Psychic Retreats
... Lemma illuminates the way technology has impacted on experiences of intimacy and desire by analysing the film Her, in which a man forms a relationship with the operating system of his computer. She considers the way the internet can facilitate engagement rather than serve only as a psychic retreat (Steiner, 1993). ...
Dynamic Interpersonal Therapy (DIT) is a manualised, time-limited, psychodynamic therapy for patients with treatment-resistant depression linked to interpersonal problems. This paper examines the central thread of DIT; a case formulation called the interpersonal affective focus (IPAF). The IPAF is a brief psychodynamic case formulation of a problematic response to interpersonal threats that is rooted in internalised object relationships. It has two dimensions: an interpersonal focus and an affective focus. The interpersonal focus is a way of viewing the self in relation to others, which creates a bias towards perceiving the self and others in particular ways. The affective focus is an emotional reaction that contributes to interpersonal problems due to the inflexible character of the behaviours it evokes. A composite case study illustrates the value of using an IPAF to explore patients’ internal representations and work through painful emotional states that may be contributing to their relational problems. However, it also illustrates that for DIT patients with borderline aspects to their personality organisation, extra care may need to be taken with the pacing and timing of the approach.
The therapeutic encounter with psychotic patients presents therapists with moments in which they may regress, together with the patient, toward primitive and psychotic areas of experience. Within this shared psychotic world, therapists might feel persecuted, as if the ground is slipping from beneath their feet. The author suggests that the psychotic part of the personality, as argued by Bion, is inherent to all of us and may come alive in the psyche of the therapist in response to patients in psychotic states. The psychotic dialogue that emerges between patient and therapist, which involves projective identification and counter-transference mechanisms, must be worked through. Therapists' capacity to survive the psychosis forced upon them and to move through and beyond it is highly significant. By examining clinical material from therapy with a patient diagnosed with schizophrenia, the author discusses this unique countertransference phenomenon, which he terms induced psychotic countertransference.
Sunset Boulevard is a film that breaches the frames that cinema has conventionally used. It playfully satirises Hollywood with its silent era, its glossy nostalgia, its mystique that conceals its brittle cynicism. Norma Desmond is satirised but she is also the means by which Hollywood stands exposed. In many ways, the audience like Joe Gillis thinks they are in on the joke, till it turns against them. This paper argues that we can read this as a cautionary tale for psychoanalysts as we enter into an analysis of the patient, only to discover that we have been recruited into a world that never was in our control.
Canny and uncanny, like their German equivalents heimlich and unheimlich, have ambiguous double meanings. The relationship between canny, which means familiar, but also hidden threat, and uncanny which means unfamiliar, but strangely expected knowledge, is explored. The author proposes that the uncanny is derived from the reawakening of oedipal phantasies about parental coupling and the birth of siblings. He suggests that psychic growth requires toleration of the uncanny and free movement between it and canny states, corresponding with the oscillation between states, described by Bion, of Ps and D, where this promotes ‘Being’, through the realization of O. Childhood traumatic losses and oedipal anxieties can prevent this movement. This is illustrated by a woman who feared that the emergence of the uncanny would reveal her to be monstrous, through embodying her phantasy of being the ghost of her mother's dead sister and the damaged child of her parents’ disastrous marriage. She was thus unable to allow this free movement and was condemned to ‘life on the margin’. This is contrasted with extracts from Wordsworth's Prelude where ‘spots of time’, corresponding with screen memories, show how the liberation of the uncanny, and its free interchange with the canny, promotes mourning and growth.
Dynamic assessment embeds interaction within the framework of a test-intervene-retest approach to psychoeducational assessment. This book offers an introduction to diagnostic assessors in psychology, education, and speech/language pathology to the basic ideas, principles, and practices of dynamic assessment. Most importantly, the book presents an array of specific procedures developed and used by the authors that can be applied to clients of all ages in both clinical and educational settings. The authors discuss their approach to report-writing, with a number of examples to demonstrate how they incorporate dynamic assessment into a comprehensive approach to assessment. The text concludes with a discussion of issues and questions that need to be considered and addressed. Two appendixes include descriptions of additional tests used by the authors that are adapted for dynamic assessment, as well as information about dynamic assessment procedures developed by others and sources for additional information about this approach.
Dynamic assessment embeds interaction within the framework of a test-intervene-retest approach to psychoeducational assessment. This book offers an introduction to diagnostic assessors in psychology, education, and speech/language pathology to the basic ideas, principles, and practices of dynamic assessment. Most importantly, the book presents an array of specific procedures developed and used by the authors that can be applied to clients of all ages in both clinical and educational settings. The authors discuss their approach to report-writing, with a number of examples to demonstrate how they incorporate dynamic assessment into a comprehensive approach to assessment. The text concludes with a discussion of issues and questions that need to be considered and addressed. Two appendixes include descriptions of additional tests used by the authors that are adapted for dynamic assessment, as well as information about dynamic assessment procedures developed by others and sources for additional information about this approach.
The paper describes an analysis with a very difficult, emotionally inaccessible patient who, after more than a year, unexpectedly terminated the analysis, leaving the analyst with a sense of frustration due to incomplete and interrupted analysis. In the theoretical section of the paper, the author presents his understanding of the creation of such a pathological organization, starting with Freud's concept of death drive, then going on to Melanie Klein's and her successor's discoveries. John Steiner's concept of ‘psychic retreat’ helps us to understand the process of development of a pathological organization of personality. In the last part, the author describes how he works through mourning and prompts reflection on the reasons for the premature termination of the treatment by the patient. He indicates the causes in both the patient and the analyst.
This article is based on a presentation I made to a Group Analytic Society International (GASi) event on ‘The Impact of Homophobia on Mind, Body and Soul’ in May 2021. Much of what I discuss applies to gay women and people who are transgender. However, I will foreground the experience of gay men because I have more clinical and personal experience in this field. I provide a working definition of homophobia and how it impacts on the psychological development of gay men at various points during their earlier life stages. My contention is that the presentation of gay men in our clinics and practices in terms of their psychological difficulties and issues can be attributed, largely, to the impact of homophobic trauma rather than anything that is innate. This is largely due to gay men, from very young ages, having to manage a wide range of traumatizing negative responses and betrayal from their families and communities, ranging from ostracism to extreme violence and rejection from those who are meant to care for them. The more damaging impacts of these attitudes occur at points in the early developmental stages of gay men when they do not have a mature psychic apparatus with which to process and manage repeated and relentless homophobic trauma. This has implications for their personality formation and can lead to their developing some very unhelpful and dysfunctional defences. It is, in fact, surprising that gay men are such positive contributors to society and are not far more disturbed and destructive, given the amount of trauma that they face throughout their early development. I conclude with a discussion of the clinical needs of gay men.
The author describes some obstacles encountered teaching undergraduates psychoanalytic theory. In academic environments that reflect a broader cultural skepticism, disinterest and animosity to analytic ideas, the author argues that it is imperative to develop and utilize teaching methods that have an experience‐near quality. Without clinical experience and perhaps hesitant to use their own personal lives for material, students may seemingly lack data to test out the explanatory value of analytic ideas. This essay illustrates one device the author developed of using students' “celebrity object” relationships to idiosyncratically cathected popular culture figures to allow for increased engagement with analytic ideas.
The author presents a clinical psychoanalysis in which his Jewish patient fears that her non‐Jewish analyst hates her for being Jewish. Antisemitic expressions of hate toward the analyst have been well‐documented, but a fear of the analyst's hateful transference to the patient has not been previously examined in a published report. This transference led to an impasse in the treatment and prompted exploration of countertransference on the analyst's part; was he, unconsciously, expressing any religious hatred? The author examines a technical question of whether such a transference can be analyzed in the usual way as a displacement of infantile trauma? Or do the antisemitic aspects of the transference need to be examined and understood in their cultural and religious implications first and then analyzed as a real aspect in the external world before its infantile roots can be exposed? In this particular case, the author concludes that the latter approach is necessary and useful to facilitating clinical progress. The author suggests that this approach may be applicable to other analyses where there are racial, class, or religious differences and the patient develops fears about the analyst's attitude. The author offers this case as an example of the necessary integration of cultural and sociological issues into the classical model of intrapsychic conflict.
In this paper we present the main features of a 10‐year, twice‐weekly psychoanalytic psychotherapy with a female subject (Clare) who presented with severe depression, self‐harm and suicidality. Serious traumatic events in her upbringing led to the formation of a pathological defensive structure based on a rigid identification with the aggressor, used as a dysfunctional means of protecting her against the threat of severe anxiety and psychic annihilation. Although the prognosis appeared bleak, her motivation for greater self‐understanding, her resilience and her therapist's commitment to analytic work allowed for a strengthening of the therapeutic alliance. Gradually and painfully, Clare succeeded in recognizing the difference between her cruel primary figures and the figure of a caring and containing psychotherapist, which in turn allowed her a more robust internalization of a benign object. The change in the nature of the transference towards greater trust coincided with improvements in her life, in the quality of her interpersonal relationship and external functioning. Psychiatric medication was gradually withdrawn and Clare found a part‐time job. Improvements were maintained by follow‐up consultations. The positive outcome confirms that long‐term psychoanalytically oriented therapy is an effective approach for the treatment of subjects presenting with severe emotional difficulties.
In this paper I initially describe Benjamin's conceptualization of the Third followed by Complementarity, within an evolving psychoanalytical context marked by a ‘relational turn’. I then briefly outline the current debate surrounding the use of therapist self-disclosure in the analytic process. With the clinical vignette, I aim to illustrate the impact of self-disclosure on relational dynamics in the room, and I do so via two self-reflective appraisals, separated in time and interpretive quality, of an affectively charged session with a client of mine I refer to as Anne. With this narrative structure I endeavour to highlight the inherent complexity in discerning the intrapsychic and the intersubjective in the therapeutic process. I also suggest a basic guideline for the verbalization of disclosures as a kind of sextant to help the analyst negotiate the affective tempests that can suffuse a therapeutic encounter. However, I emphasize it is the analyst's capacity for embodied self-reflection, which needs to be developed via personal therapy, supervision and experiential groups, that remains the most important navigational instrument.
Proceeding from oneness to twoness is a psychological process of relating inter- and intrapersonally. This article links the perspectives of French psychoanalyst André Green's concepts of the dead mother and narcissism with Hester Solomon, British Jungian analyst writing on the 'as-if' personality. These concepts are elucidated with the composite example of a self-described sexually addicted man. His behaviours attempted to mask the shadows of melancholy, a fragile self, and the absence of self-animation from early emotional wounds. He did not know love or the other. André Green, French psychoanalyst, described feelings of misery, lack, and emptiness. The defence against relatedness arises from fears of replicating the original object losses. He delineated death narcissism and life narcissism as limiting relationships and creating the illusionary. Narcissus could not live if he knew himself. Immersion within singularity occludes relationship to the unconscious and the other, like Echo. Jung's concept of the transcendent function evolves from inclusion of the symbolic through listening to the language of the unconscious. Through the transference and countertransference, the former disowned and split-off others, secreted in the shadows of addictions, open relatedness to self, soul, and world.
Abstract
This paper is based on the author’s experience of working with a particular group of female/male trans children and young people who present a similar clinical profile: a fragile ego prone to fragmentation and concrete thinking. Often, there is evidence of a grievance over the failed ideal object, which is internalized, projected into the body, and then attacked. Faced with the developmental challenge of sexuality at puberty, young adults withdraw to a psychic retreat designed to halt development. This paper focuses on the development of a trans identity in defence against an underlying fear of depressive anxieties and psychic collapse. It describes the ongoing assessment of Joanne, a 19-year-old biological female who wanted to be known as Luke in therapy and wished to transition in the belief that this was the only way she could have a life. The concrete nature of Joanne’s thinking created problems in the therapy, as thoughts were often experienced as physical actions. This paper describes the function of the phantasy that transitioning performs in creating a psychic retreat from the demands of psychological development.
In this paper, I am concerned with the question of relationship between internal personality integration and external integration in the community within the context of voluntary migration. Migration always includes a loss of all that one has left behind. Both internal and external integration in the new community thus involve a mourning process that involves a working through of depressive position anxieties. Only then can the migrant turn towards the new object, the new community and initiate a process of integration. This process is particularly difficult for patients with an entrenched system of narcissistic defences, in which they have turned away from the helpful object, also the helpful object of the community around them and the helpful object of the analyst. These are often patients who have used the migration as a kind of psychic retreat. The difficult process of integration is illustrated in this paper with the treatment of Mr B.
In this paper we present a theoretical framework to understand the underlying psychological mechanism involved in human-Companion Robot interactions. At first, we take the case of Sexual Robotics, where the psychological dynamics are more evident, to thereafter extend the discussion to Companion Robotics in general. First, we discuss the differences between a sex-toy and a Sexual Robots, concluding that the latter may establish a collusive and confirmative dynamics with the user. We claim that the collusiveness leads to two main consequences, such as the fixation on a specific and atypical type of sexual interaction, called paraphilic, and to the infantilization of the user, which we explain through the theoretical framework of "object-relation theory". We argue that these dynamics may degrade to an infantile stage the relational abilities of users, extending this argument to Companion Robots in general. Then, we enquire if and how the relational dynamics enacted in HRI may shift to human relations: we discuss the analogy with virtual reality concluding that, under certain condition, a symbolic shift might happen. In the last part of this work, we propose an experimental setup to verify if a collusive and confirmative interaction with a Companion Robot can, over time, impact on the user's ability to manage relational frustration.
This paper explores potential reasons why a high proportion of children of alcoholics develop significant substance misuse problems. The author suggests it is potentially indicative of transgenerational trauma, which results in developmental deficits that may be managed by substance misuse. The paper describes how Jung's concept of the transcendent function provides a powerful therapeutic tool to link divided and split off parts of the self in a containing matrix. This is contrasted with Kleinian approaches to addictive states of mind. The alcoholic defence or ‘solution’ is examined through a Jungian lens. The transformative potential lies in holding the tension between wanting to ‘give up’ the family cycle of alcoholism versus ‘giving in’ to the alcoholic solution. Moving away from an identification with the alcoholic solution involves mourning and loss which is often vehemently resisted. The value in Jung's idea of the transcendent function is in the creative potential leading to growth arising from the dynamic tension of these opposites. The paper describes how they come together in fantasy, symbols and transference using a clinical case.
A presentation of emotional detachment is sometimes encountered in working with challenging patients. The term ‘disavowal’ describes a particular kind of splitting of consciousness in which the person repudiates awareness of disturbing realities or their meanings. Disavowal involves a distortion of emotional significance, rather than a distortion of perception, as in the case of a dissociative split in consciousness. Detachment protects the individual from emotional contact, which is experienced as potentially overwhelming. Safety is achieved, but at the cost of denuding mental life of meaning. With the help of detailed clinical material, the challenges of working with a person who has established a psychic retreat based upon disavowal are outlined. I describe the clinical challenges of working with someone who places themselves out of reach of emotional engagement. A state of inbetweenness protects the person from knowing about their aggressive impulses, their need for care and the passing of time. This forestalls experiencing the dangerous, shameful feelings of dependence. The clinician needs to recognize the necessity for the defensive retreat, whilst being patiently ready to enter engagement when the patient becomes available.
Peacemakers dealing with violent conflicts are often exposed to stressors that are detrimental to the peacemaking process. Such stressors hinder performance and challenge the peacemakers' professional identity and identifications, both consciously and unconsciously. Moreover, peacemakers may risk contamination by the “radioactive,” traumatic elements of the violence inherent in the bellicose situations they deal with at the peace table. They may become “crypt carriers” of expulsed mourning and denied lost objects. In this study, I elaborate on whether a group psychoanalytic approach to analyzing peacemakers' practice can offer mediators the space to explore, elaborate on, and symbolize the unconscious dynamics underlying their practice. Having such a space can help them perform the psychic “work of trauma,” and shield or decontaminate them and their practice from the “radioactive” effect of the potentially traumatic elements of their profession. Such an approach can provide peacemakers with a complementary tool for developing their practice.
The guilt and shame of participating in an indecent consumerist way of life that causes climate change and mass extinction of species inflicts a moral wound on us. This moral wound arouses an indignation of which the "Greta generation" is one of the spokespeople, and it involves developing an ethic of relations between our species and non-human species. We must learn to "think like a mountain", in the words of Aldo Leopold, that is to say in an ecosystemic way, in order to accept our true place in the biotic community of microorganisms, flora and fauna: that of "children of the biosphere", a biosphere on which we are as dependent as an infant is its parents. The author argues that developing such an ethic requires a work of culture to think about new environmental paradigms, especially the fact that humanity endlessly artificializes nature, even its own nature, to the detriment of the wild part of them. Can the Œdipal situation, its taboos and its respect for fecundity be extended to our biotic family?
Professional work groups engaging with traumatized and dysfunctional families are presented with a disproportionate challenge to an already inevitably painful process that can be an obstacle to balanced decision-making in the children’s best interests. Trauma, abuse and neglect can influence the professional culture that condenses around these families. This occurs more often with the most challenging families with a possible history of professional failure resulting in professional conflict, impulsive and poor decision-making due to the occasions that these destructive dynamics have become unmanageable. Serious case reviews into the deaths of children regularly outline professional failures relating to a breakdown in communication within the professional system and essential and potential lifesaving information having been lost or failing to have been acted upon. The ability to understand complex group and organizational dynamics and the ability to manage relationships with traumatized adults and children, as well as within traumatized work groups is, therefore, an essential skill set for professionals working with the most vulnerable children and families. This article explores trauma and its impact on a work group and why this process was disturbed by uncontained anxiety resulting in professional conflict.
This article addresses the complex issues when working with group members who have been traumatized by institutional and inter-generational racism in the context of white supremacy. The article engages with how a group analytic understanding can assist clinicians to engage with group members who have experienced racial trauma and structural oppression when these dynamics are inevitably generated in psychotherapy groups. I discuss the concepts of ‘erasure’, ‘bearing witness’ and also introduce the concept of ‘psychic ghettoization’, which can provide the conductor with some conceptual tools to manage the complex issue of racial trauma. I argue that there is now more than ever a need to remain relevant to the diverse and often marginalized communities we serve. To do this requires group analysts and indeed all clinicians to urgently scrutinize and develop theories and techniques for working with racism in our practices and clinics. A lack of intervention equates to a by-standing and a complicit collusion with racism which risks a re-traumatizing dynamic being paralleled in our clinical work with group members from marginalized communities.
The current situation of refugees demands a redefinition of our understanding of the concept of psychological trauma. Posttraumatic stress disorder (PTSD) cannot be used to account for the variety of posttraumatic reactions. This paper presents an alternative approach illustrating how theories on traumatisation and its treatment may take into account salient dimensions of man’s semiotic relations to others: body-emotional relations to the environment, relations to the groups/family, and relations to the socio-politico-cultural context. Each of these dimensions have an unconscious base, influencing the person’s capacity for repairing the trauma-processes.
Psychoanalysis is: 1 A personality theory, and, more generally, a theory of psychological functioning that focuses particularly on unconscious mental processes; 2 A method for the investigation of psychological functions based on the exploration of free associations within a special therapeutic setting; 3 A method for treatment of a broad spectrum of psychopathological conditions, including the symptomatic neuroses (anxiety states, characterological depression, obsessive–compulsive disorder, conversion hysteria, and dissociative hysterical pathology), sexual inhibitions and perversions (‘paraphilias’), and the personality disorders. Psychoanalysis has also been applied, mostly in modified versions, i.e. in psychoanalytic psychotherapies, to the treatment of severe personality disorders, psychosomatic conditions, and certain psychotic conditions, particularly a subgroup of patients with chronic schizophrenic illness. All three aspects of psychoanalysis were originally developed by Freud whose theories of the dynamic unconscious, personality development, personality structure, psychopathology, methodology of psychoanalytic investigation, and method of treatment still largely influence the field, both in the sense that many of his central ideas continue as the basis of contemporary psychoanalytic thinking, and in that corresponding divergencies, controversies, and radical innovations still can be better understood in the light of the overall frame of his contributions. Freud's concepts of dream analysis, mechanisms of defence, and transference have become central aspects of many contemporary psychotherapeutic procedures. Freud's ideas about personality development and psychopathology, the method of psychoanalytic investigation, and the analytic approach to treatment gradually changed in the course of his dramatically creative lifespan. Moreover, the theory of the structure of the mind that he assumed must underlie the events that he observed clinically changed in major respects, so that an overall summary of his views can hardly be undertaken without tracing the history of his thinking. The present overview will lead up to summaries of his final conclusions as to the structure of the mind and how this is reflected in personality development and psychopathology. Psychoanalysis will then be described as a method of treatment, as seen from the point of view of resolution of conflict between impulse and defence, and from that of object-relations theory. We shall explore significant changes that have occurred in all these domains, and conclude with an overview of contemporary psychoanalysis, with particular emphasis upon the presently converging tendencies of contemporary psychoanalytic approaches, and new developments that remain controversial.
Despite many splits and schisms, dating back to Adler and Jung's early break with Freud, there has been an enduring attempt within psychoanalysis to hold to a central psychodynamic vision and to find common ground between differing theoretical and clinical approaches. The aim of this chapter is to describe the work of some of the major figures who have extended and developed Freud's ideas, pointing to areas of both conflict and convergence, and, wherever possible, to relate their concepts to the everyday practice of psychiatry.
Psychoanalysis is hardly a practical treatment alternative for the twenty-first century. The principles derived from this treatment, however, have powerfully influenced other psychotherapeutic approaches, whether long-term or short-term therapy or psychiatric care more generally, particularly in the United States. At the time of its invention, it was the unique effective psychosocial treatment method for psychiatric disorder which offered a genuine alternative to the sometimes barbaric and generally ineffective treatment methods available. Not surprisingly, its proponents adopted an almost religious zeal in defending its value against alternative approaches. While understandable, such an attitude has no place in the sophisticated evidence base underpinning multi-agency service planning. Psychoanalytic clinicians face a challenge in identifying their niche in the complex mental health care delivery systems of the twenty-first century.
The paper seeks to describe how a sado-masochistic dynamic for a long period of time characterized the relationship between the analyst and the analysand. But after a dawning reflective understanding that the analytic relationship was filled with sado-masochistic quality he succeeded better in liberating himself from a destructive pathological dynamic and reclaim an analytic attitude. The discussion of the clinical material consists of mainly three parts: The sadomasochistic relationship gives a picture of the power-struggle in the patient´s general way of relating. The understanding of enactment shows how this is played out in the relationship with the analyst, and technically how analyst-centred-interpretations can be a tool in addressing this difficult and emotional straining work. The author also claims that there is a natural connection between these constructs in analysis with children taken into account that children are emotionally more immature with a tendency to acting out and to a greater degree need the emotionally containing- and affirmative basis of analyst-centred interpretations that exemplifies the need of a containing analyst with an alpha-function.
This article proposes the concepts of psychodynamic intersectionality and intersectional group analysis by addressing the complex issues of the positionality, or self-location, of the group analyst when working with diverse and intersectional patient groups who have been traumatized by structural oppression, institutional and inter-generational othering. I critique the positionality of the group analyst and the essential intersectional and inter-subjective nature of the role and interventions they may or may not make in the group. The article engages with the need not to deny how an understanding of the positionality of the group analyst is central to the clinical frame. Such understanding can assist the clinician to engage with group members who have experienced structural oppression when othering dynamics are inevitably generated in the group matrix. Such dynamics are often being paralleled in the social unconscious and occurrences in society at any given time. I argue that a failure on behalf of the group analyst to reflexively position themselves in relation to powerful phenomena, such as, racism, sexism and homophobia and occurrences in the social unconscious risks a re-traumatizing dynamic being paralleled in the group matrix to the determent of group members from marginalized communities.
The article covers diverse approaches of the term secret: individual, group, social, transgenerational and psychoanalytical, with reference to various psychoanalysts having reflecting about this topic. The author pays special attention to importance of secrets in the psychoanalytic relationship. Conscious and unconscious secrets are brought into play in transfer-countertransfer, stressing on the importance of tolerating the secrets without forcing its disclosure. The analyst’s capacity to tolerate the unspoken and wait for the timely moments of intervention can allow the development of the internal space in the analytical process.
The paper gives a survey of the origin of the concept of the super-ego in Freud’s work and its further elaboration within the different psychoanalytic traditions. It introduces three papers on the perverse and psychotic super-ego, the development of the concept in Bion’s work and its significance for psychoanalytic social psychology.
The ideal, an unrealizable state of perfection where reality does not apply, is a familiar phenomenon in the consulting room and in the wider society. Its grip is immensely powerful and it is connected to two significant negative emotions, shame and ressentiment (a particular form of grievance in which the grievance is nursed). This article examines whether these two different emotions arise from two different kinds of relation we take up to the ideal. Shame arising when we fail to be the ideal, ressentiment arising when we fail to have or possess the ideal. There are also good grounds for believing that each emotion is connected to a distinctive form of splitting, whilst shame seems to be governed by the law of all or nothing, ressentiment is governed by the law of right or wrong. Western civilization seems to be in thrall to the ideal, that is, to a place where there are no limitations to the possible and where time and loss do not apply. With the climate emergency deepening every month the question remains, when will we Moderns wake up to reality?
In this paper I try to summarise the contributions of some analysts who have been engaged in the therapy of psychotic patients. I have divided them into two categories: one following intuitive-non-systematic models, and the other theoretical-systematic models. My hypothesis is that the psychotic process is formed and nourished in childhood withdrawal, where the child constructs an alternative world that is dissociated from psychic reality. The patient no longer uses his mind as a thinking organ but as a tool to produce sensations that make psychic and emotional reality incomprehensible; this state of mind produces hallucinations and delusions. There is no doubt that psychoanalysis is faced with an important task as regards theoretical and clinical research in the field of psychosis. No therapeutic method possesses such a useful and effective observational tool as clinical psychoanalysis, which allows daily contact with the patient and continuous reflection on his transformations.
In this paper, I explore the topic of primitive bodily communications and countertransference enactments, with a particular focus on the part played by bodily odour. To explore this topic, I discuss a two‐year treatment with a patient who presented with a mix of borderline and narcissistic diagnostic features. I describe meaningful aspects of the difficulties faced in countertransference work when receiving and making sense of the patient's use of primitive defences and I highlight their expression through a very uncomfortable symptom: an extremely unpleasant bodily smell. My thesis is that the smell communicated preverbal and unsymbolized experiences of early physical and emotional neglect, as well as evacuating the toxicity of those experiences. In this way the smell acted both as a bridge, which could help me reconstruct my patient's early traumatic past, and as a drawbridge, to keep me at distance and maintain his past dissociated. The invasive and aversive nature of the smell can also be seen as representing the approach‐avoidance dilemma typical of a disorganized attachment state of mind, acting both as a bridge and as a drawbridge to attachment and relating.
Notions of whiteness, white supremacy and racial hatred such as the recent multiple racist murders by a white supremacist in New Zealand are at the forefront of public consciousness. How do whiteness and racism play out in a clinical and social welfare context? This article illustrates the impact of trauma on a vulnerable young white woman who although was not the direct target of a racist assault was left traumatised by witnessing it. It discusses how initially she sought refuge in a racist solution synonymous with a psychic retreat to her own detriment. Working with such complex, unconscious and bewildering dynamics is extremely challenging for clinicians. It describes the impact of these dynamics on a clinician of colour who attempted to work with this young woman in a child and adolescent mental health service after the family was referred as a consequence of her assaulting her child shortly after witnessing the racist attack. The unconscious responses to trauma and challenges for clinicians and clinician of colour in particular when working with racism in the consulting room are also discussed.
The work begins with general considerations about man’s symbolic universe and his varied languages. It carries on with the consideration that the linguistic essence of man is his nominating speech, different from all other languages in the animal kingdom. Through a clinical illustration the work moves on to discuss the vicissitudes of human language when it cannot name certain experiences. The work proposes that the contemporary analyst can and should listen to the varied languages of man and, with a specific technical stance, help the patient, through intermediary moments, to think what was unthinkable, to name what was unnameable. It departs from listening to the language of the non-symbolic, which depends on the analyst’s capacity for reverie and their capacity to metaphorise the patient’s reports, to propose instead the construction of symbolic forms through the use of scaffolding for thinking. This is what permits the historicising, the placing of the patient’s life in a narrative. If this does not take place, there is an eternal presentification of the traumatic emotional experience, resulting in the “murder of time” (Green).
This paper aims to expand our thinking about and understanding of two very primitive anxieties that are prominent in various primitive mental states in general and in disorders found along the autistic spectrum, in particular: the fear of falling and the dread of self‐dissolution. These anxieties are illustrated through two personal dreams of the author, two clinical cases, various art works and Beckett's short story ‘The expelled’ (1946). Theoretical developments in psychoanalytic theories for understanding these anxieties are presented and discussed, with the aim to clarify the matrix of object relations specific to each of these two anxieties.
This paper raises a series of historiographical issues about the nature of lunatic asylum archives. It addresses one central thread, namely the relationship between the phenomenology of mental illness, and the many kinds of records in which it is reflected. It suggests that there is a fundamental paradox involved in the rational, orderly and coherent representation of mental illness generated by lunatic asylum bureaucracy, and the chaotic multiplicity of the lived experience of patients, many suffering from illnesses that involved irrational, disordered and incoherent states of mind.
The paper begins by raising as background the relationship between thought, language and experience, and ways in which this defies straightforward representation in clinical case histories. It goes on to examine aspects of lunatic asylum archives, including statistics, correspondence and case records, and ways in which these might either mislead, or fictionalize histories of these institutions. It suggests that archival work, particularly with respect to capturing the complexity and emotional violence of these institutions might require historians to ‘dream the archive’. This is the work of disciplined imagination that might act as a guide in traversing deeply irrational territory.
The paper ends by highlighting several issues that historians of lunatic asylums might address.
Using material from clinical practice and social research, this paper examines the many connections between the analysis of ressentiment provided by Nietzsche and Scheler and recent psychoanalytic analyses of grievance. Psychoanalysis has been particularly insightful regarding the process of ‘nursing’ grievance, something which illuminates both the righteousness of the anger involved and the yearning for an idealized past. It is argued that in their different ways both analyses explore blocked responses to perceived injustice and, whilst the emphasis in both cases is essentially upon how existential reality itself can be experienced as an injustice, Scheler's analysis also provides us with a way of understanding how ressentiment can be a response to real social injustices. Indeed social ressentiment is now widely regarded as the affective foundation of reactionary forms of populism.
What emotional experience settles a disturbed state of mind? In this paper I use the work of three psychoanalytic clinicians (John Steiner, Eric Brenman and Henri Rey) to describe the negative state of mind of a patient and draw on clinical material to illustrate my efforts to settle deep emotional disturbance. Recognizing the size of the emotional task by conceptualizing the depth and breadth of the pathological organization, along with thinking carefully about the ingredients of a ‘strengthening introject’ and locating an ‘introjective site’, taking into account the developmental disparity between therapist and patient are all seen as essential counter-transference processes required to facilitate movement from a bad to a good state of mind.
This chapter outlines the interdisciplinary framework for understanding child welfare used throughout the book. This includes children’s rights, sociology, feminist, anthropology and psychosocial approaches to the study of childhood and child protection as a foundation for understanding contemporary child welfare policies and practices. Issues of social inequality, poverty, and ‘race’ and ethnicity are explored in relation to social work practice and child protection. Lastly it also makes use of some of the literatures that have been developed around children’s geographies and mobilities. The chapter introduces child-centred practice which is at the core of the book. It critically examines the way that children’s participation in decision making has been embedded into social work practice.
This article discusses the anxieties that lead to resistance to anti-racist and culturally sensitive reflection and engagement on social work trainings. It briefly discusses a culturally diverse social work training and the anxieties described by the students that hindered the integration of the teaching of race and culture during the training. The article then contrasts this with another more successful training experience on another social work course at a different university with a similar level of cultural diversity by the use of the group as a psycho-educational method to manage the student’s defences and avoidance of the difficult and painful knowledge required to enhance reflexivity when it comes to issues of race. It discusses how the role and skills of the seminar leader can manage the student’s defences through the use of group dynamic processes and concepts as psycho-educational tools; thereby deepening the observational and reflective skills of the social work students during their training in preparation for their future work within diverse settings and in line with the social work competencies and regulation requirements.
It is common knowledge that the same phenomena can be viewed in a variety of ways. This paper considers the implications of a constellation observed in some adult patients who have increasingly reminded the author of some of the children of latency age with whom he has also worked. In the literature these patients may also have been thought about in terms of 'defences of the self' (Fordham), patients who are 'difficult to reach' (Joseph), 'psychic retreats' (Steiner), and those who make 'attacks on linking' (Bion). They may equally be considered in terms of schizoid, narcissistic or borderline personalities, or as showing features on the autistic spectrum, such as mindlessness and extreme obsessionality. Writers such as Helene Deutsch with her concept of an 'as-if personality', Winnicott with his 'false self', and Rosenfeld, discussing the split-off parts of the personality in narcissistic patients, have also offered much to think about in their consideration of some of these phenomena. This paper proposes yet another vertex - the author's own imaginative conjecture - that is by no means mutually exclusive of any of these others.
This paper discusses the challenges of struggling to build and maintain a therapeutic alliance with a psychotic adolescent boy who did not share an allied perception of reality with his therapist, and who insisted that his therapist did not exist. The paper poses the question of whether, under such circumstances, it is ever appropriate or tolerable to make transference interpretations. Drawing on detailed clinical material, the author attempts to make sense of how it was possible to make some contact with his patient, given these technical difficulties.
This paper will consider what impact a learning disability may have on development and transition in a child's life. With reference to Hollins and Sinason's ‘Three secrets’ (2000), Alvarez's ‘Levels of psychoanalytic work’ (2012), and attachment theory, I will reflect on the development of the self when there is learning disability. The paper will go on to relate Winnicott's paper, ‘Transitional objects and transitional phenomena’ (1953) to the theory and practice of integrative arts child psychotherapy (IACP). In IACP, objects, play and creativity form a central part of the treatment. Drawing on clinical material from my long-term treatment of two young people in particular, I will link the therapeutic effect of objects with Winnicott's ideas about creativity, aggression, motivation and the expression of self. In the paper I set out how, through the therapeutic use of objects and what I call, ‘object games’ we were able to address the children's experiences of trauma as well as the impact of their disabilities. I will describe the changes I saw in the internal worlds of my patients which in turn led to significant and positive changes in their relationships with self and with others. These changes came, over time, to allow them greater independence and self-determination in everyday life.
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