Attention and Narration to Micro-Moment Registrations of Embodied Dialogue in the Clinical Interaction: How Are We Doing?

ABSTRACT

This article offers a comparison between two different strategies for clinical attention. The author compares his lens shaped by a musical metaphor of “polyrhythmic patterning” on embodied registrations which he describes as “fluidity” in contrast to a lens of structures or categories of experience. He then contrasts this lens to that offered by Lewis which she describes with the metaphor of an “imaginary camera” with which she creates “snapshots” as representations of unbearable (and often unformulated) trauma shaped by the patient's narrative and her own trauma history. Acknowledging the exquisite connection between analyst and patient, the author uses 2 clinical moments to further illustrate the benefits of each metaphoric lens for possible analytic work.     

Working with Bangladeshi young women

The author describes once-weekly psychoanalytically informed work in a child mental health setting with young Bangladeshi women making the transition to adulthood. She argues that the prevalent notion of 'culture conflict' used to account for patterns of emotional disturbance and self-harm in these young women is reductionist and represents a denial of severe family dysfunction and individual psychic pain. She shows how, despite cultural differences, psychoanalytically informed thinking can provide a basis for understanding these young women's experience and facilitate their emotional growth. However, faced with complex unconscious processes, the worker has to remain alert to her countertransference in order not to be drawn into an unhelpful collusion or denial of reality. Organizational defences may also operate to protect staff and their institutions from awareness of such high levels of emotional distress, which therefore remain hidden. The author is grateful to the two young women who consented to publication in the hope that it might help others. Details have been changed to protect their anonymity.     

Coming Out in Voices

This paper articulates the personal experiences of a woman with a physical disability who enters therapy to explore issues involving lesbian identity, health and illness, disability oppression and pride, and relationships. Written in the first person, the article uses anecdotes, poetry, and journal entries to chart the author's process of self-discovery. As a woman, a lesbian, and a person with a disability, the author frequently finds herself at odds with the culture around her. This creates conflicts between the author's real self, and the self she must present to others. She discusses how she had learned to "silence the voices" which were not useful in challenging the stereotypes, making others comfortable, or communicating with assistants. The author describes how therapy offered her the opportunity to unlearn the silence, value all of her voices, listen to herself, resolve her internal dilemmas, and develop a deeper sense of self.     

TERMINATION OF A FE/MALE TRANSSEXUAL PATIENT'S ANALYSIS: AN EXAMPLE OF GENERAL VALIDITY

The author describes the termination of an analysis, which, while relating to the particular case of a male-to-female transsexual patient, may be relevant to all analysts, particularly those whose patients need to integrate disavowed and split-off parts of themselves. The patient had undergone sex-change surgery at the age of 20. Having lived as a woman thereafter, she had asked for analysis some twenty years later. The author, who discussed the first three years of that analysis in an earlier paper, as well as her hesitation about undertaking it, considers that its termination after seven years illustrates not only the specific problems posed by transsexuals but also the general ones presented by 'heterogeneous patients'. To the best of her knowledge, this is the first published case history of a transsexual patient who has undergone surgery. In the author's view, the patient has acquired a new sense of internal unity based on a notion of sex differentiation in which mutual respect between the sexes has replaced confusion and mutual hate, and her quality of life has improved. On the general level, this termination shows how the reduction of paranoid-schizoid anxieties and the reintegration of split-off parts of the personality lead, as the depressive position is worked through, to a better toleration of internal contradictions, a new sense of cohesion of the self and a diminution of the fear of madness.     

Internal state of emergency – working with an international student suffering from trauma in a student counselling service

In this paper I look at the suicidal state of mind of an international student who comes from a country at war and has been traumatized by a violent event. The student is tortured by an internal dilemma surrounding unbearable feelings of guilt and shame that arise when she leaves her home country to study abroad. Her dilemma or survivor guilt triggers an internal contract with herself, whereby she is internally persecuted when she makes an attachment to the university and her course. I suggest that an individual in this state of mind, suffering from post-traumatic stress, has regressed to a primary state of unintegration where the self is at the mercy of psychotic anxieties and the student is at risk of suicide. It is suggested that a safety net made up of the student services and the wider health service can provide a symbolic or mental space and containment for the student's state of mind until she can function as a student.     

Janine Chasseguet-Smirgel and psychosexuality - a reminder

Janine Chasseguet-Smirgel, who would have turned 90 this year, had a passion for truth that placed her work at the very heart of psychoanalysis. Never leaving the field of Freudian analysis she explored the inevitable difficulties, due to our premature birth, to become moral subjects. Psychoanalysis was to her, as it was to Freud, a psychology of conflict. She was suspicious of seemingly optimistic views which saw conflict as created between the potentially free subject and one repressive external system or another. Freedom is always limited in psychoanalysis. In an attempt to follow the line of thought in her vast production the article touches upon her critique of Freud’s so called phallic monism, the significance of both parents’place in the psyche, the question of “Falsehood”, perversion as a dimension of the human psyche, and her concerned view on the situation of Western thought today. The author suggests that we might benefit from her radical Freudian stance in a time when the view on truth is undergoing many unfathomable transformations. Perhaps Chasseguet-Smirgels thought can also be an important reminder about the foundations of our work; not just sexuality, not just mental acts but their specific relationship to each other     

One surprise after another

The author of this article describes her childhood, career, and some of her main findings as a personality psychologist who studied women's creativity and adult development as she herself constructed her personal and professional identity in a changing environment and developed in a number of ways.     

Knowing hatred2,3

Hatred is known to be a common phenomenon and a lot has been written about this affect. However, the author believes that the more we read and write about hate the further away we find ourselves from a real sense of understanding of this so familiar and yet so elusive experience. She feels that using a single concept to describe ‘hatred’ seems to be a simplification of the matter, since it consists of a chain of affects that does not lend itself to easy theoretical or experiential distinction. In this paper the author aims at ‘knowing’ the experience of hatred as the individual's reaction to an unbearable existential excess, that is, as the psychic attempt to handle an emotional profusion in the context of human relation and in relation to it. The emotional abundance that the psyche cannot contain and process by itself is dealt with by the defensive use of simplification, detachment and distancing. An attempt is made to understand the relation between psychic existing and hatred, between craving, desiring and hate, between passionate aliveness‐or a passion to live‐ and the difficulty in containing the excessive dimension of it. The author illustrates her thesis through a reading of Tolstoy's ‘Kreutzer sonata’ as a monologue of hatred.     

Integrating Behavior into Health Research and Health Care: One Psychologist's Journey

The author narrates a history of the development of her interest in integrating behavior into heath research and health care. Using diabetes as an exemplar, she describes some of the challenges of integrating behavior into health research and health care: (1) becoming a member of interdisciplinary research and health care teams; (2) acquiring funding for behavioral research with medical populations; (3) communicating scientific findings; and (4) acquiring reimbursement for psychological services rendered. Specific examples of how the author and other psychologists can address these challenges are provided.     

One Surprise After Another

The author of this article describes her childhood, career, and some of her main findings as a personality psychologist who studied women's creativity and adult development as she herself constructed her personal and professional identity in a changing environment and developed in a number of ways.     

Simone Weil’s Passion Mysticism: The Paradox of Chronic Pain and the Transformation of the Cross

Simone Weil’s theology is deeply connected to her experiences with chronic pain. Pain is paradoxical in that it is an essentially private phenomenon yet it simultaneously demands to be shared with another. Weil’s life and thought exemplify both aspects of this paradox, demonstrating how her pain alienated her from her own body and from others, and how her thought found full expression as she attempted to share experiences with pain. Weil’s experience of pain was transformed in her passion mysticism, the deep connection she felt with the crucified Christ. In this connection, the most unbearable aspect of her pain, the threat, which it presented to her very self through annihilation, was absorbed into the cross and transformed by God’s love. While this did not necessarily diminish Weil’s pain, the meaning it had for her as a person was transformed through an encounter with Christ crucified, in which she experienced God’s suffering along with her.     

DISTINGUISHING THE DRAMA FROM THE HISTRIONICS IN A CASE OF HYSTERIA WITH MULTIPLE TICS

The author describes a clinical experience with a hysterical patient with multiple tics, an upper-middle class, married woman, who when she started analysis at the age of 30 was in a state of profound tension and anxiety. The first eight years of this analysis are presented in order to describe how the analyst came to identify the dynamics of unconscious phantasies in a situation where analyst and patient found themselves involved in several roles of a drama dominated by theatrics. The insights and therapeutic benefits suggested that this patient unconsciously experienced her oral needs as intensely destructive and cruel, an experience she felt to have been exacerbated by her mother's lack of response to her emotional needs. This primitive cruel orality was accompanied by a split-off experience of a secret, mystical union with the primitive idealised mother. The author considers that this split experience of cruel and idealised orality suffused the patient's genital sexuality, hindering the evolution and realisation of her adult sexuality, giving her a distorted view of the primal scene as an impenetrable fused amalgam acting as an omnipotent, self-sufficient, excluding phallus. Gradually analysis enabled the patient to transform her bodily theatrics into thoughts and to broach the difficult task of relating to others instead of being either fused with them or totally excluded by them.     

Letter to a genetic counselor

The author describes her personal experience terminating a pregnancy after receiving an abnormal amniocentesis result: While still waiting for the results, she and her husband attempted to deny the importance of the pregnancy, an approach which they subsequently regretted. When they received the abnormal result, they found themselves able to make necessary decisions quickly, despite being in shock. It then took some time before they realized what a major loss they had actually suffered. The painful aftermath included accepting emotional responsibility for their decision to abort, as well as explaining that difficult decision to their older children. Thoughts of a possible subsequent pregnancy could not be faced at once. Over time, the author found the support of friends and colleagues, and even of a support group, to be invaluable. All in all, the entire experience was more painful than she would have predicted, and she hopes that this account will prove helpful both to genetic counselors and to other patients who receive abnormal results from prenatal diagnosis. A list of suggested readings is appended.Rose Green is a pseudonym.     

A Knock on the Door

In this paper, the author, who is a single mother of a young man with mental illness, describes her son’s first psychotic break. By melding poetry, prose, dream journal entries, and medical case notes, she explores the embodied experience of witnessing her son’s decompensation. In sharing her story, she reminds other caregivers of people with mental illness that they are not alone. She makes sense of her experience with findings from the literature about posttraumatic stress among family caregivers of people with chronic illness and explores the implications for caregivers, practitioners, and scholars of mental illness, trauma, and loss.     

Dreaming of spiders: Abuse,economics, and theological insecurity in pastoral counseling

... This hope in no hope is clearly demonstrated in the following dream of a young adult woman who had been severely hurt emotionally in her relationships in her family of origin and again in her failing marriage. In this dream, which was presented in a group and dealt with mainly by my co-therapist, the woman placed herself in a glass room like a shower, with the handle to the room's only door on the outside. There was a crack in the glass of one of the room's corners, and through this crack came some spiders. She was lying on the floor and the spiders began to crawl over her. Though she screamed for help, no one would come to open the door. As one approach (among many) to the interpretation of this dream my colleague utilized the manipulation of the dream symbols to ask her to imagine that the spiders had changed into kittens. She resisted this suggestion intensely, saying that she could not allow such an imaginary change. Besides, the spiders weren't too bad to endure, for if she changed the spiders into kittens and the kittens turned out to be evil, then she would be at her rope's end. She preferred to live with her perspective that the world is hostile rather than risk the possibility of another hope being shattered. (Jordan, 1986, pp. 98–99)     

As If Religion Matters: Teaching the Introductory Course as if it Does

This essay chronicles the academic odyssey of a young professor who sets out to revise the department's Introduction to Religion course only to realize that she must first clarify her vocational commitments before she can create a teachable course. She is convinced through working with many students who express disdain or even hostility toward the subject matter that she wants to model a relationship to the subject matter that says religion matters, but is uncertain how to do this. After an autobiographical foray into her academic upbringing in active learning, the author articulates four values to model in her teaching: personal relevance, academic responsibility, ethics, and community. The author then engages current scholarship in active learning, and narrates the process of translating those four values into concrete course goals and particular assignments. The essay concludes with an assessment of teaching the revised course.     

Negligent Liability and the Foreseeability Factor: A Critical Issue for School Counselors

Negligent liability suits involving school counselors are not common, but such litigation seems to be increasing. In most of the cases cited, the defendant's alleged negligence emanated from his or her failure to provide reasonable care to individuals who were later injured or killed. Reasonable care is the standard of conduct that a reasonable and prudent person maintains in protecting those to whom he or she owes a duty of care from unreasonable risks. The author emphasizes the role that the element of foreseeability plays in determining the outcome of negligence cases and indicates those areas of responsibility that are most subject to litigation.     

The Pregnant Clinical Psychologist:

Le is a married 35 year old South Vietnamese refugee who works two jobs to support her three children and elderly relatives. The family of eight was one of many boat people whose journey to freedom involved prolonged stress as they left their home secretly and withstood the deprivation of a refugee camp for more than a year before being chosen by a sponsor to relocate in the U.S. Ten years later, Le proudly recites the new responsibilities she has acquired through this transition which have profoundly affected her roles as an employee, mother, and wife. Her story reveals several key elements which hold theoretical significance for the study of successful coping. She refers often to the salience of family values learned early in her life, and the importance of adhering to these during the most stressful periods. She lists several attitudes that helped her maintain hope and focus on her goals during the most difficult times. And, she describes a variety of supportive networks that were developed at different stages of the refugee experience that contributed to a successful transition. These elements clarify the interwoven effects on predisposing factors, coping, and social support on psychological functioning, and imply parameters that clinicians may find helpful in working with a refugee population.     

People are not cabbages: reflections on patient and analyst change

The author describes how her own internal change was a vital part of transformation between herself and two patients. She draws on Loewald's work as she discusses how change in her own internal relationship with her father was part of a lifelong emotional reorganization of Oedipal relations. She describes a process of mutual change whereby her and her patients' unconscious growth each stimulated the other. She suggests that the analyst's own emotional growth is a vital, not an incidental, part of psychoanalysis, as it brings new life to the work for patients as well as analysts themselves.