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PubMed1994

[Complaints of depression and therapeutic perspectives].

Having reviewed the place of depressive complaint within contemporary nosography, the authors study the psychopathological aspect of clinical pictures called "dysthymias". The rapport of patients with their internal or external objects is deeply ambivalent and characterized by a link that Michael Balint calls "ocnophilic". Those patients also appear peculiar regarding their relationship with temporality, with what can be called: a "dictatorship of the present" reflecting their inability to be located in a "narrative" development. Some principles stem from these considerations, concerning therapeutic strategies as does a reminder of the difficulties in bringing about a genuine evolution.

Antidepressive Agents↗
PubMed1994

[Developmental pathways in adolescence. Narcissism and transitional phenomena].

The author describes the development of the adolescent self as a three-stage process. After termination of the accord between the young person and the parents that marks the latency period, the adolescent creates a carefully guarded inner reality serving to distance him/her from infantile images of the self and the parents. In the second stage, the young person achieves stability by electing narcissistic configurations (self-aggrandisement, dissociation, turbulent self with day-dream fantasies) which are described here as transitional phenomena and assessed by Streeck-Fischer much less negatively than by other authors. The capacity for self-distance that evolves in this stage and the attendant potential for self-definition in constant oscillation between repetition and re-creation brings the process of adolescence to its close.

Adolescent↗
PubMedDate not supplied

[Work with psychiatrically ill parents in a pediatric psychiatry treatment facility].

Since the new law for hospitalization has come into effect (1991) in Austria more than before children from parents who have psychoses or other serious mental disorders have to be taken into in-patient wards in psychiatric institutions for children-often according to a court decision. This article discusses the cases of 21 such children and their 16 (respective) families. The various difficulties in dealing with the mentally ill mothers and fathers as well as some first experiences with possible strategies for working with these parents, which were gathered in therapeutic practice, are described individually. Work with these parents means trying to establish reality or risking losing reality.

Adolescent↗
PubMed1993

[Asymmetry and mutuality in the analytic relationship: lessons for today from the relationship between Freud and Ferenczi].

Against the background of the controversy between Freud and Ferenczi on the nature of the psychoanalytic relationship, Hoffer examines the perennial issue of the way in which analysts come to terms with the warring claims of asymmetry (Freud) and mutuality (Ferenczi) in analysis. While discerning an inherent tendency towards mutuality in the psychoanalytic constellation, the author nevertheless calls for the upholding of asymmetry because the psychoanalytic relationship is not a relationship "of the usual kind". The analyst, he contends, must sustain the tension between mutuality and asymmetry and use this reflected tension as a therapeutic instrument for fathoming the patient's psychic reality.

Adult↗
PubMedDate not supplied

["...at least in my village, it is the custom...". From stagnation to transformation of familial reality constructs in immigrants].

The overrepresentation of immigrant children in special-education facilities and their underrepresentation in the stationary and ambulatory child and adolescent psychiatric services is becoming more and more alarming. It is inadequate to understand the reality of immigrant families by focusing on the concept of the "back and forth" between two cultures. It is more adequate to understand the reality of immigrant families by making use of the concept of the "construct of transitional realities". This newer and more relevant concept of understanding the reality or situation of immigrant families is based on the method of ethnobiographic case reconstruction and case comparison. Through this new approach, it is possible to discern the ways and means by which some families living in a foreign culture achieve a more or less autonomous mode of living and how they succeed in overcoming difficulties when going from one frame of reference to another or from one phase of life to another. This report presents excerpts from a study of southern Italian families living in Switzerland. As drawn from the collected material, these families can be typified as: traditional-progressive, traditional-sclerotic, traditional-regressive. In analyzing these individual family biographies and the various constructs of problem solving, the general societal background is always taken into consideration by the author. Therefore, the three types of families are neither singular nor particular but rather universal.

Acculturation↗
PubMed1993

Beneath the analytic surface: the analysand's theory of mind.

A growing body of research on the way children change their forms of thinking and views of the world from around the ages of 2 to 5 strongly suggests that something called a 'theory of mind' is acquired during this time which significantly affects the course of language acquisition, moral development, interactive problem-solving and other cognitive attributes. As we learn more about the adult varieties of this theory of mind we begin to realise their implications for psychoanalysis. This paper considers such issues as: what kind of theory of mind is assumed by our reliance on the Basic Rule? What kind of theory is required to understand the usual range of standard interventions? How can deficiencies in the analysand's theory of mind interfere with standard interpretations? As research on theory of mind makes us increasingly sensitive to the importance of different forms of thinking about thinking, we can apply many of these insights to common problems of psychoanalytic technique.

Humans↗
PubMed1993

[Problems and strategies of qualitative psychotherapy research in clinical institutions].

The neglect of institutional codetermination in therapeutic decisions is exposed as a desiderative in research. Qualitative approaches as developed in the social sciences must come to grips with the social unconscious institutional procedures; therapy is proposed to be considered as a social event. Thus Reality Work is viewed as field and object of qualitative research in clinical institutions, a concept close to ethnographic and social constructionist approaches. The generative techniques (as dissonance reduction, narrative transformations and selection of rules of discourse) institutions use for the establishment of their social-emotional integration are illustrated by examples; they are instruments to produce a processible image of the patient. Images thus generated rule treatment, they can be formulated as metaphors und looked for at different levels.

Hospitalization↗
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↗
PubMed1993

Concepts of reality and psychic reality in psychoanalysis as illustrated by the disagreement between Freud and Ferenczi.

In this paper, the concepts of reality and psychic reality are discussed in relationship to a number of controversies about the therapeutic and scientific aims of psychoanalysis, as illustrated by the disagreement between Freud and Ferenczi. Because the nature of psychic reality is necessarily incomplete and indeterminate, there are inherent limitations and dangers to any psychoanalytic attempt to discover historical and experiential truth. Modell's interpretation of Nachträglichkeit ('deferred action') as 'retranscription' expresses the ambiguity of psychic reality in analysis, which is not fixed or foundational but part of an evolving inner and outer dialogue in relation to new experience. It is argued that Freud accepted this ambiguity, while Ferenczi sought to overcome it through modifications of technique.

Freudian Theory↗
PubMed1993

Knowing and not knowing massive psychic trauma: forms of traumatic memory.

It is in the nature of trauma to elude knowledge, both because of deficit and defence. Massive trauma cannot be grasped because there are neither words nor categories of thought adequate to its representation; knowledge of trauma is also fiercely defended against, as it poses a momentous threat to psychic integrity. Yet knowing nevertheless occurs on some level, often in restricted or defensive forms. This paper sets forth various forms of knowing and not knowing massive historical trauma as manifested in clinical symptomatology, transference phenomena, life themes and witnessing narratives. Metaphor is also mentioned as yet another form of knowing and addressing trauma, available primarily to those who have not been directly affected as victims nor as family members of victims. The different forms imply a continuum of progressively more integrated and subjectively owned levels of knowing, directly related to the actual and psychological distance from the traumatic event. Illustrations drawn from clinical and testimonial settings are given for each level of knowing described, and implications for therapeutic strategy are discussed.

Adult↗
PubMed1993

The bi-logic perception of time.

The problem of perception and conceptualisation of time in the unconscious and the conscious is seen in terms of Matte-Blanco's theories. In a short outline of his ideas, symmetrical and asymmetrical logic and his newer concept of 'bi-logic structures' are discussed. Clinical examples from the psychoanalysis of a patient with a time problem are presented to illustrate the hypothesis that a misperception and misconception of time lead in this case to obsessive-compulsive pathology. The clinical application of Matte-Blanco's postulations not only explains the psychopathology of the patient but also allows the formulation of a treatment strategy leading to a positive solution of the problem.

Adult↗
PubMed1993

Personality death, object loss, and the uncanny.

The concept of uncanny anxiety can be distinguished from other clinical entities such as anxiety states, depression, or mourning. It has a special relevance to the impact of 'personality death' in which sudden dramatic alterations in psychological function occur. Clinical examples are presented from cases involving neurological trauma and its impact on the beholder. The uncanny experience is composed of, first, a perception that the object is familiar and unfamiliar in an intertwined way; and second, that the object is wooden and dead in a way that strains object constancy. Lastly, a sense of a double, of one person within another, develops in the observer. The uncanny sensation is viewed as a reaction to this doubling. It is a symptom that occurs in reply to the threatened emergence of the unconscious belief that there really are two people there. This belief would be a threat to the ego's soundness. Uncanniness rushes in to protect the ego from feeling attacked by something completely unreal.

Adult↗
PubMedDate not supplied

[Designation of symptoms in mental disorder].

In the author's opinion, language and clinical facts in psychiatry are misused and it is hypothesized that many malfunctions of psychiatric practise are symptomatic. It is indeed very hard to modelise mental illness: what terms should be chosen and how should they be articulated? Considering the complexity of the relationship between language, ideas and memory, an empirical and experimental approach has been chosen; working out structures of concepts isomorphic to psychiatric reality, either from observed phenomena or from words. In our view, language skills are sufficient to build these sophisticated models, and language skills can be trained as can be trained sensorimotor skills. Experimenting psychiatric language in using their encyclopedic knowledge will allow staff members to teach themselves and will have a heuristic value in changing their beliefs about reality. These experiments have been undertaken for a year and an half, in a general psychiatry ward, in a ward for retarded and autistic adults and in a rehabilitation ward. Rigour and perseverance are required but these experiments seem particularly promising.

Adult↗