of a drama dominated by theatrics. The insights and therapeutic benefits suggested that this patient unconsciously experienced her oral needs as intensely destructive and cruel, an experience she felt to have been exacerbated by her mother's lack of response to her emotional needs. This primitive cruel orality was accompanied by a split-off experience of a secret, mystical union with the primitive idealised mother. The author considers that this split experience of cruel and idealised orality suffused the patient's genital sexuality, hindering the evolution and realisation of her adult sexuality, giving her a distorted view of the primal scene as an impenetrable fused amalgam acting as an omnipotent, self-sufficient, excluding phallus. Gradually analysis enabled the patient to transform her bodily theatrics into thoughts and to broach the difficult task of relating to others instead of being either fused with them or totally excluded by them.

Adult↗
PubMed2001

Collaborating with the unconscious other. The analysand's capacity for creative thinking.

The analysand's capacity for making use of psychoanalytic treatment has been a subject of importance since the beginning of psychoanalysis. The author addresses an aspect of the difficulty encountered by analysands in achieving a psychic state that allows the creative use of free association, dreams, parapraxes and other spontaneous phenomena occurring during the course of treatment. He suggests that a very specific state of mind is essential to both the psychoanalytic process and the creative process. Using theoretical concepts derived from Freud, Klein and Bion, he develops the idea of an internal object relationship, 'the collaboration with the unconscious other', which forms the basis for both creative thinking and the psychoanalytic function of the personality. Creative thinking is distinguished from artistic endeavour and discussed as a universal potential, on which growth in psychoanalysis depends. The term 'unconscious other' is meant to signify the subjective experience of a foreign presence within oneself from which both spontaneous creative inspiration and involuntary psychic phenomena are felt to emanate. The author presents clinical material to suggest that paranoid-schizoid and depressive anxieties form obstacles to collaborating with the unconscious other, and must be worked through in order to achieve an analytic process.

Creativity↗
PubMed2001

Irreducible subjectivity and interactionism: a critique.

The authors offer a critique of the privileging of subjectivity in psychoanalysis characteristic of what Hanly has called interactionism, with specific reference to the work of Renik. First, Renik's argument for the irreducible subjectivity of the analyst is explored and critiqued from a philosophical perspective. The need for and plausibility of a subtler notion of objectivity that takes into account the limitations of human subjectivity and that analysts can meaningfully pursue is defended. Second, Renik's 're-visioning' of psychoanalysis, which follows from his notion of irreducible subjectivity, is explored and critiqued. Renik's view of enactments is contrasted with a 'totalistic' perspective of countertransference that allows for important, finer conceptual distinctions. Renik's conceptualisation of countertransference enactments is characterised as a 'special case' of countertransference as a vice. Next, Renik's view of transference is critiqued for privileging the adaptive dimensions of transference, and for potentially sidelining archaic dimensions. Finally, Renik's conclusions and 're-visioning' of psychoanalysis are shown to follow from his modifying or jettisoning certain features of the analytic situation and process. These features and their implications are elaborated on. The conclusion outlines the extent to which the arguments presented can be extended to other advocates of interactionism.

Ego↗
PubMed2001

A preoccupation with object-representation: the Beckett-Bion case revisited.

Taking issue with the notion of a profound reciprocal influence of Samuel Beckett and his analyst, Wilfred Bion, based on supposition all too often passed as fact, the author refutes the idea that Bion's 'Attacks on linking' was based on his later-to-be famous patient. Choosing, rather, to apply Bion's concepts of transformation and assaults on verbal thought to Beckett's remarkably visual and highly dissociative writing, she finds in the analyst's work a means of exploring a startling preoccupation with object representation and an anxiety of remembrance constant throughout the writer's texts. Is this fixation attributable only to aesthetic strategy or does it say something about the writer's own inner representational world? Relating the writer's obsession to Bion's concepts and, moreover, its dissociative expression to the decathexis and blank mourning explored by Green, she uncovers within it a reflection of the kind of evocative memory disturbance identified with primary dyadic dysfunction. This application of Bion and Green to Beckett veers distinctly less towards psychohistory, however, than to how sublimation has rendered this object-relational failure an aesthetic success.

Humans↗
PubMed2001

A-void--an exploration of defences against sensing nothingness.

The author describes the potentially annihilating terror implicit in the experience of contact with the void--the 'domain of the non-existent' or nothingness, conceived as an immensely hostile object, terrifying space or a place of 'nameless dread'. All manifestations of existence are threatened by contact with the void, necessitating the deployment of a variety of defences. These various defences--universally employed to avoid contact with this domain--are then discussed. These include trying to search for a fixed sense of identity that can often propel people to seek refuge inside an object or state of mind, as described in Meltzer's 'claustrum' and Steiner's 'psychic retreat'. Other defences, including distraction and grandiosity, are also described. The author then goes on to discuss techniques for helping patients to tolerate contact with mental states engendered by the threat of potential contact with the void, in order to strengthen their capacity to feel and thus enlarge their repertoire of coping with anxiety in a non-reactive and thus growth-inducing manner. This involves discussion about psychoanalytically informed Buddhist understanding of these states and the nature of identity itself, as well as the correlation between these insights and those offered by Bion and other psychoanalytic writers.

Adaptation, Psychological↗
PubMed2001

The only clinical and quantitative study since Freud of the preconditions for recurrent symptoms during psychotherapy and psychoanalysis.

In this paper the author aims to evaluate theories of onset conditions both before psychological and before somatic symptoms by the first ever clinical-quantitative assessment of their preconditions, and then to compare these preconditions with Freud (1926) and with other theories of symptom formation. The seven cases in the sample were the only cases of recorded psychotherapy or psychoanalysis, each with recurrent symptoms in segments of sessions before symptoms versus segments of sessions before controls (with no symptoms) that were suitable for 'the symptom-context method'. The recurrent psychological symptom cases were: momentary forgettings, depressive shifts, and phobic feelings and behaviours; the recurrent somatic symptoms were stomach ulcer pains, migraine headaches, absence (petit mal) episodes and premature ventricular contractions (PVC) of the heart. Independent ratings of pre-symptom segments versus pre-control segments showed significant differences in all seven cases. Many emotional state qualities differentiating the pre-symptom from the pre-control segments were similar across cases. These were, in rank order, hopelessness, lack of control, anxiety, feeling blocked, helplessness, concern about 'supplies', depression, hostility to therapist, guilt, involvement with therapist, separation concern and hostility to others. For example, hopelessness significantly differentiated pre-symptom versus pre-control for all seven cases. For the first time, samples of segments of sessions before recurrent symptoms have been both clinically and quantitatively compared with segments without symptoms. Brief segments before recurrent symptoms showed significantly more of certain qualities than brief segments before controls where no symptoms appeared. These qualities led to the author's revised symptom-context theory of symptom formation and then to a comparison with five classical theories of symptom formation.

Adult↗
PubMed2001

The riddle of femininity: the interplay of primary femininity and the castration complex in analytic listening.

This study elucidates the application of an analytic attitude to questions of gender and sexuality. The paper reports on a study group's exploration of the relative heuristic use of two important organising concepts in analytic work with female analysands: primary feminity and the phallic castration complex. A tendency to cling to one position over the other skews analytic listening. Two cases are presented of women struggling to consolidate positive feminine identifications and, to that end, working through conflicting feminine identifications and defences against a resolution of the awareness of gender differences. Analytic listening requires a view of each psychic construction as a layer to be understood in its own right yet as a cloak soon to reveal the next layer--a different construction. The study includes observations on perverse fantasies in women.

Adult↗
PubMed2002

'Never twice without thrice'. An outline for the understanding of traumatic neurosis.

Following the review of Freud's work on trauma (1916-17, 1920, 1926, 1933, 1939), this article proposes to view the traumatic scene as a screen which acts as an active process in the case of many victims who, like Mrs D, break down a few days after being assaulted. After a first attempt at denial, the ego is submerged with repressed content. Repetition is seen as a means of abreacting the trauma by seeking to bind the enormous quantity of excitations that cannot find discharge. Repetition, because of its compulsive quality, fails. The victim remains in a state of helplessness against which she resorts to denial, splitting and projection (Freud, 1920, 1926). This strategy is seen, however, as maintaining the victim in a state of helplessness. Thus, I suggest that, overwhelmed, the ego finally resorts to a multi-levelled system of defence. On a first level, fixation to the trauma, like in screen-memories, gives way to a first displacement. On a second level, the adoption of an identity built upon being a victim contributes to the strength of this displacement. On a third level, identification with the aggressor consolidates this defensive strategy by giving meaning to the hostility awakened by the sexual assault.

Humans↗