The play's the thing how the essential processes of therapy are seen most clearly in child therapy

Analytic child therapy techniques developed as modifications of techniques from adult psychoanalysis. Child therapy continues to be regarded as an adaptation of adult analysis and to give a central place to the methods and conditions of adult analysis, such as interpretation, in its understanding of how therapy heals. I propose that child therapy is not a modified form of therapy and that the essential processes of therapy are fully present in child therapy. In fact, they often may be seen more clearly there than in adult therapy. I suggest two interrelated processes as the essential ones in all analytic therapy. The first is play. I examine several interrelated aspects of play, specifically as they occur in child therapy. These include the emergence and integration of dissociated self‐states, symbolization, and recognition. The second process I propose as essential in analytic therapy is the renegotiation of self—other relationships through action. This renegotiation is what can help patients become able to play in therapy when they have difficulty doing so. Since I suggest that action is at the heart of analytic therapy, I go on to consider the role of talking in an action therapy. Finally, I explore the dimensions of mutuality in the relationship between child and therapist, including mutual influence and regulation, mutual recognition, and mutual regression. The intersubjective nature of psychotherapy, which is increasingly appreciated in adult analytic therapy but not in child therapy, provides a fertile context for the evolution of play and for the productive renegotiation of self—other relationships.     

Strangers to Ourselves: Exploring the Limits and Potentials of the Analyst's Self Awareness in Self- and Mutual Analysis

The analyst's self-analysis—originally fashioned on Freud's solo foray into his own unconscious mind—continues to play an important psychoanalytic role. A summary of relevant literature is presented that includes recent relational psychoanalytic and neuroscientific data. Three major findings emerge: First, analysts' achievement of self-awareness in the analytic setting is clearly limited, more limited than we might like to admit, especially when we act alone; second, analysts reaching clinical self-awareness is a mutual, interactive process that, in addition to psychological processes, can be understood on the basis of operations uncovered by neuroscience, especially the mirror neuron system; third, accordingly, a form of “mutual” analysis is seen as an indispensable element of the analytic process. Analysts' achievement of self-awareness is discussed with a particular focus on our intrinsic relationality, and on mentalization, self-reflexivity, new relational experience, and therapeutic action. Illustrative case material is discussed.     

Contributions and novelties from Functional Analytic Psychotherapy

Functional Analytic Psychotherapy is based on the principles of radical behaviourism. It emphasises the impact of events occurring during therapeutic sessions, the therapist-client interaction context, functional equivalence of environments, natural reinforcement, and shaping by the therapist. Functional Analytic Psychotherapy makes use of both the basic principles of behaviour analysis: individual functional assessment and application of in vivo treatment. This paper analyses novelties and new contributions of this therapy. New contributions are classified in various categories: integration with other psychotherapies, improvement of therapeutic skills, methods for evaluation and data recording in therapy, its application to several clinical problems, and studies of its efficacy.     

Agent-neutral deontology

According to the “Textbook View,” there is an extensional dispute between consequentialists and deontologists, in virtue of the fact that only the latter defend “agent-relative” principles—principles that require an agent to have a special concern with making sure that she does not perform certain types of action. I argue that, contra the Textbook View, there are agent-neutral versions of deontology. I also argue that there need be no extensional disagreement between the deontologist and consequentialist, as characterized by the Textbook View.     

The specificity triad: notions of disease and therapeutic specificity in biomedical reasoning

Biomedicine is typically defined as the branch of medicine that is based on the principles of biology and biochemistry. A central tenet for biomedicine is the notion of disease and therapeutic specificity, i.e. the idea of tailored treatments for discrete disorders underpinned by specific pathologies. The present paper is concerned with how notions of disease and therapeutic specificity guide biomedical reasoning. To that end, the author proposes a model – the specificity triad – that draws on late philosopher and physician Ludwik Fleck’s concept of “style of thought” to offer a frame for investigating the intricate process through which links between disorders, mechanisms, and therapeutics are established by biomedicine. Next by applying the specificity triad model to scrutinize research efforts in two discrete areas of medicine—psychiatry and regenerative medicine—this paper seeks to stimulate pertinent discussions in and about biomedicine. These include discussions on the ambiguous epistemic status of psychiatry within contemporary biomedicine, as well as the relationship between developmental biology — historically relatively disjointed from biomedical enterprise — and the burgeoning field of regenerative medicine.     

Thinking Differently Principles of Process in Living Systems and the Specificity of Being Known

As a way of integrating emerging knowledge of biological systems, developmental process, and therapeutic process, we identify principles in the process of exchange between organism and its context of life support that are present at all levels of complexity in living systems, from the cellular to the organization of consciousness. These principles range from specificity, rhythmicity, recurrence, and pattern to coherence, wholeness, and a relative unity in the organization of component parts. By proposing that these principles are also governing the exchange between mother and infant as they negotiate a sequence of essential tasks of adaptation, or “fitting-together” between them over the first years of life, the author suggests that the biological level becomes integrated with the developmental. A sequence of adaptive tasks extends from specificity of recognition in the newborn state, to recognition of inner awareness, purpose, and intention—shaping conscious organization. The bridge to the therapeutic level is constructed as therapist and patient build increasingly inclusive and coherent moments of recognition between themselves at the level of conscious organization, which act as corrective experiences, bringing the patient's own senses of “true self” and of “agency-to-initiate” to new levels of validity and competence.     

Autopoietic enactivism: action and representation re-examined under Peirce’s light

The purpose of this article is to start a dialogue between the so-called autopoietic enactivism and the semiotic pragmatism of C. S. Peirce, in order to re-examine both action and representation under a Peircean light. The focus lays on autopoietic enactivism because this approach offers a wider theoretical scope to cognition based on the continuity of life and mind, embodiment, dynamic and non-linear interaction between a system and its environment which are compatible ideas with Peirce’s semiotic pragmatism. The term ‘pragmatic’ has been introduced in cognitive science to reinforce the idea that cognition is a form of practice and to help action-oriented viewpoints to escape representationalism. In this paper, I shall try to demonstrate that Peirce’s semiotic pragmatism can be a meaningful methodological path to guide a reconciliation between not only anti-Cartesianism and representation but also representation and action. In order to accomplish this purpose, Peirce’s account to action, habit, thought and mind will be addressed through some of the guiding principles of his semiotic—sign and sign action. What follows is the re-examining of the problem of representation—as refuted by autopoietic enactivism—under the light of Peirce’s semiotic pragmatism.

     

Luck,the Range of Obligations,and Frankfurt Examples

Abstract

The following two principles are invoked to argue, first, for the view that it is often a matter of luck (or beyond our control) to avoid performing many garden-variety sorts of acts in everyday life that are seemingly obligatory for us. It is impossible for one to perform an action that is morally obligatory for one unless one could have done otherwise; and it is impossible for one to perform an action without having some pro-attitude to perform it. Next, the view is defended that if our being able to do otherwise is frequently a matter of luck, then the range of obligations for each of us is narrower—perhaps far narrower—than we may have hitherto believed.     

“Nothing About Me, Without Me”: Participatory Action Research with Self-Help/Mutual Aid Organizations for Psychiatric Consumer/Survivors

Participatory action research with self-help/mutual aid organizations for psychiatric consumer/survivors is reviewed. We begin by tracing the origins of and defining both participatory action research and self-help/mutual aid. In so doing, the degree of correspondence between the assumptions/values of participatory action research and those of self-help/mutual aid for psychiatric consumer/survivors is examined. We argue that participatory action research and self-help/mutual aid share four values in common: (a) empowerment, (b) supportive relationships, (c) social change, and (d) learning as an ongoing process. Next, selected examples of participatory action research with psychiatric consumer/survivor-controlled self-help/mutual aid organizations which illustrate these shared values are provided. We conclude with recommendations of how the key values can be promoted in both the methodological and substantive aspects of future participatory action research with self-help/mutual aid organizations for psychiatric consumer/survivors.     

Faith as the Fulcrum of Psychic Change: Metaphors of Transformation in Jewish Mysticism and Psychoanalysis

This paper examines the role of faith in transformation, proposing that faith, on the part of the patient as well as the analyst, is the turning point of psychic change. It uses the metaphors of transformation of the Jewish mystical tradition as an organizing framework with which to consider the transformational experience within psychoanalytic process and the evolving view within psychoanalysis of the relationship between analyst and analysand as one of asymmetry and mutuality. It posits faith as a mutual yet asymmetrical stance within the psychoanalytic relationship of intersubjective, mutual recognition. In faith, one opens to the possibility of the transcendent Third, an experience of union with a larger whole from which one emerges with a sharper sense of one's authentic truth.     

Going Deep,Going Wide

Contemporary theories of psychoanalytic action have for the most part shifted from an archeological model—analyst as objective scientist/detective in search of patients’ deeply repressed affective experience—to analyst as often unwitting co-participant in a relationship ultimately designed to broaden patients’ awareness and acceptance of their varied internalized self-other configurations. These sometimes dissociated configurations often emerge in the context mutual enactments between patient and analyst.     

Dyadically expanded states of consciousness and the process of therapeutic change

This paper addresses an intersubjective issue that arises out of our model of therapeutic change: Why do humans so strongly seek states of emotional connectedness and intersubjectivity and why does the failure to achieve connectedness have such a damaging effect on the mental health of the infant? A hypothesis is offered—the Dyadic Expansion of Consciousness Hypothesis—as an attempt to explain these phenomena. This hypothesis is based on the Mutual Regulation Model (MRM) of infant–adult interaction. The MRM describes the microregulatory social-emotional process of communication that generates (or fails to generate) dyadic intersubjective states of shared consciousness. In particular, the Dyadic Consciousness hypothesis argues that each individual, in one case the infant and mother or in another the patient and the therapist, is a self-organizing system that creates his or her own states of consciousness (states of brain organization), which can be expanded into more coherent and complex states in collaboration with another self-organizing system. Critically understanding how the mutual regulation of affect functions to create dyadic states of consciousness also can help us understand what produces change in the therapeutic process. © 1998 Michigan Association for Infant Mental Health     

The Epistemic Regress Problem,the Problem of the Criterion,and the Value of Reasons

There are important similarities between the epistemic regress problem and the problem of the criterion. Each turns on plausible principles stating that epistemic reasons must be supported by epistemic reasons but that having reasons is impossible if that requires having endless regresses of reasons. These principles are incompatible with the possibility of reasons, so each problem is a paradox. Whether there can be an antiskeptical solution to these paradoxes depends upon the kinds of reasons that we need in order to attain our epistemic goals. This article explains the problems and considers the ways in which two different conceptions of human flourishing support the value of different kinds of reasons. One conception requires reasons that allow an easy solution to these paradoxes. The other—rational autonomy—requires reasons that depend upon endless regresses. So we cannot have the kinds of fully transparent reasons required for rational autonomy.     

A Jewish Modified Divine Command Theory

We claim that divine command metaethicists have not thought through the nature of the expression of divine love with sufficient rigor. We argue, against prior divine command theories, that the radical difference between God and the natural world means that grounding divine command in divine love can only ground a formal claim of the divine on the human; recipients of revelation must construct particular commands out of this formal claim. While some metaethicists might respond to us by claiming that this account leads to an inability to judge between better and worse constructions of the commanded life, we propose that an analysis of the human response to divine love—theological eros—can be the basis for an articulation of a philosophical theology (in our case, negative theology) that can guide the religious believer toward generating particular principles for ethical action that are grounded in an account of divine action. By linking divine command to imitatio Dei, the believer can have confidence that her imitative acts of God are not inaccurate constructions of the commanded life.     

Countertransference, conflictual listening, and the analytic object relationship

Analytic listening is an ongoing conflictual process, containing all the components of conflict and shaped in every moment by both the patient's and the analyst's conflicts. The mutual responsiveness that develops between analyst and patient stems from a complex conflictual object relationship, fundamentally no different from any other object relationship, in which countertransference at all times simultaneously facilitates and interferes with the analytic work. Detailed clinical process is used to illustrate these and related phenomena, including the use of signal conflict, the benign negative countertransference, the function of countertransference structures, and the analyst's use of projection. The analyst's affects, thoughts, and actions trace the shifting nature of the patient's transference and resistance, and the level of the object relationship continuously being created between patient and analyst.     

Interweaving the Symbolic and Nonsymbolic in Therapeutic Action: Discussion of Gianni Nebbiosi’s “The Smell of Paper”

Gianni Nebbiosi’s paper speaks to therapeutic action in a new key in the challenges of finding communion with a hard-to-reach patient. He achieves this through the creative interweaving of the nonsymbolic, his mime and music, and the symbolic, which attains greater purchase through painful personal reckoning in concert with his increasing awareness of previously unformulated states within and between each member of this particular analytic dyad. Central to this paper is the move from an empathic stance to greater complexity for each of the dyad. Distinguishing between empathy and recognition is germane. Particularly as we witness the transformation through therapeutic action of empathic presence to recognizing presence that permits the emergence of a more complex empathy—an achieved empathy that incorporates feeling and knowing the multiple, more deeply held, and often paradoxical aspects of our patients and indeed of ourselves as these play out in intersubjective space.     

Reflections on creative aspects of psychoanalytic diagnosing

This paper explores the therapeutic value of considering psychoanalytic diagnoses as co-constructions, and emphasizes two interrelated points: First, there are distinctions between medical, psychiatric, and psychoanalytic diagnoses, and similarly, a distinction may be drawn between diagnoses as nouns and the activity of diagnosing. Second, the author stresses that psychoanalytic diagnoses are theory bound. Various competing theories facilitate or interfere with the maintenance of an optimal analytic attitude. Some theories facilitate an analyst's urge to engage in the activity of diagnosing, which may reflect a destructive countertransference enactment. Analytic data in support of these premises is presented and discussed.     

Toward a New Model of Integrative Psychotherapy: Psychosynergy

The goal of resynthesizing that which has been disconnected in our field is what the author has designated as psychosynergy. This article seeks to advance our shared interest in the subject matter of psychotherapy. Particularly noted are efforts to reconnect the separate realms that give support to therapeutic practice, namely its undergirding scientific principles, its theoretically deduced personality and psychopathologic features, its classification format for organizing psychic pathology, its empirically grounded assessment instruments, and its integration of diverse therapeutic modalities. This overall goal stems from the author's belief that a synthesis of these components not only is possible, but will strengthen progress through mutual reinforcement and reciprocal enhancements.     

A procedural theory of therapeutic action: Commentary on the symposium,Interventions that effect change in psychotherapy

Operating largely outside of awareness, the procedural mode of processing has been neglected in psychotherapy and psychoanalysis, and yet it is critical to our understanding of therapeutic action. This group has made an outstanding contribution to a procedural theory of therapeutic action, integrating some of the most important current concepts in infant research, cognitive psychology, systems theories, and adult psychoanalysis. The procedural mode of “implicit relational knowing” is placed within the context of a moment-by-moment, mutual regulation model of co-constructed exchanges. Nonlinear dynamic systems theory has greatly influenced their theory of change. The centerpiece is Louis Sander's concept of the “moment of meeting.” Although the concept of intersubjectivity is central in all the papers, the multiple uses of the term suggests that a careful re-examination of the definitions of intersubjectivity is sorely needed. We must now integrate the work of this group with other current procedural theories of therapeutic action. © 1998 Michigan Association for Infant Mental Health     

Understanding Linkages Among Mixture Models

The methodological literature on mixture modeling has rapidly expanded in the past 15 years, and mixture models are increasingly applied in practice. Nonetheless, this literature has historically been diffuse, with different notations, motivations, and parameterizations making mixture models appear disconnected. This pedagogical review facilitates an integrative understanding of mixture models. First, 5 prototypic mixture models are presented in a unified format with incremental complexity while highlighting their mutual reliance on familiar probability laws, common assumptions, and shared aspects of interpretation. Second, 2 recent extensions—hybrid mixtures and parallel-process mixtures—are discussed. Both relax a key assumption of classic mixture models but do so in different ways. Similarities in construction and interpretation among hybrid mixtures and among parallel-process mixtures are emphasized. Third, the combination of both extensions is motivated and illustrated by means of an example on oppositional defiant and depressive symptoms. By clarifying how existing mixture models relate and can be combined, this article bridges past and current developments and provides a foundation for understanding new developments.