Jeremy Holmes

University of Exeter | UoE · Department of Psychology

This paper outlines the ways in which Karl Friston’s work illuminates the everyday practice of psychotherapists. These include (a) how the strategic ambiguity of the therapist’s stance brings, via ‘transference’, clients’ priors to light; (b) how the unstructured and negative capability of the therapy session reduces the salience of priors, enablin...

Research inspired by attachment theory has focused on how early experiences of being soothed when distressed give rise to attachment-related differences of lifelong significance. However, we currently do not understand how these differences influence the breadth of later outcomes with which they are associated. This knowledge gap is increasingly fe...

The free energy principle (FEP) is a new paradigm that has gain widespread interest in the neuroscience community. Although its principal architect, Karl Friston, is a psychiatrist, it has thus far had little impact within psychiatry. This article introduces readers to the FEP, points out its consilience with Freud's neuroscientific ideas and with...

Psychotherapy is a practice in search of a theory. Recent advances in relational neuroscience and attachment research now offer convincing avenues for understanding how the 'talking cure' helps clients recover. Drawing on Karl Friston's Free Energy Principle and contemporary attachment theory, this pioneering text provides a deep theoretical explan...

La teoria dell'attaccamento fornisce un modello per comprendere: 1) lo sviluppo nel contesto delle relazioni primarie e formative del bambino; 2) l'orientamento di un adulto verso legami intimi instaurati nel corso della vita, relazioni sociali ed esplorazione autonoma. I ricercatori in psicoterapia hanno messo in relazione le modalità di attaccame...

Résumé Le principe de l’énergie libre (PEL, « free energy principle », FEP en anglais), devient le centre d’un intérêt croissant, et est de mieux en mieux accepté en tant que nouveau paradigme de la fonction cérébrale, mais il n’a eu jusqu’à présent que peu d’impact sur la théorie et la pratique psychothérapeutiques. Le but de cet article est de co...

Recent advances in attachment-informed relational neuroscience point to possible mechanisms of action of psychological therapies, with implications for effective practice. Declaration of interest None.

The paper proposes Shakespeare's The Winter's Tale (WT) as foundation narrative for attachment‐informed psychotherapy, and a counterpart to Oedipus Rex (OR), covering similar psychological territory but in a strikingly different way. Both start with a father's rejection of a baby and its rescue and adoption by distant shepherds. Both revolve around...

Dostoyevsky's Brothers Karamazov as essential psychiatric text – psychiatry in literature - Volume 214 Issue 4 - Jeremy Holmes

The free energy principle (FEP) has gained widespread interest and growing acceptance as a new paradigm of brain function, but has had little impact on the theory and practice of psychotherapy. The aim of this paper is to redress this. Brains rely on Bayesian inference during which “bottom-up” sensations are matched with “top-down” predictions. Dis...

‘Two Scrubby Travellers’: a psychoanalytic view of flourishing and constraint in religion through the lives of John and Charles Wesley By Pauline Watson. Routledge. 2018. £83.48 (hb). 200 pp. ISBN 9781138241046 - Volume 214 Issue 2 - Jeremy Holmes

This paper investigates attachment themes in the life history narratives of professional orchestral musicians and their relationship with music performance anxiety (MPA). Narrative accounts derived from open-ended in-depth interviews of ten professional musicians were analysed from an attachment perspective using content and thematic analysis. We h...

Colours of Ageing: 30 years of Research on the Mental Health of the Singapore Elderly By Kua Ee Heok. Write Editions. 2017. US $24.99 (hb). 180 pp. ISBN 978-981-11-1946-0 - Volume 213 Issue 3 - Jeremy Holmes

Attachment theory provides a model for understanding (1) development within the context of the child's primary, and formative relationships, and (2) an adult's orientation toward lifelong intimate connections, social relationships, and autonomous exploration. Psychotherapy researchers have linked measures of patient attachment with therapeutic alli...

Encounters with John Bowlby: Tales of Attachment By Arturo Ezquerro . Routledge 2016. £28.79 (pb). 266 pp. ISBN 978 1138667648 - Volume 212 Issue 2 - Jeremy Holmes

How attachment theories and research can inform and improve the practice of psychotherapy and counselling across a wide range of modalities. Attachment delves into the 'DNA' of the therapeutic relationship, providing a meta-theory and practice rubric which informs seemingly incompatible varieties of psychotherapy. Secure therapist-patient relations...

Suicide is one of the most mysterious and most challenging of human behaviours, an inherently traumatic, barely imaginable phenomenon, outside the usual range of expectable human behaviour—Hamlet’s ‘bourn from which no traveller returns’.

This is a concise, accessible introduction to the basic principles of attachment theory, and their application to therapeutic practice. Bringing together 70 years' of theory and research, its expert authors provide a much-needed user-friendly guide to attachment-informed psychotherapy. The book covers:  the history, research base, and key figures...

Psychoanalysis in Britain 1893–1913: Histories and Historiography By Phillip Kuhn. Lexington Books. 2017. £80.00 (hb). 468 pp. ISBN 9781498505222 - Volume 211 Issue 5 - Jeremy Holmes

The Psychopathology of Everyday Life, Sigmund Freud - Volume 211 Issue 2 - Jeremy Holmes

Attachment theory was built by Bowlby as an attempt to link psychoanalysis with the wider world of ethology, cybernetics, and evolutionary theory. Although it was initially rejected by the psychoanalytic establishment, there has been a gradual rapprochement. This article attempts to accelerate this process by laying out the points of overlap and di...

Developmental research on resilience is summarised and illustrated with a case example. Self-reflection, positive relationships, and agency foster resilience in the face of adversity. Attachment and resilience are related categories. The different patterns of attachment - secure, insecure-organised and insecure-disorganised - are manifest in differ...

Prosser et al [1][1] cogently argue that psychotherapeutic treatment is no less ‘biological’ than pharmacotherapy – a point also made by Bowlby, who argued, from an ethological perspective, that behaviour is shaped by evolutionary processes no less than anatomy.[2][2] However, in linking

Despite continuing technological advance, there is a widespread view that something is missing in current medical culture. This arises in part at least from the lack of a theoretical framework that describes the complexity of patient-centred clinical practice. Attachment theory, working in tandem with the ideas of Michael Balint, provides just such...

It has been drawn to my attention that my article1 implicitly criticises the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI), attributing to it comments which are rarely if ever found in its pages. In fact the NCI makes specific focused recommendations which, when implemented, reduce suicide rates.2 My re...

In the context of a Professional Doctorate in Psychoanalytic Research, we examined how a group of psychoanalytic therapists responded to the ethos and methods of qualitative research. Although experienced therapy practitioners, the students were mostly new to qualitative research. We were interested in the extent to which students found psychoanaly...

The aim of this paper was to contribute to the further development of a coherent theory of music performance anxiety (MPA). Kenny (2011) proposed three forms of MPA – focal, MPA with social anxiety, and MPA with panic and depression. An attachment disorder was proposed as the underlying psychopathology for this third type of MPA. Accordingly, an op...

Attachment theory was built by Bowlby as an attempt to link psychoanalysis with the wider world of ethology, cybernetics and evolutionary theory. Initially rejected by the psychoanalytic establishment there has been a gradual rapprochement. This paper attempts to accelerate this process by laying out the points of overlap and distinction between th...

Tolstoy's life and work illustrate resilience, the transcendence of trauma and the enduring impact of childhood loss. I have chosen the famous oak tree passage from War and Peace to illustrate recovery from the self-preoccupation of depression and the theme of 'eco-spirituality' - the idea that post-depressive connectedness and love apply not just...

The theme of the paper is the quotidian debate about the role of theory in analytic practice. Based on examples from recent psychoanalytic publications, I argue that psychoanalytic theory may influence therapists as ideology, heuristics, or empiricism, or combinations thereof. Bion's eschewing of theory, and advocacy of an analytic stance ‘beyond m...

Use of the imagination is a key aspect of successful psychotherapeutic treatments. Psychotherapy helps clients get in touch with, awaken, and learn to trust their creative inner life, while therapists use their imaginations to mentalise the suffering other and to trace the unconscious stirrings evoked by the intimacy of the consulting room. Working...

This resource brings together perspectives from a group of highly respected psychiatrists, each with decades of experience in clinical practice. The topics covered range from scientific discoveries of all kinds, advances in treatment, and conceptual breakthroughs. The highlights are countered by the field's negative sides: perennial indecisiveness...

What follows are some clinical and evidential reactions to a stimulating and original paper. Writing as a clinician, indulgence is craved for inevitable philosophical naiveté. First, Nykänen’s distinction between conscience and guilt makes good phenomenological and clinical sense. To take a fictional example, imagine a highly respected professional...

A personal bereavement from suicide prompts a critique of current mental healthcare. Fragmentation, lack of long-term attachment to a tenured professional, the dearth of family therapy, and professional ambivalence are identified as weaknesses in current provision. Implicit is the case for change in UK psychiatric services, both structural (need fo...

John Bowlby's ‘Attachment and Loss’ trilogy set the scene for half a century of attachment research and theorising. This article picks out the key themes of his work – the attachment dynamic, the impact of trauma and life events, defensive exclusion, loss and bereavement, and internal working models – and points to their continuing relevance.

Strong on diagnosis, but weak on prescription, Bracken et al 's[1][1] critique of contemporary psychiatry suffers from the very difficulty which they decry. They rightly complain that current paradigms ignore the psychosocial, fail to combat stigma, and that academic psychiatry has little impact on

Gerada applauds the shadow health secretary’s call for the NHS to move to “whole person” medical-social care, but fails to mention an insidious undermining feature, introduced by the Labour government, the Quality and Outcomes Framework.1 …

This paper is written from a psychodynamic clinician's perspective, juxtaposing a psychoanalytic-attachment model of depression with recent developments in neuroscience. Three main components of the attachment approach are described: the role of loss, of childhood trauma predisposing to depression in later life, and failure of co-regulation of role...

This paper is written from a psychodynamic clinician's perspective, juxtaposing a psychoanalytic-attachment model of depression with recent developments in neuroscience. Three main components of the attachment approach are described: the role of loss, of childhood trauma predisposing to depression in later life, and failure of co-regulation of role...

Reviews the book, Psychoanalysis and Psychoanalytic Therapies: Theories of Psychotherapy Series by Jeremy D. Safran (see record 2010-23094-000). The bulk of this book, and its accompanying DVD, is devoted to an exposition of the techniques, achievements and problems of real-life psychoanalytic therapy as exemplified by his work with “Simone,” an Af...

In 1967 the neurologist Henry Miller provocatively stated that “psychiatry was neurology without physical signs.”1 It was unclear then whether Miller was half a century behind or ahead of his time. In their call for diagnostic fusion between psychiatry and neurology, White and colleagues clearly think he was ahead.2 In their view, psychiatric …

Psychodynamic psychiatry makes a significant educational, scientific and therapeutic contribution to contemporary psychiatry. Recent developments in gene-environment interaction, neuropsychoanalysis and the accumulating evidence base for psychoanalytic therapies and their implications for practice are reviewed.

The paper develops the post-Winnicottian psychoanalyst Kenneth Wright's theory of the face which he sees as insufficiently theorized psychoanalytically. As compared with the breast, the face is intrinsically a vehicle for generating meaning and representation, rather than satisfying bodily need. Infants see themselves reflected back in the mother's...

The contrast between the cover of the August issue of The Psychiatrist and the content of the related article[1][1] could hardly have been greater. On the outside: shocking depiction of a winged Freud in drag - women’s bathing costume, high heels - flanked by the sphinx. Inside: announcement of

With the help of attachment theory and research, the paper attempts to broaden and build on classical and current views on the superego. Attachment theory's epigenetic approach and the concept of the subliminal superego are described. The superego, it is argued, is as much concerned with safety as sex. The superego is 'heir', not just to the Oedipu...

abstractRelational Psychoanalysis as a paradigm is presented through an exposition of the work of Donnel Stern. Stern's ideas centre around four aspects of clinical theory: the therapeutic conversation; dissociation; enactment; the emergence of new meanings. The impact on Stern of the German philosopher Gadamer's ideas is discussed. Key clinical co...

Effective therapists need guiding models, but, paradoxically, the benefits of psychoanalytic psychotherapy may not flow from its espoused theories. Using an attachment framework, it is argued that psychoanalytic psychotherapy in common with all therapies has three principal components: an attachment relationship; meaning-making; and change-promotio...

Psychiatrists use their feelings to empathise with patients. But sometimes love, hate, fear, rage, horror overwhelm, leading to bad decisions. Projective identification helps theorise this. Babies expel difficult feelings into a ‘ bad mother’, who then ‘detoxifies’ what the baby cannot

The patient first manifested chronic depression in 1972 when she attempted suicide. She was admitted to a county asylum, where the conditions and treatment she received coloured her subsequent lifelong depression

Reviews the book, Partners in thought: Working with unformulated experience, dissociation, and enactment by Donnel Stern (see record 2009-17014-000). Following Stephen Mitchell’s untimely death, Donnel Stern is rightly seen as the doyen of Relational Psychoanalysis (RP). In a series of publications he has eloquently and passionately expounded its t...

Grant and colleagues correctly assert that the emotional, psychological, existential, and sometimes religious needs of dying (and indeed all) patients are often neglected.1 They have no doubt that more “spirituality” is needed—the word, …

Effective therapists need guiding models, but, paradoxically, the benefits of psychoanalytic psychotherapy may not flow from its espoused theories. Using an attachment framework, it is argued that psychoanalytic psychotherapy in common with all therapies, has three principal components: an attachment relationship; meaning-making; and change-promoti...

Dein et al [1][1] appear to believe, on the basis of suggestive but by no means overwhelming evidence, that religious belief is associated with good mental health. Bruno Bettelheim, in his account of his concentration camp incarceration,[2][2] noted that those who survived best were those with

In Wallang’s tour de force[1][1] (history of Western philosophy in four pages) arguing for a narrative-based approach to psychiatric consultation, there was a striking omission: nowhere was psychodynamic/psychoanalytic psychiatry mentioned. Yet this etiolation of psychodynamics underpins the

Charles Rycroft played a significant part in gaining psychoanalysis understanding and intellectual acceptance within the wider intellectual community of post-war Britain. However he became gradually disaffected with the schisms and inward-looking character of UK psychoanalysis in its post-controversial discussions phase. He was ahead of his time in...

This short article is a commentary on a research study investigating therapist and client attachment styles and their relationship to alliance development in a 12-week psychodynamic psychotherapy program for nonpsychotic inpatients. The relationship is complex; unsurprisingly, securely attached therapists with less distressed clients formed the str...

[⇓][1] ![Figure][2] It is now nearly 50 years since the action–research sociologist Erving Goffman turned his insider-view daily notes into a devastating critique of the realities of mental hospital life. Back then, sociologists and psychotherapists were natural allies rallying to the

Background and Aim Although there is existing activity within the NHS and local communities to support self-care there has been no previous attempt at integration across a Primary Care Trust (PCT). The Joining Up Self-Care (JUSC) study aimed to implement and evaluate such a programme.Methods Three self-care support modules for members of the public...

Medical and psychiatric treatments contain three indispensable components: a therapeutic relationship, meaning-making and change-promotion. For people who have borderline personality disorder each is problematic. Relationships are chaotically sought or fled from; meaning equates to control or

When subject to stress, threat or illness, humans seek an older wiser figure or \`secure base'. The patient comes to the psychiatrist in a state of arousal. An empathic response on the part of the doctor, with accurate verbal identification of emotion, produces assuagement of attachment behaviours,

Mentalisation: ‘mind-mindedness’, the ability to see ourselves as others see us, and others as they see themselves; to appreciate that all human experience is filtered through the mind and therefore that all perceptions, desires and theories are necessarily provisional. Psychotherapy, whether

Because illness-bearers, our patients, come to us not just with diagnoses but with their dreams and character . In dreams lie cherished fears and desires. Character is the precipitate of our material and social being – genes, developmental experiences, choices, relationship patterns, strengths and

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An invitation to the Balint Society’s annual dinner provided a welcome opportunity to revisit and review the enduring legacy of Michael Balint on British general practice and psychiatry. I was one of the smallish band of “Balint boys” (and girls) who were lucky enough to be in his seminars for medical students at University College Hospital, Londo...

The work of John Bowlby, although influential in developmental psychology and social psychiatry, has had relatively little impact within his parent discipline of psychoanalytic psychotherapy. The paper traces Bowlby's relationship with the British Psychoanalytic Society, contrasting his ideas with those of Klein. Drawing on recent findings in devel...

Loneliness, a lack, and solitude, a self-sufficiency, are distinguished. Winnicott's concept of the capacity-to-be-alone is described as the basis of solitude. A child who is watched over non-intrusively by a good-enough mother acquires the foundations of solitude in later life. Where the capacity to be alone has not developed adolescent breakdown...

Psychotherapy training for psychiatrists has often been honoured more in the breach than the observance. While most training schemes pay lip service to psychotherapy, few provide the comprehensive training to which national and international bodies aspire. Recent educational changes, especially the move from course completion to competency evaluati...

ABSTRACT Endings in psychoanalytic psychotherapy are often problematic, especially in publicly-funded therapies. Endings may be premature or delayed -‘too soon’or‘too late’. This paper looks at some parallels between endings in literature and endings in psychotherapy; considers the gender bias in Freud's‘Analysis Terminable and Interminable’; intro...