Treatment of developmental stress disorder: mind,body and brain – analysis and pharmacology coupled

The schism between psychiatry, psychology and analysis, while long present, has widened even more in the past half‐century with the advances in psychopharmacology. With the advances in electronic brain imaging, particularly in developmental and post‐traumatic stress disorders, there has emerged both an understanding of brain changes resulting from severe, chronic stress and an ability to target brain chemistry in ways that can relieve clinical symptomatology. The use of alpha‐1 adrenergic brain receptor antagonists decreases many of the manifestations of PTSD. Additionally, this paper discusses the ways in which dreaming, thinking and the analytic process are facilitated with this concomitant treatment and hypervigilence and hyper‐arousal states are signficiantly decreased.     

A dynamic systems approach to the feeling toned complex

A review of Jung’s writing on the ‘feeling‐toned complex’ shows that he considered it to comprise independent, split‐off, psychic elements. Modern advances in scientific thinking and technology, namely Dynamic Systems Theory and neuro‐imaging, allow us to better define and explore this psychic phenomenon. Considering the constellation of the complex as a hierarchy of dynamic systems allows for a prediction of the timing of brain activity. This has been confirmed by two independent studies using fMRI and QEEG while administering the Word Association Experiment, the tool Jung used to investigate brain/psychic functioning over a century ago. Using as a framework the stages of the constellation of a complex viewed as a hierarchy of dynamic systems, I review the neuro‐imaging studies reported by Petchkovsky et al. (2013, 2017) and Escamilla et al. (2018), concluding that quantitative theoretical predictions and experimental results are in agreement within an order of magnitude. The change in attention caused by the constellation of the complex can also be conceived as the switching from a default neuro‐network, a startle response activating executive functioning in the frontal cortex of either the ego‐complex or an autonomous complex.     

The controversy around the concept of archetypes and the place for an emergent/developmental model

This paper addresses two key controversial questions to do with the concept of archetypes – do they operate autonomously without connection to an individual's personal life experience? Does their biological base mean they are genetically determined, innate and thus a priori inherited psychic structures? These questions are addressed through the case of a person who began life as an unwanted pregnancy, was adopted at birth and as an adult, experienced profound waking visions. An emergent/developmental model of archetype is outlined which stresses developmental start‐points through this infant's engagement via response and reaction to the affective and material world of the infant/birth mother matrix and from which emergence later occurs by way of participation in a socio‐cultural and material context. The emergentism aspect of this model rescues it from being reductionist since it allows for cultural and socialisation inputs. The model's explanatory power is vastly enlarged by combining this with the developmental component. Critically, once developmentally produced mind/brain (image schema) structures are in place, they have the capacity to generate psychological life. Imagery can then appear as if it is innately derived when that is not the case. The contemporary neuroscience which supports this model is both outlined and related back to the case example.     

Psychotherapy research: an interplay between inner and outer and a succession of meanings

Psychotherapy research is a rapidly developing area of study that aims to explore the integration of inner and outer conditions of an individual’s experience, the interplay between subjective and objective, as well as between individual and collective. Questions regarding a more integrative view and qualitative research in psychotherapy are discussed in the paper. The author introduces some ideas from the studies on psychotherapy effectiveness that were done at Vilnius University by a group of researchers who work in the ‘Centre for research on the psychodynamics of personality’. Clinical psychologists who hold a doctorate degree or who are in doctoral studies in the Department of Psychology at Vilnius University are members of this research group. The subjective understanding about healing episodes and the development of depth premises were the main tasks of these studies. Among other methods, the researchers used the drawing a picture of a healing moment and telling a psychotherapy story recalled by the client to collect data. Two examples of drawing a picture of a healing moment and one example of telling a therapy story are analyzed in the paper. The themes of subjective experience of renewal in psychotherapy as well as the multiplicity of experience and results in psychotherapy are discussed in the paper with case illustrations. This study showed that drawing a picture opens one more dimension of reflection and that it can be an appropriate tool for developing individual narratives as well. Authoring and re‐authoring one’s life narrative is accepted as part of a productive therapy as well as discovering one’s inner authorship. The ability to follow a succession of meanings, as well as a connection to nature and culture could be one of the ways of actualizing an integrative view in psychotherapy research.     

Disquiet in the consulting room: everything/nothing that is said here is confidential

Writing from experiences in the consulting room in private practice in Australia, the author refers to the layered complexity of a conflict of ethical duty which has legal and social implications. The paper explores how the ethics that are congruent with creating a safe vas bene claustrum can be diametrically opposed to the social and legal structures and processes on which we all rely. It is suggested that within the vas, analysts and analysands engage in a shared process of emotionally connected, layered, symbolic thinking. Subpoenas directed at analysts are seeking concrete evidence that will stand up in court. The paper argues that this is a category error based on ignorance and misconceptions of what analytic work entails. The intrusion of a subpoena into the vas has the potential to cause havoc in the mental health and the lives of already vulnerable, possibly traumatized and isolated individuals. It can undermine a fundamental human right and undermine the profession of psychotherapy as a whole. The paper proposes that analysts have an ethical obligation to protect the work contained within the vas from these category errors and to educate other professionals as to why we cannot provide the kind of evidence that the courts require.     

Psychodynamic Psychotherapy Process Research: A quick ride through what you should know about process (research)

This paper gives an overview of psychoanalytic process research, which brings to light the complexity of psychotherapy sessions. This complexity is so rich that many instruments intended to make the process measurable failed in the past because they initially used a strategy of complexity reduction. This method however did not help to further our understanding of the complexity involved. Three former presidents of the Society for Psychotherapy Research (Stiles, Hill, Elliot 2015) decided to solve the following equivalence paradox: many therapies work successfully though they all follow different theories, produce a heterogeneity of processes and often enough a misfit between what theories maintain to be a good process and their realization in the treatment room. As theories are often compared to maps, a driver would wonder which route to take. But therapists‐as‐drivers go undaunted ‐ and nevertheless achieve their goals together with their patients. Norcross and Wampold (2018) found that good therapists invent new therapies with every new patient. They hypothesize that it is because of conversation. This is in accord with the 3 former presidents’ proposal to return to detailed single case analyses including the micro‐analytic power of conversation analysis of which a few insights are outlined in this article.     

Synchronistic mind‐matter correlations in therapeutic practice: a commentary on Connolly (2015)

This commentary adds some ideas and refinements to the inspiring discussion in a recent paper by Connolly ( 2015 ) that makes use of a dual‐aspect framework developed by us earlier. One key point is that exceptional experiences (of which synchronicities are a special case) cannot in general be identified with experiences of non‐categorial or acategorial mental states. In fact, most exceptional experiences reported in the literature are experiences of categorial states. Conversely, there are non‐categorial and acategorial states whose experience is not exceptional. Moreover, the psychodynamics of a synchronistic experience contain a subtle mesh of interacting processes pertaining to categorial, non‐categorial and acategorial domains. We outline how this mesh may be addressed in particular cases of synchronicity described by Connolly.     

The latency complex: the dead hand of anti‐development

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.     

Intersubjectivity and the creation of meaning in the analytic process

By means of a clinical illustration, the author describes how the intersubjective exchanges involved in an analytic process facilitate the representation of affects and memories which have been buried in the unconscious or indeed have never been available to consciousness. As a result of projective identificatory processes in the analytic relationship, in this example the analyst falls into a situation of helplessness which connects with his own traumatic experiences. Then he gets into a formal regression of the ego and responds with a so‐to‐speak hallucinatory reaction—an internal image which enables him to keep the analytic process on track and, later on, to construct an early traumatic experience of the analysand.     

With respect to prejudice

The basic assumptions of psychotherapy must necessarily reflect the cultural orientations and dilemmas of the western societies, and historical periods, in which these originated. This paper considers how the racialised biases of that period, namely, the era of European domination built upon the conquest, colonisation and enslavement of non‐European peoples, may linger in psychotherapeutic training and practice today. This not only limits the potential usefulness of the discipline in the multicultural populations of the west, but also risks it being read as covert neo‐colonialism in the ‘non‐west’. In a world that ever more clearly demonstrates the human costs of prejudice psychotherapists in general, and Jungians in particular, might wish to consider how, wittingly or otherwise, they maintain prejudiced ways of thinking. This paper examines material from the author's professional and personal experience, using literature that lies outside the specifically Jungian canon, to expose how such bias might work.     

Political and clinical developments in analytical psychology, 1972‐2014: subjectivity,equality and diversity—inside and outside the consulting room

Utilizing Jung's idea of theory as a ‘personal confession’, the author charts his own development as a theorist, establishing links between his personal history and his ideas. Such links include his relationship with both parents, his sexuality, his cultural heritage, and his fascination with Tricksters and with Hermes. There follows a substantial critical interrogation of what the author discerns as the two main lines of clinical theorizing in contemporary analytical psychotherapy: interpretation of transference‐countertransference, and the relational approach. His conclusion is that neither is superior to the other and neither is in fact adequate as a basis for clinical work. The focus then shifts to explore a range of political and social aspects of the clinical project of analytical psychology: economic inequality, diversity within the professional field, and Jung's controversial ideas about Jews and Africans. The author calls for an apology from the ‘Jungian community’ for remarks about Africans analogous to the apology already issued for remarks about Jews. The paper is dedicated to the author's friend Fred Plaut (1913‐2009).     

Foetal trauma,body memory and early infant communication: a case illustration

This paper presents the complex case of a male patient who started life as an unwanted pregnancy and adoptee in an era of socio‐cultural shame and blame. When able to contact his birth mother later in life, he experienced a number of confronting synchronicities as well as visions which he felt were related to failed abortion attempts and to other pre‐ and post‐natal events. The case material lends weight not only to Freud's, Ehrenwald's and FitzHerbert's assertions that the earliest form of mother‐infant communications is telepathic in nature but that this mode of communication can be retained if emotional trauma inhibits normal developmental processes. Contemporary neuroscience research is presented supporting the hypothesis that emotional memory can become imbedded in the psyche/soma of the foetus. Such memory traces can later emerge into imagery and/or words if the traumatic impingement has been substantial enough and if other defensive strategies are in place. Clinical implications are then suggested regarding analysts’ attention to the emotional conditions underpinning their patients’ conceptions and foetal development; the connection to projective identification components of the countertransference as being aspects of the earliest telepathic mother/infant communication channel and the need for reductive analyses in analyst training programmes.     

Psychological implications of a vision disorder

The paper discusses how the condition of crossed‐eyes affects a baby's eye contact with mother and potentially results in the loss of a vital emotional connection with her during the earliest days of life. This loss may contribute to a rupture that arrests emotional development at a deep psychic level. It is suggested that, in the same way as premature separation, the rupture can precipitate a ‘fusional complex’, a defence that develops to protect the infant against psychotic anxieties. The paper proposes that psychological development atrophies in this place and creates a blind spot. These ideas are explored through analytic theory and developmental literature. The dreams of a patient and his art are used to illustrate a 10‐year ‘alchemical’ process of bringing repressed material into consciousness and transformation. Healing the psychological wounds of deficits in early eye contact may be found to bring sight to a blind spot that was created by the nature of the condition itself.     

Tele‐analysis: the use of media technology in psychotherapy and its impact on the therapeutic relationship

A growing number of approaches in psychotherapy make use of internet‐ and other media‐based interactions. This paper discusses the impact on the therapist‐client relationship of using media technology and gives an overview of the current state of the debate. It is suggested that the technical conditions of internet‐based interactions produce new forms of social relationships that differ significantly from face‐to‐face‐interactions and that unconscious, nonverbal cues get lost. Research on the therapeutic interaction making use of ‘discourse linguistic’ methods is presented. The loss of nonverbal cues has implications for psychotherapy in general and especially for the treatment of patients who have difficulties relying on a secure therapeutic relationship. Emotional security in interactional relationships is transmitted to a much greater extent by nonverbal cues than by verbal content; psychoanalytic methods are specialized to refer to this level of interaction. Two alternative scenarios are discussed based on the psychoanalytic theories of Winnicott and Lacan: the risk of an illusionary, idealized image of the other and the possibility that cyberspace can be used for psychological development as a transitional space.     

Mind,brain and body. Healing trauma: the way forward

The paper explores an interdisciplinary whole person approach to healing from trauma that conserves our rich inheritance from Jung but also takes on board insights from research in the areas of attachment, trauma and the neurobiology of emotion. It is now over 20 years since insights from neurobiology began to be used to inform clinical practice. The paper reviews key insights which have emerged, along with the ways they enable therapists to help mind, brain and body to heal and the ways in which they clarify why, in clinical practice, we do what we do. Traditionally the emphasis has been on words, interpretations, and meaning‐making. Currently there is greater appreciation of the affective, relational, embodied aspects of therapeutic work and the way in which these relate to traumatic early interactive experience that is held outside of human awareness. The ways in which knowledge of particular systems of connectivity inform understanding of the whole mind‐brain‐body relationship are examined. The way forward for clinical practice to become more focused in order to help clients to heal in mind and body is reviewed.     

On Murray Jackson's 1961 ‘Chair,couch and countertransference’

One of the problems facing psychoanalysts of all schools is that theory has evolved at a much faster pace than practice. Whereas there has been an explosion of theory, practice has remained, at least officially, static and unchanging. It is in this sense that Murray Jackson's 1961 paper is still relevant today. Despite the rise of the new relational and intersubjective paradigms, most psychoanalysts, and not a few Jungian analysts, still seem to feel that the couch is an essential component of the analytical setting and process. If the use of the couch is usually justified by the argument that it favours regression, facilitates analytical reverie and protects the patient from the influence of the analyst, over time many important psychoanalysts have come to challenge this position. Increasingly these analysts suggest that the use of the couch may actually be incompatible with the newer theoretical models. This contention is strengthened by some of the findings coming from the neurosciences and infant research. This underlines the necessity of empirical research to verify the clinical effectiveness of these different positions, couch or face‐to‐face, but it is exactly this type of research that is lacking.     

Revisioning Fordham's ‘Defences of the self’ in light of modern relational theory and contemporary neuroscience

This paper explores the evolution of Michael Fordham's ideas concerning ‘defences of the self’, including his application of this concept to a group of ‘difficult’ adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a ‘self‐care system’ in the psychological material of early trauma patients (Kalsched 1996 ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a ‘real person’ to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.     

Rediscovering the ritual technology of the placebo effect in analytical psychology

Technology, viewed more generally, is a collection of skills and methods that are used to accomplish an objective of some kind. Modernity has produced many kinds of ever‐expanding new technologies, but it is also evident that technologies can be lost or fall out of use. A cross‐cultural survey of ritual reveals a rather startling observation: that while developed nations often exceed other cultures in terms of material technology, they often pale by comparison in their use of ritual technology. In this essay we will see how ritual is a powerful sort of technology that developed nations have mostly allowed to drift out of regular, vigorous use, despite its numerous psychological and biological effects. This tendency has left one of the rituals we still have – psychotherapy itself – to be bereft of some of the typical tools for concretizing the symbolic in recurrent patterns around the world. Jung himself could be accused of being somewhat anti‐ritual himself, enmeshed as he was in the post‐Protestant, post‐Enlightenment cultural environment that defines the West in many ways 1 . But these under‐utilized elements of ritual technology may be a natural fit for Jungian therapy due to its use of symbols.     

The image schema and innate archetypes: theoretical and clinical implications

Based in contemporary neuroscience, Jean Knox's 2004 JAP paper ‘From archetypes to reflective function’ honed her position on image schemas, thereby introducing a model for archetypes which sees them as ‘reliably repeated early developmental achievements’ and not as genetically inherited, innate psychic structures. The image schema model is used to illustrate how the analyst worked with a patient who began life as an unwanted pregnancy, was adopted at birth and as an adult experienced profound synchronicities, paranormal/telepathic phenomena and visions. The classical approach to such phenomena would see the intense affectivity arising out of a ruptured symbiotic mother‐infant relationship constellating certain archetypes which set up the patient's visions. This view is contrasted with Knox's model which sees the archetype an sich as a developmentally produced image schema underpinning the emergence of later imagery. The patient's visions can then be understood to arise from his psychoid body memory related to his traumatic conception and birth. The contemporary neuroscience which supports this view is outlined and a subsequent image schema explanation is presented. Clinically, the case material suggests that a pre‐birth perspective needs to be explored in all analytic work. Other implications of Knox's image schema model are summarized.     

Brain activation patterns in response to complex triggers in the Word Association Test: results from a new study in the United States

C.G. Jung's theory of psychological complexes lies at the root of analytical psychology theory and practice. Functional magnetic resonance imaging (fMRI) provides a powerful tool to validate the theory of complexes and eludicate the neuropsychologic mechanisms underlying the unconscious activation of significant memories. In this study, using fMRI, we identify two brain circuits which are activated in response to complex triggering words. Circuit one involves brain regions involved in episodic memory and somatic (body) responses and the experience of uncertainty. A second circuit involves episodic memory, emotion, visual and language association, and semiotic meaning. Specific brain regions include the right prefrontal cortex, SMA cortex, left temporal cortex, and the caudate and cingulate. These brain circuits may be thought of as the biological form in which complexes are experienced. Implications for analytic psychology practice and theory are discussed.