Mother—infant psychotherapies: A widening scope in technique

Evidence-based practice in psychotherapy is gaining ground, but we are in great need of more detailed study concerning some basic aspects: the interrelationships between nonspecific and specific factors and their impact on outcome and the precise observation of what goes on between therapist and patient. A comparison of two forms of mother–infant psychotherapy reveals an important gap between what therapists believe and what they actually do. We describe several components of processes: the contribution of the infant, the treatment of affect, the construction of an interpretative focus, and the relationships between cognitive and emotional contributions. These observations indicate the need for a more realistic appraisal of what goes on in technique applications, as well as for a widening of the definition of technique. © 1998 Michigan Association for Infant Mental Health     

Working through and its various models

Working through is an integral part of the psychoanalytic process, one could even say its epitome. It is therefore always present in the work of an analysis but, depending on the various phases and constraints that arise in that process, changes are brought to its form, to the issues involved in it and to its economic dimension. The author explores three forms or models of how working-through functions in relation to the dominant feature of any given analytical process. In the first of these, the issue that has to be worked over involves insight into a repressed representational complex; in the second, work has to be done on bringing into consciousness drive-related impulses or mental experiences that have until then not been able to be represented, so that the analysis itself is the first occasion on which retroactive [après-coup] processing can be initiated; and in the third, when representation and some kind of symbolization of the subjective experience and the drive-related issues that are part of it have been accomplished, the analysand then has to appropriate these subjectively and integrate them.     

Working through: 1914-1984

This paper reviews the various meanings given to "working through" by Freud and others. The relation of "working through" to "analysis" is discussed and illustrated.     

The scope and control of attention as separate aspects of working memory

The present study examines two varieties of working memory (WM) capacity task: visual arrays (i.e., a measure of the amount of information that can be maintained in working memory) and complex span (i.e., a task that taps WM-related attentional control). Using previously collected data sets we employ confirmatory factor analysis to demonstrate that visual arrays and complex span tasks load on separate, but correlated, factors. A subsequent series of structural equation models and regression analyses demonstrate that these factors contribute both common and unique variance to the prediction of general fluid intelligence (Gf). However, while visual arrays does contribute uniquely to higher cognition, its overall correlation to Gf is largely mediated by variance associated with the complex span factor. Thus we argue that visual arrays performance is not strictly driven by a limited-capacity storage system (e.g., the focus of attention; Cowan, 2001), but may also rely on control processes such as selective attention and controlled memory search.     

From schisms through synthesis to informed oscillation: an attempt at integrating some diverse aspects of psychoanalytic technique

There exists a conceptual bifurcation at the core of psycho-analysis. It has been viewed from differing vantage points and portrayed as subsuming various dichotomies (oedipal-preoedipal, conflict-deficit, one person-two person, classic-romantic, and so on). While each such conceptual pair has its own heuristic accompaniments, these dichotomies share a profoundly important element. They have divergent effects upon the analyst's mode of listening and the nature of his or her interventions. These and other related technical implications are the topic of this paper. With the help of three clinical vignettes and by coalescing the isolated voices of many distinguished theoreticians, the author attempts to elucidate and heal this split. This paper proposes three levels of increasingly sophisticated resolution of the technical divergence resulting from this schism. The paper recommends an informed oscillation between the two polarities of psychoanalytic technique, an oscillation that must remain in consonance with the patient's shifting ego organization. The paper concludes by highlighting the developmental bases for the proposed technical conceptualizations.     

Life within death: Towards a metapsychology of catastrophic psychic trauma

In this paper the author offers a phenomenology and a metapsychology for the effects on the mind of catastrophic psychic trauma, defined as the reaction of the psyche to an utterly external event, which the person is helpless to resist, and against which there is no possible defense. The author affirms that the experience of 'infinite affliction' produces a radical break in being which disarticulates the psyche and causes a headlong descent to the most primitive levels of psychic functioning. When there is a complete surrender to the process of disarticulation, it continues until it extinguishes even the most basic level of mental activity, contact with sensation, producing psychic and then psychogenic death. The author then offers a phenomenological and metapsychological analysis of how the process of disarticulation is stopped so that the state of survival is assured, affirming that, faced with this situation of utter emergency, the survival urge instantly mobilizes the organism in furious activity to preserve life and regenerates psychic activity by sensing the ongoing existence of the psychesoma. Then anguish precipitates on to the body and is sensed as psychophysical pain, which diverts conscious attention from the infinite destruction of utter affliction which is thus encapsulated so that, as an experience, it is no longer present to the mind. This assures survival, but it leaves the psyche in a state of non-integration and begins the unending battle for mastery over the deadly inner object which ceaselessly threatens to become present. This constitutes the precariousness of the state of survival.     

Working through the pain: Working memory capacity and differences in processing and storage under pain

It has been suggested that pain perception and attention are closely linked at both a neural and a behavioural level. If pain and attention are so linked, it is reasonable to speculate that those who vary in working memory capacity (WMC) should be affected by pain differently. This study compares the performance of individuals who differ in WMC as they perform processing and memory span tasks while under mild pain and not. While processing performance under mild pain does not interact with WMC, the ability to store information for later recall does. This suggests that pain operates much like an additional processing burden, and that the ability to overcome this physical sensation is related to differences in WMC.