Assessing the risk of self-harm in adolescents: A psychoanalytical perspective

SUMMARY

This paper explores the way psychodynamic factors can be used to extend and improve the quality of the assessment of adolescents at risk of self-harm. Conventional risk factors are clearly of value to identify those young people who require admission or other interventions. However, a consideration of the internal and external factors and their interaction, as manifest in the transference and in a consideration of the history and present circumstances, allows shape and depth to be added to the assessment. In this way an assessment can be a therapeutic intervention in its own right, and can play a part in reducing the risk. This approach is described and illustrated with clinical examples.     

A case of premenstrual distress: bisexual determinants of a woman's fantasy of damage to her genital.

Case material is used to illustrate specific clinical application of the concept of primary femininity. Some contemporary contributions to the psychoanalytic theory of female psychosexual development are presented as complementary with, rather than contradictory to, more familiar, longstanding formulations that emphasize phallic strivings in women. In the clinical example reported, a fantasy of genital damage underlay a woman's premenstrual distress. Aspirations and concerns related to both aspects of her fundamental bisexuality participated in symptom formation and had to be investigated in order to achieve symptom relief. As the analytic work unfolded, it could be seen that the patient's awareness of her feminine aims served to keep her masculine aims out of awareness, and vice versa.     

The Kore complex: on a woman's inheritance of her mother's failed Oedipus complex

The Greek myth of Kore/Persephone captures a particular psychopathology of women who are torn between a deadened and often asexual husband (Hades) and an ongoing close relationship with a caretaking mother (Demeter). Psychoanalytic work often reveals that these women live in the shadow of their mothers' failed oedipal complex. Their identificatory preoccupation with maternal object preservation disrupted or distorted their oedipal development, and ever since continues to serve as a defense against sexual strivings. Thus, these women are trapped in a Kore complex: as maiden caretakers, they remain attached to and torn between a "grain mother" and a grandfather transference object.     

A psychoanalytical phenomenology of perversion1

After stating that the current tasks of psychoanalytic research should fundamentally include the exploration of the analyst's mental processes in sessions with the patient, the author describes the analytical relation as one having an intersubjective nature. Seen from the outside, the analytical relation evidences two poles: a symmetric structural pole where both analyst and patient share a single world and a single approach to reality, and a functional asymmetric pole that defines the assignment of the respective roles. In the analysis of a perverse patient, the symmetry‐asymmetry polarities acquire some very particular characteristics. Seen from the perspective of the analyst's subjectivity, perversion appears in the analyst's mind as a surreptitious and unexpected transgression of the basic agreement that facilitates and structures intersubjective encounters. It may go as far as altering the Aristotelian rules of logic. When coming into contact with the psychic reality of a perverse patient, what happens in the analyst's mind is that a world takes shape. This world is misleadingly coloured by an erotisation that sooner or later will acquire some characteristics of violence. The perverse nucleus, as a false reality, remains dangling in mid‐air as an experience that is inaccessible to the analyst's empathy. The only way the analyst can reach it is from the ‘periphery’ of the patient's psychic reality, by trying in an indirect way to lead him back to his intersubjective roots. At this point, the author's intention is to explain this intersubjective phenomenon in terms of metapsychological and empirical research‐based theories. Finally, some ideas on the psychogenesis of perversion are set forth.     

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.     

Influencing a partner to use a condom. A college student perspective

Little is known about the influence strategies that young heterosexual adults use to persuade a new sexual partner to use or avoid the use of condoms. College students'(N = 393) opinions about and experiences with six condom power strategies were examined. Overall, students gender-typed the strategies as "feminine" when the goal was to persuade a partner to use condoms and as "masculine" when trying to avoid condom use. Effectiveness and comfort ratings of the strategies varied both by students'gender and the particular tactic being evaluated. Gender differences also emerged in students'actual experiences with the strategies. When trying to encourage condom use, men utilized seduction most often; whereas, withholding sex was the most popular tactic used by women. For avoiding condom use, men were more likely than women to employ seduction, reward, and information. Implications for understanding the impact of gender and social influence in the domain of condom use are discussed.     

A signal detection theory analysis of an unconscious perception effect.

The independent observation model (Macmillan & Creelman, 1991) is fitted to detection-identification data collected under conditions of heavy masking. The model accurately predicts a quantitative relationship between stimulus detection and stimulus identification over a wide range of detection performance. This model can also be used to offer a signal detection interpretation of the common finding of above-chance identification following a missed signal. While our finding is not a new one, the stimuli used in this experiment (redundant three-letter strings) differ slightly from those used in traditional signal detection work. Also, the stimuli were presented very briefly and heavily masked, conditions typical in the study of unconscious perception effects.     

A response to Maggie Turp's paper from a body psychotherapy perspective

Whilst appreciating the quality of containment in Turp's work as a learning point for the Body Psychotherapy tradition, the author argues that Turp does not represent a psychotherapeutic way of ‘working with the body’. This would require a deconstruction of the body/mind dualism inherent in much psychotherapeutic (and psychodynamic) theory, so that the complexity of the spontaneous and reflective body/mind processes, especially in their polar extremes (body/mind dissociation – body/mind integration / ‘psyche/soma unity’), can be contained. An holistic body/mind formulation of countertransference is approached by which – rather than being used as a gratifying or cathartic therapeutic shortcut which avoids the intensity of the transference – the body can be seen to constitute an avenue into the full experience of the transference/countertransference process and its relational sources in early development.     

Religious and national radicalism in Middle-Eastern countries: A psychoanalytical point of view

Abstract

This article explores the Adlerian concept of inferiority complexes that serve as a possible source of unconscious motivation for religious and national radicalism. The Middle-Eastern countries of Iran, Iraq, Syria and Turkey serve as examples. Religious extremism and national radicalism are described as a result of the overcompensation of underlying inferiority complexes caused by belonging to ethnic and religious minorities.     

Affect, unconscious and sensemaking. A psychodynamic, semiotic and dialogic model

The work presents a psychodynamic, semiotic and dialogical model of affect and of the role it plays in sensemaking. The model is based on the following three general assumptions.A) Affective semiosis works in accordance to the dynamic unconscious which Freud conceptualized in terms of primary process. According to this interpretation, the unconscious is the mind’s homogenising way of functioning, which transforms every categorical relation into a relation of identity. B) Affect is the generalized, homogenising and absolutizing embodied basic intersubjective meanings according to which experience is interpreted. C) Affective semiosis performs both the grounding and regulative functions in sensemaking, orienting the way people interpret experience.     

A developmental perspective on the use of metaphors in family therapy

Because families generally consist of individuals at various developmental levels, family therapists require interventions that are effective regardless of an individual's developmental status. Although metaphor has proven particularly beneficial in therapy, it may be ineffective in families with preschool children who have yet developed sufficient cognitive capacities and knowledge for understanding metaphors. Previewing, a prospective technique derived from interaction between parent and infant, may be used for communicating metaphors about future change to individuals regardless of developmental level. Previewing provides knowledge about development and stimulates the cognitive skills necessary for viewing the present as a metaphor for the future.