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PubMed2000

Notes on Bion's "memory and desire".

Memory and desire, along with understanding and preconception, are to be abandoned (really, suspended) for the analyst to be ever open to unexpected emerging from the analysand's unconscious. The discipline that Bion suggests allows the analyst to be open to his/her own native feelings as an emotion-receptor and analytic instrument.

Attitude↗
PubMed2005

A psychodynamic (NonOedipal) and brain function hypothesis regarding a type of male sexual masochism.

A clinical observation suggests a hypothesis that differs from classical analytic oedipal theory as to the origin and psychodynamics of a type of male sexual masochism. This type of masochism may occur when a painful childhood life experience regarding severely forbidden sexual pleasure is associated and amalgamated with shame, humiliation, and feared physical and psychological punishment resulting in sexual pleasure. If this takes place with sufficient frequency during the critical phases of childhood sexual development, possibly including early adolescent sexual development, it becomes recorded as long-term memory in brain neural networks. The phenomenon of its recording includes, at least in part, the commonly accepted theory of Donald Hebb. In later years, the man feels compelled to reproduce in a masochistic ritual the former childhood psychological and physical conditions, to bring about the most intense sexual pleasure. Humiliation, shame, discomfort, helplessness, and even possible pain are simulated or actually instigated. By voluntarily placing himself in charge of the type of sadistic treatment he receives in acts of masochism, a patient may unconciously place himself in charge of his plight, in an attempt to master it, in contrast to his childhood helpless state. This formulation does not require an Oedipal explanation.

Adult↗
PubMed2005

The use of metaphors in the service of the therapeutic alliance and therapeutic communication.

The use of metaphor as a conceptual and clinical tool in the treatment situation can enhance the therapeutic alliance and strengthen the effectiveness of therapeutic communication. The evolution of a special metaphoric system of communication in the course of the treatment situation enhances the positive alliance between patient and therapist. In a way analogous to the poetic use of metaphor, the therapeutic use of appropriate metaphors can be a powerful tool because a metaphor is a symbol that represents a condensation of multiple impulses, conflicts, fantasies, and affects. Case material will be presented to illustrate the use of metaphoric communication in the clinical situation.

Anger↗
PubMed2006

The psychoanalyst at the medical bedside.

Consultation-liaison psychiatry is now a subspecialty recognized by the American Board of Psychiatry and Neurology. The presence of the psychiatrist as a member of the medical team is the result of contributions by psychoanalysts in the 1930s, 1940s and 1950s who studied the psyche acting on the soma. Psychoanalysis, from its theoretical inception, was holistic, and brought together biological, psychic, and social-ecological perspectives to unravel the mysteries of somatic illness. The early psychoanalysts were retracing a biopsychosocial model whose origins could be found in ancient Greece. A patient who is medically ill is more than an illness. Subjective experience, experiences before the onset of illness, losses, and the triad of helplessness, hopelessness, and giving up all became areas for psychoanalytic study. Some medically ill patients present degrees of complexity that puzzle physicians. These patients require a psychiatric consultation and treatment. The alliance with the psychiatrist unravels the problems complicating their cases and results in a collaborative treatment with the treating physician. The psychoanalyst training residents in psychiatry during their period in a consultation-liaison service is able to teach transference and countertransference issues that arise with patients and nonpsychiatric physicians. The creation of such an alliance can be a difficult task for the authoritarian resident who may be culturally conditioned to a rigid doctor-patient relationship. With the guidance of the psychoanalyst-teacher, residents change, and patients benefit.

Cooperative Behavior↗
PubMed2006

The place of psychodynamic psychiatry in consultation-liaison psychiatry with special emphasis on countertransference.

Psychodynamic theory can be applied to all aspects of consultation-liaison work. There are various psychodynamic treatment approaches that can have a powerful meaning to the patient. This can include understanding the patient's life trajectory through the elicitation of a life narrative, understanding defense mechanisms, and utilizing the patient's fantasies about illness. Patients who are physically ill regress and want to be understood. When this is achieved through a psychodynamic approach, the patient will be more likely to accept a referral for psychiatric follow-up when it is indicated. The consultation-liaison psychiatrist will also encounter transference and countertransference manifestations. Of particular usefulness can be derivatives of classical countertransference, which can be seen as reactions and identifications by the treating psychiatrist or the medical team to the patient that may interfere with effective care. "Countertransference Rounds" is a technique for examining such manifestations during the C-L team's discussion of patients.

Adult↗
PubMed2006

Psychodynamic psychotherapy: a core conceptual model and its application.

Contemporary American psychiatry, influenced by the "biologic revolution" with its emphasis on a brain-disease model of mental illness, and operating in a managed care delivery system, is in danger of relinquishing its listening and talking functions--psychotherapy--in favor of prescribing drugs. However, despite remarkable advances in the neurosciences, there is still no pharmaceutical magic bullet. The author argues for the continued relevancy of psychotherapy and outlines a practical psychodynamic approach that utilizes fundamental analytic concepts. These concepts--transference, the dual theory of drives, the repetition compulsion, and mechanisms of defense--are described and their clinical application is illustrated. This core conceptual model has significant heuristic value in treating patients and in teaching psychotherapy to psychiatric residents. With its emphasis on the power of the doctor-patient relationship, it teaches residents an effective body of knowledge that helps them define their professional identity-as psychiatrists whose most effective therapeutic tool is themselves, not the drugs they dispense.

Anger↗
PubMed2006

Silent scream: the cost of crucifixion--working with a patient with an eating disorder.

In working with individuals who have experienced extreme deprivation in early relationships, the pain is often depicted silently and repetitively. There can be a tension between the need for validation and an avoidance of growth. The analyst, then, can find herself caught between her empathic resonance to the silent scream and the need to keep in mind the "cost of crucifixion." The latter has become my inner way of fixing in my own mind the type of dilemma that ensues when the individual truly feels helpless and at the mercy of outside sources and also resents and fears the other's power. Marking (and often magnifying) the distress, then, becomes a way of inviting salvation. The dramatic element lends an air of inauthenticity to what is, in fact, very real pain. If we are unable to note the air of dissonance with which we receive these distress calls, we miss a crucial healing element: that the self is paying a huge price for defining the other as a source of salvation, and that part of the distress ensues from the denial of the hostility expressed toward the object for being an insufficient savior. We find ourselves cast in the role of savior/persecutor, and must find some means for healing these splits so that we might become a deidealized support for the other's emerging attempts toward constructing a more viable self. This is a dilemma we encounter when working with individuals who communicate protosymbolically, as is the case with eating disorders.

Adult↗
PubMed2006

Cognitive development, memory, trauma, treatment: An integration of psychoanalytic and behavioral concepts in light of current neuroscience research.

The goal of Freud's Project was to place all psychological functioning on a neurological foundation; however, the resources of his time were inadequate for the task. This article attempts to link basic psychoanalytic and behavioral constructs to current neuroscience, specifically the memory paradigm of multiple trace theory. We propose that Freud's theory of early cognitive development, in which primary process is succeeded by secondary process, corresponds to the progression from a noncontextual taxon-based memory system to a locale system (mediated by hippocampal and cortical structures) in which memories are formed within space/time contexts. The effects of trauma within these models is then examined by noting how Freud's views of repression and regression parallel neuropsychological hypotheses about the ways in which traumatic experience impacts specific brain areas. Finally, the treatment implications of this theoretical synthesis are explored. We posit that transference resembles the learning theory construct of generalization, and the non-contextualized coding of the taxon system. In conclusion, we suggest that orthodox psychoanalytic approaches may have overestimated the efficacy of words and intellectual vectors in effecting therapeutic change. Nonverbal strategies may be required to reach material that is stored in early developing brain areas that may be inaccessible to words.

Behavior Therapy↗