From Disconnection to the Seesaw to the Stage

In this article, I narrate how I used creativity in order to deal with two challenging phases in my analytic work with Sarah. In the first phase of the treatment, I used the image of the seesaw as a way to capture the procedural, nonverbal aspects of our constant stalemates, thus shifting our pattern of interaction and providing the necessary stability to further the treatment. In the second phase, I enlisted Sarah's skills as actor and director in order to enhance and expand her capacity for self-exploration, creativity, and playfulness, thus helping her extricate herself from her need to defer to my insights and observations. In this way, Sarah and I transformed the analysis into a theatrical stage where, as Helen and Nancy, we could engage as collaborators, and where she could become an agent in her own treatment, feel more competent, and assert her individuality.     

A Single Intervention: A Visit to the Family

The following letter is reported unchanged except for disguised names. Concern with repairing disrupted relationships of adult members of a family with their own parents has been a matter of growing interest to a number of family therapists; Bowen (1), Boszormenyi-Nagy (2), and Framo (3), among others have stressed the importance of sending family members back to their families of origin. This report makes no effort to formulate the process in any particular theoretical framework (i.e., as reestablishing connectedness after an “emotional cut-off” or rebalancing a ledger of fairness, or whatever) but is intended only to illustrate the kind of outcome one may hope for in prescribing such a maneuver. It is offered simply as a clinical note. The letter needs little prefatory explication. Mr. Jack Newburgher had been a patient in psychoanalytic treatment for four years, with a quite successful outcome. On two occasions in the course of his therapy a joint session had been held with Mr. Newburgher and his wife, Muriel, when changes in his behavior had precipitated crises in the marital relationship. His therapy had terminated about two years before the visit referred to in the letter. Mr. Newburgher had called and asked for a joint consultation with Muriel about an acute family problem they were experiencing. Some — not all — of the background material was described, not nearly as coherently as it is reported in Muriel's letter, but in sufficient detail to make it plain that she was in distress about having to withdraw completely from her parents and that their family was in disarray as a consequence of her distress. The acuteness of the emotional disturbance, against a background of a lifelong adversary relationship between Muriel and her father and a history of ten years of illness on her fathers' part, suggested that the distress was the product of Muriel's anxiety and guilt over a decision to cut herself off completely from her parents. As a consequence, Muriel was urged to visit her family of origin, with the caveat that she might indeed discover them to be malignantly self-centered people indifferent to their effect on her and her family, but that she would at least have the gratification of having tried. The reference to “speaking French” was to the therapist having suggested that, on the other hand, she might find that her parents expressed their feelings in a different modality from her definitions of how feelings should be expressed, much as though their native tongue were French and she were insisting that they must speak to her in English.     

Impediments to the development of attachment

The function of the mother's reverie, as described by Bion, is viewed as a psychological parallel, following birth, to the physical function of the placenta.

Clinical material from psychotherapy with a 3 1/2-year-old girl illustrates that, as long as she maintained the delusion of being attached to her mother's body by a physical placenta, she was hindered from learning to experience herself as a separate individual and from developing normal feelings of attachment and grief over loss.

She was referred soon after her parents' separation when she showed a lack of reaction to the loss of her father. The material suggests that at the time of separation from her father she regressed to an earlier stage where there had already been a failure to work through infantile separation and individuation from her mother

The material reveals stages of her emergence from an illusory state of union, into one in which she could increasingly tolerate her separate existence. There followed an enrichment of her psychological means of communication through the use of imagination and symbolic play. She also became more receptive to her therapist's communications and could increasingly use psychological support to share and face inner pain.     

A body with chronic fatigue syndrome as a battleground for the fight to separate from the mother

I describe the therapy of a 20-year-old woman who believed that her difficulties in concentrating and remembering were caused by her 'ME' (Myalgic encephalomyelitis, Chronic fatigue syndrome, or CFS). She had been fathered by a man who never left his own wife. Work with her dreams revealed a within-body drama in which she was locked in an unspeakable fight to the death with her mother. Her symptoms improved after parallels between a dream and an accident showed her own self-destructive hand in her story. Another dream, reflecting her first 'incestuous' affair, showed her search for her original father-self as someone separate from mother, and a later affair provided a between-body drama, helping her to own the arrogant and abject traits she had before seen only as her mother's. I show how we worked in the area of Winnicott's first 'primitive agony' as experienced by a somatizing patient, stuck in a too-close destructive relationship with her mother-body. I discuss how analytical work can be done with the primitive affects and conflicts against which the ME symptoms may be defending.     

A physically handicapped teenager is helped to own her body

In this paper I am presenting my work with a 15-year-old girl, Nina, who was born premature with congenital feet deformities. Her twin had died at birth, and Nina spent eight weeks in a Special Care Baby unit. She had also suffered from bronchial asthma, which was under control during the months she was in therapy with me.

An attempt to overdose, and a letter she had written to a teacher, brought Nina to our services and to individual psychotherapy. The weekly sessions gave Nina the opportunity to elaborate her mourning for the dead twin and to face her physical problems more realistically. She had coped with these by idealising a beautiful body and giving it, in her phantasy, to her dead sister for whose death she felt responsible. Her identification with characters from horror stories, of which she was an avid reader, was a key to understanding how she felt trapped in her deformed body, to which she would refer in the phrase ‘It doesn't bother me.’ The working through of her feelings of guilt, anger, and envy enabled her to lessen the split and to own her body.     

The self in transformation: the passage from a two- to a three-dimensional internal world

This paper seeks to describe some of the steps in the process of transformation from a two-dimensional to a three-dimensional inner world as experienced by a patient who had essentially used up her remaining vital resources. An important hurdle had first to be crossed when the analyst was required to demonstrate her capacity to survive with her in a two-dimensional claustrum, in a solitary confinement. Here, an oppositional defensive system had been created in which positive and negative personifications of vital but withdrawn energies ensured that she was locked within an interior world that sought to bar entry to anyone else, and where the possibility of the transformation of her self was disallowed. The patient had to accept the risk of breaching the system of self-defence before the analyst was allowed a mutual position within her interior world. A series of dreams tracks this transformation internally and in relation to the analyst.     

Intergroup contact: The typical member and the exception to the rule

Three studies examined the role of the perceived typicalness of an out-group member on her effectiveness in improving evaluations of her group. Subjects were students at two adjacent colleges. In the first study they interacted with a member of the out-group college. The interaction was either pleasant or unpleasant, and the contact person either confirmed or disconfirmed several stereotypes of the out-group (typicalness manipulation). Subjects evaluated the out-group most favorably when they interacted with the typical-pleasant member of the out-group. The second study demonstrated that contact with a highly typical member is not beneficial if her typicalness is based on stereotypes that reflect negatively on the subject's in-group. Several explanations of the typicalness findings were considered in a third study. Support was found for the hypothesis that the more typical member is perceived to be more predictive of the personality and actions of other out-group members.     

The dreams of a cancer patient: a "royal road" to understanding the somatic illness

In this paper we have presented the principal dreams of a 39-year-old female patient in order to demonstrate how closely the dreams were linked with the understanding of her cancerous condition. The analysis, lasting over a period of eight years, ended with the remission of the patient's cancerous condition to the point where she was without pain and symptom-free. The findings suggested that her dreams played a special role in her analysis by providing important landmarks regarding her treatment's progress and state of her cancerous condition. In a general sense, it was concluded that the patient's dreams did provide a "royal road" to understanding her somatic illness. Specifically, it was concluded that, first, the patient's dreams were able to represent quite reliably, in symbolic form, the state of her cancerous condition; second, that the cancer condition and transference-countertransference reactions were closely entwined; and third, that each of the patient's dreams seemed to be introduced by a crisis situation connected with a traumatic early memory.     

Delayed reaction to sibling-loss: The unmourned sibling as a block to procreation and creativity; A post-traumatic state

In this paper I describe a delayed reaction to sibling-loss in a woman patient who had decided to start a family. She began to have unexplained panic attacks after making the decision to have a baby. In analysis it gradually became apparent that these panic attacks were a delayed reaction to the trauma of the loss of her baby brother when she was 16 years old. Recovery of her feelings about the death of her brother led to a gradual resolution of her symptoms and to her successfully being able to have her own baby. It also led to a marked increase in her creativity and to greater satisfactions in personal relationships. The unmourned nature of the death of her brother had had a deadening effect on her feelings including her own maternal feelings and procreative capacity.     

From "Anna O." to Bertha Pappenheim: transforming private pain into public action

Bertha Pappenheim ("Anna O,") was treated for hysteria by Josef Breuer when she was a young adult. As a mature adult she became a leading social worker, writer, and feminist activist in the German Jewish community. This article examines her therapy with Breuer, her own struggle for recovery, and some links between her earlier and later life, in particular the lack of intimate relationships in her life and her work against the victimization of women. Throughout the article psychoanalytic interpretations, social history, and feminist analyses are integrated to provide a contextualized examination of Pappenheim's life.     

Assessment of the Effectiveness of Genetic Counseling by Telephone Compared to a Clinic Visit

Maternal serum screening, also known as the triple screen, is used during pregnancy to assess the risk of carrying a fetus with specific chromosome abnormalities or open spina bifida. All women in British Columbia who screen positive are eligible for genetic counseling and are offered amniocentesis. The purpose of this study is to determine what differences (if any) exist in patients' understanding and/or anxiety when genetic counseling for a positive triple screen is conducted in person versus over the telephone. Each patient who participated was given the choice of having genetic counseling in person or over the telephone, this after a randomized design failed to elicit any participants. Using a written postcounseling questionnaire, each patient was assessed for her understanding of the information presented in the session, and her anxiety regarding her risk. In this small pilot study, no large differences were detected in patients' understanding or anxiety when genetic counseling was conducted by telephone versus in person.     

一例使用态度治疗对大学新毕业生神经衰弱的案例报告

大学新毕业生工作适应不良是常见的现象,也是目前大学生就业担忧和顾虑的问题之一。这位刚毕业进入工作岗位的求助者出现了明显的抑郁症状,且在咨询过程中发现其抑郁的根源可以追溯到童年时期,并且有深刻的家庭教育文化背景。诊断为神经衰弱,采用态度治疗和心理稳定化技术后,经过两个月的咨询,求助者的神经衰弱症状基本消失,对自己和未来的态度基本明朗。一个月后电话回访,显示咨询效果良好。     

The Analyst's Uses of Theory and the Theory the Analyst Uses: Reply to Commentary

Where Slochower focuses her discussion on the analyst's multiform uses of theory, I focus my response on how the theory we each use informs a quite different way of understanding what is at issue for my patient in the apparent disengagement that marks her quest for help. More broadly, I consider how the theoretical perspective Slochower brings to her rendering of my clinical understanding and position makes for a reading that diverges significantly from my own view of what transpired in the treatment process I present.     

Infanticide and the Right to Life

Michael Tooley defends infanticide by analysing ' A has a right to X' as roughly synonymous with 'If A desires X , then others are under a prima facie obligation to refrain from actions that would deprive him [or her] of it.' An infant who cannot conceive of himself or herself as a continuing subject of experiences cannot desire to continue existing. Hence, on Tooley's analysis, killing the infant is not impermissible, for it does not go against any of the infant's desires. However, Tooley's argument in support of his analysis seems to justify, instead, a slightly more subtle analysis—namely, ' A has a right to X ' is roughly extensionally equivalent with 'Unless A expresses his or her desire that not- X , then others are under a prima facie obligation to refrain from actions that would deprive him or her of X .' But given this analysis, the infant's purported lack of any capacity to conceive of himself or herself as a continuing subject of experiences implies that we cannot be released from any duty that we might have not to harm him or her. In short, Tooley's argument in support of his analysis actually implies that infanticide may well be impermissible.     

Revisionist Responses to the Amoralism Objection: A Reply to Julia Markovits

Some subjectivist views of practical reasons entail that some people, in some cases, lack sufficient reasons to act as morality requires of them. This is often thought to form the basis of an objection to these subjectivist views: ‘the amoralism objection’. This objection has been developed at length by Julia Markovits in her recent book Moral Reason. But Markovits—alongside many other proponents of this objection—does not explicitly consider that her objection is premised on a claim that her opponents deny on first-order grounds, often as part of a socially and politically motivated revisionism about the assessment of agents and their actions. As such, the amoralism objection as she presents it misses its dialectical mark. This has interesting consequences for subjectivism—and the methodology behind it—more generally.     

The countertransference: When painful traumatic traces sustain the countertransference and reveal themselves to the psychoanalyst … 14 years later!

Although she experienced, as did the many psychoanalysts before her, the countertransferential dynamics of disgust towards a patient presenting great deficiency in terms of mentalization capacity, the author strives to understand what urged her to tolerate the patient, to invest in her and lead her to develop a capacity for internalization, after 6 years of analytic work filled with transgressive‐transferential acting‐out. Fourteen years later, she becomes aware of the way in which the revival of some grief related to traumatic traces in her own lived experience, sustained, without her knowledge, a saviour/countertransference, creating a specific transferential‐countertransferential spiral which rescued a situation whose advent could have been compromised. This could happen thanks to what she refers to as the unique inter‐relation between her and this particular patient.     

Nussbaum,Kant, and the Capabilities Approach to Dignity

The concept of dignity plays a foundational role in the more recent versions of Martha Nussbaum’s capabilities theory. However, despite its centrality to her theory, Nussbaum’s conception of dignity remains under-theorised. In this paper we critically examine the role that dignity plays in Nussbaum’s theory by, first, developing an account of the concept of dignity and introducing a distinction between two types of dignity, status dignity and achievement dignity. Next, drawing on this account, we analyse Nussbaum’s conception of dignity and contrast it with Kant’s conception of dignity. On the basis of this comparison between Nussbaum and Kant, we highlight tensions between Nussbaum’s Aristotelianism, which is central to her conception of dignity, and her commitment to political liberalism. This leads us to conclude that Nussbaum’s claim that her conception of dignity is only a partial political conception is implausible and that her conception of dignity seems to commit her to a satisficing form of perfectionist liberalism.     

Assessing the social behavior of infants: Use of the ADBB Scale and relationship to mother's mood

Infants can show a range of social behavior when interacting with their main caregiver. Previous work has demonstrated that when the caregiver is depressed, the infant may demonstrate withdrawn behavior not only to this person but also to others. This pilot study used a relatively new assessment tool, the Alarme Distress de Bebe Scale (ADBB; Guedeney and Fermanian, 2001), to assess the social behavior of 44 infants during a routine physical checkup. Results indicated that withdrawn infant social behavior to the clinician was related to the mother's report of whether she had felt more irritable, sad, anxious, or depressed since the birth, but not to her current mood as rated by her score on the Edinburgh Postnatal Depression Scale (Cox, Holden & Sagovsky, 1987). The psychometric properties of the ADBB also were explored. The findings are further evidence for the need to screen for mood difficulties in women with infants not just by focusing on a woman's current mood but also her mood since the infant's birth.     

Allergic to People: Building Bridges in a Ripped Psychic-Soma

An exploration of the use mind/body metaphors in a woman whose physical, environmental and psychoneurotic trauma culminated in an irreversible colostomy. She lived in a world of concrete symbols, her primary process damaged such that she could not create generative symbols to process her trauma. She regressed to a state of infantile megalomania, recoiling from the external reality of subjective others. Her introjective disorder mirrored her digestive disorder as she could absorb neither good objects nor good nutrients. The analytic situation has been an auxiliary fecal container and we work to bridge her mind body split with mind/body metaphors. As she reclaims lost development mastery, she displays a symbolized sphincter. As her capacity to form symbols grows, she rages and mourns for the loss of her fantasized ideal parents and her ideal body.