The symbolic and concrete: Psychotic adolescents in psychoanalytic psychotherapy

Unique disturbances in symbolisation are characteristic of the pathology of schizophrenia. Drawing on the case vignette of a psychotic adolescent, the author discusses theoretical problems in the symbolisation process in general and then in psychosis, in particular the relation between 'concretism' as a thought disorder and other psychotic defences. The ability to symbolise on the one hand and to maintain sufficiently stable ego boundaries on the other hand are examined in their relation. The author's clinical experience supports her hypothesis that there is a close relationship between the impairment of the symbolisation process in the adolescent or adult psychotic patient and his/her inability to engage in symbolic play as a child. Special attention is paid to the role of early trauma and consequent pathology of object relations for disturbances of symbolic play in childhood. Regression to concrete thinking is understood as the chance of the psychotic patient to give some meaning to reality in an unreal, delusional world and as his/her last chance to communicate at all. Conclusions are drawn for psychoanalytic techniques in the treatment of patients who are deeply regressed in this respect. Special attention is given to the particular circumstances and challenges of adolescence and to providing psychoanalytic psychotherapy to adolescent psychotic patients.     

Nymphea: from psychic breakdown to the emergence of subjectivity

In the first part of the paper the author presents an account of the analysis of a woman who is psychically extremely disturbed. This clinical presentation focuses on the unfolding of the transference process, and on the countertransference difficulties encountered during the course of the treatment which lasted more than ten years. In the second part of the paper the author proposes a theoretical approach to the breakdown experienced by the patient, and puts forward the hypothesis that there was insufficient differentiation between her internal objects and the archetypes, and that this prevented the development of symbolization. The author proposes the idea of a collapse between internal and external objects, which destroys the space necessary for representation and symbolization that normally arise between the two poles of the object. The account of this transference process between the analyst and the patient is thus seen as the account of the (re)construction of true internal objects, and of the resumption of a symbolic process to make possible the development of subjectivity.     

Dreaming up the patient in supervision: from the concrete to the symbolic*

This paper discusses the importance of parallel processes within the therapeutic and the supervisory context of therapy with an eight-year-old boy diagnosed with Asperger’s syndrome. During the first months of the therapy, through powerful projective identification, the therapist found herself in the ‘clothes’ of the ‘dead mother’. She was unable to think and feel in the sessions. Deadness could not be symbolised – it was enacted in the sessions. The therapeutic encounter had to start elsewhere: the supervisor’s reverie brought to life the patient’s material in the context of the supervision, allowing thinking to occur, first within the supervisory relationship and only then in the therapeutic relationship. In the context of supervision, the encounter of two mentally alive people could contain anxieties, metabolise them and open the way to mental connections. This encounter facilitated the development of creative thinking of both the therapist and the young patient in the consulting room, which allowed the child to become the subject of his existence and to evolve.     

Addictions and the family: An introduction

The editors of this special issue would like to express their appreciation to William C. Nichols, editor ofContemporary Family Therapy, for his support and encouragement in putting together this issue. We would also like to acknowledge and thank H. Allan Dye, Joan Jurich, Kevin R. Kelly, Richard M. Loughead, Nancy Shook, and Paul H. Wright for their patience, assistance, and editorial reviews.     

Positive psychology. An introduction

A science of positive subjective experience, positive individual traits, and positive institutions promises to improve quality of life and prevent the pathologies that arise when life is barren and meaningless. The exclusive focus on pathology that has dominated so much of our discipline results in a model of the human being lacking the positive features that make life worth living. Hope, wisdom, creativity, future mindedness, courage, spirituality, responsibility, and perseverance are ignored or explained as transformations of more authentic negative impulses. The 15 articles in this millennial issue of the American Psychologist discuss such issues as what enables happiness, the effects of autonomy and self-regulation, how optimism and hope affect health, what constitutes wisdom, and how talent and creativity come to fruition. The authors outline a framework for a science of positive psychology, point to gaps in our knowledge, and predict that the next century will see a science and profession that will come to understand and build the factors that allow individuals, communities, and societies to flourish.     

Alvin I. Goldman's Epistemology and Cognition: An introduction

‘Epistemics: an enterprise linking traditional epistemology, first with cognitive science and, second, with social scientific and humanistic disciplines that explore the interpersonal and cultural processes impinging on knowledge and belief’ (Epistemology and Cognition, p. vii)     

Counselling and health: An introduction

The special issue on 'Counselling and Health' is introduced, and the context in which counsellors are concerned with both well-being and ill-health is explored.