Phallic Integration and Male Identity Development

The analytic setting as well as the analyst's initial communications unavoidably exert influence that may be perceived by the patient as a sexually tinged intrusion, which evokes questions about what the analyst wants. Together with the asymmetry of the analytic relationship, these phenomena uncannily bring to life a repressed relationship between infant and adult in which analogous stimuli constitute enigmas for the child. The theoretical understanding of Jean Laplanche of such enigmatic transference in terms of “primal seduction” is reviewed and clinical material is provided to illustrate Laplanche's ideas. The discussion addresses “recentralized” and “decentralized” aspects of sexuality. Primal seduction is discussed as including not only intrusion, but also qualities of stimulation and trust.     

Enter Ghosts: The Loss of Intersubjectivity in Clinical Work With Adult Children of Pathological Narcissists

This paper examines the relationship between narcissism and intersubjectivity through the lens of clinical work with adult children of pathologically narcissistic parents. Exposure to parental narcissistic pathology constitutes cumulative relational trauma, which subverts the development of intersubjective relating capacities in the developing child. This trauma is inherited and bequeathed intergenerationally. The paper focuses on the interpersonal dynamics of narcissism, which are conceptualized as “the pathological narcissist's relational system,” describing the need to establish complementarity in relationships through coercive projective processes, and through the adoption of the “complementary moral defense.” Clinical material highlights the loss of intersubjective functioning typical of the relationships formed by adult children of pathological narcissists, and the inevitability of episodes of mutual dissociation in analytic work with these patients.     

At the verge of unthinkable anxiety: On the relevance of a neurophysiologically informed relational perspective on meaning-making in psychosis

Abstract

This article examines the relevance of relationally oriented psychoanalytic phenomenology as a frame of reference for understanding psychotic states in schizophrenia. The etiology and structural characteristics of such states are examined from both a neurophysiological, and a relational and interpersonal point of view. Many findings indicate organic abnormalities in schizophrenia, acquired through an exposure to physical risk factors and genetic predisposition, but relational traumas also seem to have an impact on the form and content of psychotic states. This may happen through interruptions in the “use-dependent” maturation of the brain in a relational milieu. In addition, at the level of meaning-making, we find that the emotional and relational contexts—both past and present—give the substance or “raw material” for hallucinations and delusions. In a psychotic state, the person also tries to handle basic affects and relational needs, and to make meaning in states of overwhelming chaos and anxiety. Donald W. Winnicott's theory of “a holding environment”, Stephen Mitchell's theory of the relational matrix, and Stolorow, Atwood, and Orange's concepts of a “shattered world” and annihilation anxiety are used as a framework in the analysis of the phenomenology of psychosis. Two case illustrations, one from child psychotherapy and one from therapy with an adult patient, are used to illuminate the theoretical points of view.     

Gender Policing in the Clinical Setting: Discussion of Sandra Silverman’s “The Colonized Mind: Gender,Trauma, and Mentalization”

This is a discussion of Sandra Silverman’s clinical paper “The Colonized Mind: Gender, Trauma, and Mentalization.” Her patient, David née Ava, started early in life as a gender variant child. In adolescence, she became more stereotypically gender conforming. She entered treatment with Silverman as a young adult who was feeling great shame about both her past and present gender dysphoria. This discussion focuses on the clinical problem of gender policing, its external and internal manifestations as well as its appearance in the countertransference.     

Shades of Mark Twain: Commentary on Paper by Steven H. Cooper

The author considers Cooper's notion of the pluralistic third from several angles as Cooper's use of the term covers a range of applications from that of an internal supervisor to the use of ideas from psychoanalytic traditions other than one's own in evaluating one's clinical work. The impression created of the American situation is contrasted with the institutionalized pluralism of the British Psychoanalytical Society since the Second World War. The author believes that the theoretical question of the analyst's accountability to a professional authority is overdetermined in the paper because the clinical material is dominated by the patient's problems in facing up to parental authority. A crucial enactment is seen as starting at the analyst's first contact with the patient, which seems to subvert the analyst's capacity to be an authority figure. The analyst finds a working relationship with his own psychoanalytic authority in the second session of the analysis but seems to lose it through an overextension of the ideas of “play,” self-questioning, and the seeking of agreement between patient and analyst. The author considers the clinical material from the point of view that his peer supervision group would take.     

Commentary on Paper by Lawrence J. Brown

Brown's historical overview of post-Kleinian psychoanalysis traces key steps in the evolving and diverse practice of working in the psychoanalytic situation while regarding it as a two-person field. The Barangers' “The Analytic Situation as a Dynamic Field” is central to his narrative. I develop my understanding of the originality of their contribution in theorizing a situational unconscious, and of their continuing relevance for thinking about analytic listening and intersubjective collaboration. Brown presents a countertransference dream of his own along with the dream of a patient as an example of the Barangers' concept of the “shared unconscious fantasy” of the analytic couple. A detailed alternative reading of Brown's clinical vignette reveals an absence of fit with the Barangers' views on collaboration in the analytic situation. Some uses of Bion's “dreaming” and “becoming” are implicitly questioned as they risk encouraging the idealization of special states over process.     

Introduction to Group-Analytic Psychotherapy by S. H. Foulkes

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she “understands” because of having also grown up in an alcoholic family); (b) the “will to restore,” which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a “rush to recovery” on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) “countertransference goodness and availability” as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.     

V. M. BEKHTEREV IN RUSSIAN CHILD SCIENCE, 1900S–1920S: “OBJECTIVE PSYCHOLOGY”/“REFLEXOLOGY” AS A SCIENTIFIC MOVEMENT

In the early 20^th century the child population became a major focus of scientific, professional and public interest. This led to the crystallization of a dynamic field of child science, encompassing developmental and educational psychology, child psychiatry and special education, school hygiene and mental testing, juvenile criminology and the anthropology of childhood. This article discusses the role played in child science by the eminent Russian neurologist and psychiatrist Vladimir Mikhailovich Bekhterev. The latter's name is associated with a distinctive program for transforming the human sciences in general and psychology in particular that he in the 1900s labelled “objective psychology” and from the 1910s renamed “reflexology.” The article examines the equivocal place that Bekhterev's “objective psychology” and “reflexology” occupied in Russian/Soviet child science in the first three decades of the 20^th century. While Bekhterev's prominence in this field is beyond doubt, analysis shows that “objective psychology” and “reflexology” had much less success in mobilizing support within it than certain other movements in this arena (for example, “experimental pedagogy” in the pre‐revolutionary era); it also found it difficult to compete with the variety of rival programs that arose within Soviet “pedology” during the 1920s. However, this article also demonstrates that the study of child development played a pivotal role in Bekhterev's program for the transformation of the human sciences: it was especially important to his efforts to ground in empirical phenomena and in concrete research practices a new ontology of the psychological, which, the article argues, underpinned “objective psychology”/“reflexology” as a transformative scientific movement.     

Making “Use” of Aggression in Child Psychotherapy

In this article, informed by Winnicott's seminal 1969 article, “The Use of an Object and Relating Through Identifications,” I aim to illuminate the transformational possibilities that emerge when adults view particular forms of aggression as expressions of hope. I examine the processes associated with taking a child from what Winnicott referred to as object relating to object usage, with particular focus placed on the links between theory and practice. I highlight the importance of one mobilizing the social environment toward the attention of the child through limit setting while concurrently tolerating the child's aggressive acts by not retaliating or retreating. This shared relational journey involves helping a child move from the omnipotent but very lonely, anxiety-filled, encapsulated world of their own projections to a coconstituted reality and involves the child engaging in destructive activity (aggression) and the significant adult surviving. It is hope that underpins this destructive enterprise. When the child finally comes to realize that the other is not under their omnipotent control, that is, when the child has tried to destroy, and the other has survived, the child can then, and only then, forge a mutual partnership with the other. Conceptual points are illuminated through the presentation of case material.     

From “It's Not Me” to “It Was Me,After All”: A Case Presentation of a Patient Diagnosed with Dissociative Identity Disorder

In cases of extreme childhood trauma associated with abuse and neglect, one's sense of self is seriously compromised. Attachment patterns, symptoms, defensive operations, and character formation will differ depending upon the level of interference and impingement. When repeated trauma occurs in early childhood, the dissociative response may become the first line of defense for the person to rely upon. In its most severe form, patients are diagnosed with Dissociative Identity Disorder (DID). This paper addresses the case of a woman diagnosed with DID. It describes the restoration of a cohesive sense of self from the eight parts of a dissociated and fragmented self in the course of therapy. The clinical case material presented is that of the child part of her, known as Lucy. Her treatment resulted in the integration of the “it's not me!” self to the patient's knowledge that “it was me, after all.”     

ABSTRACTS OF LITERATURE

Schizophrenia is due to a combination of genetic and environmental factors. The author asserts that there has previously been an error in conceiving the patient as being molded completely by external circumstances. In fact, it is the patient's behavior, which is a transformation of family irrationality, that constitutes schizophrenia. In 75 per cent of cases of schizophrenia seen by the author in private practice, the mother did not fit the image of the so-called “schizophrenogenic mother.” In this technique for teaching family therapy, the students take the roles of the family. Procedures, selection of players, formulating the problem, the value of the experience, and ground rules are described. This is a case report and follow-up over nine years of an alcoholic woman. The patient and husband were treated for 35 sessions by cotherapists in conjoint marital therapy. Although there was improvement in the family patterns and in drinking behavior during the treatment, the improvement did not last after termination. The case suggests that marital therapy in the absence of other treatment interventions is ineffective in changing the long-run course of women alcoholics. Based on the author's practice on an inpatient unit that specializes in the study of aggressive behavior, he describes family dynamics and treatment when the identified patient suffers from “episodic violent behavior.” The sample focuses on adolescents, most of whom had episodes of suicidal behavior and who had some evidence of “organic involvement.” Typical family patterns include overly close alliances by the adolescent with one or both parents and transmission by parents of inconsistent values regarding aggression. Family therapy is seen as the preferred treatment approach and emphasizes family ways of handling dyscontrol episodes and the responsibility of the patient for his or her actions. No results are reported. This study attempts to link family variation and core relationships in types of families with the mental health of children. Sample was from a black, poor, urban community defined in terms of the adults present in the home. Eighty-six family types were found falling into ten major classes. Measures of mental health in children were done on psychological well-being of the children and on Social Adaptational Status. Results indicate that family type is strongly related over time to child's SAS and his or her psychological well-being. Mother-alone families entail the highest risk in terms of social maladaptation and psychological well-being of the child; the presence of certain second adults has important ameliorative functions—mother/grandmother families being nearly as effective as mother/father families, with mother/stepfather families similar to mother-alone in regard to risk. Inferences from this data and implications and interventions are discussed. This is a clinical essay on the role of family therapy for black families. In addition to the usual family stresses, black families are subject to the additional strain of discrimination. Support is achieved mostly from the family and from the kinship network, rather than the community. Treatment strategies for this situation are proposed. This essay reviews recent regulations concerning consent procedures and protection of privacy as they apply to children and their families. Rigorous sample selection, nearly complete follow-up, and objective assessment of outcome are virtually impossible at this point. It is concluded that compliance with current “subjects' rights” regulations sometimes seems potentially more harmful to the subjects than the research itself. One case example is presented in support of the hypothesis that brief family therapy has the potential to lead to individual personality changes that are long-lasting. The identified patient was a 15½ year old boy with the symptom of having a falsetto voice. Father, mother, and child were seen in twelve family therapy sessions with changes in the boy's self-image documented in “man-figure” drawings. Nine-month follow-up revealed no recurrence of the presenting symptom and an improvement in social and familial relationships of the identified patient. This is another in a series of papers from a divorce-counseling project. The focus in this paper is on preventive clinical interventions developed for children of various ages in divorcing families. Developmental assessment was achieved with a “brief” history from the parents, detailed information from school, and “direct observation” of the child. This paper covers treatment strategies, interventions, failures, therapist's role, and professional dilemmas in divorce counseling of 60 families with 131 children between the ages of 3 and 18 at the time of divorce. The technique of counseling was to see one parent and child separately by the same therapist three to six times over a three-month period. This is a research study to provide data on the question of whether the disturbed behavior of parents with a schizophrenic child preexists or is a response to an identified patient's pathology. Method was to administer a conceptual task called the Twenty Questions Task individually to each family member and to the family as a unit with a sample of 36 schizophrenic families, 13 non-schizophrenic controls, and 38 normal controls. Results “indicated that far more schizophrenic sons than control sons were much more efficient individually than with their families.” A number of schizophrenic sons performed competently as individuals, but the subsequent performance of parents and sons together on the same task was generally inferior to that of the son alone. Results suggest that the parental behavior plays a part in the etiology of schizophrenia.     

Incognito or not? the patient's subjective experience of the analyst's private life

This paper examines the meaning for the patient of the analyst's personal life and personality which are ostensibly banished from the consulting room. The therapist has a not‐always‐so‐secret “secret life”; that the patient is supposed to “not know”; about. Yet, more or less unconscious perceptions, impressions, and fantasies about extratherapeutic aspects of the analyst are omnipresent and significantly color the psychoanalytic enterprise.

Moreover the analyst as a person generally plays a critical and underacknowledged role in the patient's experience of the endeavor. Constructing multiple overlapping images of the analyst and of the analytic relationship, the patient discovers himself or herself in the matrix of these relationships with various images of the analytic other. The analysand is motivated to make sense of the analyst as wholly as possible, the better to place into context the analyst's interventions. The patient's resulting view of the analyst's subjective experience acts as a lens that filters and subtly alters the meaning of the analyst's communications.

I illustrate these points by relating my work with a patient whose dreams uncannily picked up on a (consciously) unknown aspect of my private life—my having a handicapped son. The treatment thereafter centered on the patient's identification with my child (as someone “disabled") and on the meaning of her having dreamt something so personal about her therapist.     

Freud's philosophy of the uncanny

This paper is an attempt to uncover and bring to a coherent interpretation Freud's thoughts on the phenomenon of uncanniness. Starting out with the essay “The uncanny” the author wants to show that uncanniness plays an important rôle in the turn that Freud's thinking goes through at this time, and that the concept can serve as a springboard for a critical, phenomeno- logical reading of Freud's thoughts on the development of the ego. The analysis of the phenomenon of uncanniness itself tends to disrupt the coherence of Freud's earlier views and pushes him towards his later thinking. “Unheimlich” in German has the double meaning of uncanny and unhome-like, and what is not at home in itself in an uncanny sense, according to Freud, is precisely the human ego. Freud in “The uncanny” links the interpretation of uncanniness to compulsive repetition and thus makes the connection to trauma and birth anxiety discussed in later works such as “Beyond the pleasure principle” and “Inhibitions, symptoms and anxiety”. The origin of our general sensitivity to the uncanny is thus, according to Freud, the loss of the mother suffered by the child as a kind of a priori traumatic experience, which is also the very event that makes the child into an ego. The understanding of traumatic neurosis and other forms of mental illness is consequently linked to an analysis of this primal uncanniness of life.     

THE “AS‐YET SITUATION” IN WINNICOTT'S “FRAGMENT OF AN ANALYSIS”: YOUR FATHER “NEVER DID YOU THE HONOR OF”… YET

The author proposes a new hypothesis in relation to Winnicott's “Fragment of an Analysis”: that as early as 1955, in the case described in this text, Winnicott is creating the paternal function in his patient's psychic functioning by implicitly linking his interpretations regarding the father to the Freudian concept of Nachträglichkeit. The author introduces an original clinical concept, the as‐yet situation, which she has observed in her own clinical work, as well as in Winnicott's analysis of the patient described in “Fragment of an Analysis” (1955).     

“Sad day for the UK”: The linking of debates about settling refugee children in the UK with Brexit on an anti-immigrant news website

This article uniquely demonstrates how UK debates about supporting child refugees during the “refugee crisis” came to be used as support for leaving the European Union (EU). The research question “how did users of a news website respond to a report about the UK government's decision to allow child refugees into the UK?” is addressed with a rigorous discursive analysis of an internet discussion forum on the anti-immigrant website MailOnline consisting of 2,014 unique posts, with a reach of 30 million viewers. Analysis demonstrated that (1) child refugees were presented as adults, (2) allowing in refugees was presented as a “burden” on taxpayers, (3) the decision was presented as opposed to the public's will, and (4) this was used as a warrant for leaving the EU. The significant implication of this analysis is that political attempts at associating the refugee crisis with the EU may have been successful in this context.     

The Dignity of Creating: The Patient's Contribution to the “Reachable Enough” Analyst

Through the defining power of words, the phrase “difficult-to-reach” patient reflects the extent to which the analyst inverts the patient's will to change and makes the analyst the subjective agent of treatment progress. If making a constructive contribution to another person's life engenders a sense of creative agency, the traditional dichotomies of analyst/helper who gives and an empty patient who receives may not be useful. I trace the evolution of a 23-year-long psychotherapy from a parent–child dynamic through to more uncertain relational terrain in order to illustrate how the analyst's own evolution may have clashed with the patient's ambivalence toward change and endings. I raise questions of how the dignity of making a creative contribution to the “reachable enough” analyst's life may enable the patient to work through gratitude, attain a sense of belonging, and terminate with good conscience.     

Recoupling in Mid‐Life and Beyond: From Love at Last to Not So Fast

Divorce rates have dropped in the United States, except for couples over 50 where they are rising steeply, along with rates of late‐life recoupling. Both stepcouples and their young adult and adult children in new older stepfamilies are often surprised to find themselves facing many of the same challenges that younger stepfamilies do. Some challenges are even intensified by the decades‐long relationships and additional layers of extended family that come with recoupling after mid‐life. Stepfamilies formed in later life must also negotiate decisions about estate planning and elder care among stakeholders who often have sharply divergent agendas before there is time to establish trusting relationships. This article describes the “normal” challenges facing stepcouples who come together over age 50. It provides evidence‐informed guidance for therapists in meeting these challenges on three levels of clinical work: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational. As in younger stepfamilies, “family therapy” must usually begin in subsystems—often the adult stepcouple and parent–adult child. The article then describes a particularly fraught subgroup of recouplers: over‐50 fathers and their new partners, where the dad's young adult or adult daughter is very unhappy with his new relationship. In these latter stepfamilies, father–daughter repair must precede stepfamily bonding. Stepfamilies that are preceded by a partner's death and those that begin with affairs are also discussed. Finally, some “easy wrong turns” for therapists are described.     

Naughty Girls Commentary on Paper by Jackie L. Cohen

In response to Cohen's rich and evocative presentation of her case of Lisa, I offer some additional perspectives on the material. Labeling Lisa a “naughty girl,” I explore the relevance of Winnicott's notions of the antisocial tendency and of the pathology of self-sufficiency, something Corrigan and I have called the mind object. I have looked at the treatment in terms of the facilitation of regression to dependence and a child's reconnection to her body. Herzog's concept of father hunger leads me to an exploration of Lisa's finding the father in her therapist, which helps her separate from omnipotent internal objects and accept the individuality of the other. Finally, inspired by Cohen's characterization of her treatment of Lisa as “relational and action oriented,” I attempt to review what I believe is essential to child treatment and what is beautifully illustrated in Cohen's work.     

The adult attachment interview and self‐reports of romantic attachment: Associations across domains and methods

Two lines of research on adult attachment have emerged; both are based on Bowlby and Ainsworth's attachment theory, which in turn relies on evolutionary theory. Investigators in one tradition use the Adult Attachment Interview (AAI) to assess “state of mind with respect to attachment.” The AAI has been validated primarily by its ability to predict the attachment classification of an interviewee's child in Ainsworth's “strange situation.” Investigators in the second tradition use self‐report measures to assess romantic “attachment style.” The self‐report measures have been validated by their ability to predict features of romantic/marital relationships. Although the two constructs. state of mind and romantic attachment, are importantly different and so would not be expected to relate highly, some of their components, especially ability to depend on attachment figures, should be related if both stem from a person's attachment history. We report associations between components, or aspects, of the two measures. Overlap occurs mainly in the areas of comfort depending on attachment figures and comfort serving as an attachment figure for others. Implications of the findings for attachment theory and research, as well as for evolutionary psychology, are discussed.     

Two- and 3-Year-Olds Know What Others Have and Have Not Heard

Recent studies have established that even infants can determine what others know based on previous visual experience. In the current study, we investigated whether 2- and 3-year-olds know what others know based on previous auditory experience. A child and an adult heard the sound of one object together, but only the child heard the sound of another (target) object. When later the sounds of both objects were played simultaneously, the adult reacted with surprise and excitement (“Oh, listen, what is that?”). In response, both 24- and 36-month-olds directed the adult's attention to the target more often than chance and more often than in a control condition in which the adult had heard neither sound. These results indicate that by 24 months of age, children's understanding of others' knowledge and ignorance is not limited to the visual domain but extends across perceptual domains.