'To walk the last bit on my own' - narcissistic independence or identification with good objects: issues of loss for a 13-year-old who had an amputation

This paper describes two years of psychotherapy with Michael, a 13-year-old boy who had undergone a recent emergency amputation of his leg and hip for bone cancer. The work follows Michael's struggle with the enormity of the loss, in the face of his, as well as the system's, use of denial. The amputation as an 'attack' on his physical and emotional autonomy strikes at his early adolescent development. The therapeutic process is aided by his capacity 'to go back to the unhappiness'. The therapy develops from his initial shock, to despair and self-blame, as he struggles with a tendency - in the middle period of the therapy - to lose his mind as well as his leg in a retreat to withdrawal and mindlessness, or to mania. He struggles between an omnipotent, at times self-destructive, wish to 'go it alone', versus a capacity to feel sad and to value life. His capacity to think about the trauma and to find meaning emerges. The paper raises questions about whether some trauma can ever be fully assimilated, and whether, for Michael, the mourning process could lead to a reintegrated sense of self and of a 'psychic intactness', dependent on the survival of his good 'internal couple'. Hospital and ward-based child psychotherapy and its limitations are explored.     

On Traumatically Skewed Intersubjectivity

ABSTRACT

Beginning with his Interpersonal World of the Infant (1985), Daniel Stern suggested that the infant is driven from birth to connect intersubjectively with his caregivers. By the final three months of the first year of life, as the infant begins to use protodeclarative pointing and jointly attends to the outer world, he also begins to jointly attend with his caregiver to their respective intrapsychic worlds, the mental states of his caregiver and himself. Clinically, analysts observe at this crucial point of development of secondary intersubjectivity mothers who, more often than not, respond only selectively and often unpredictably to their infants. In many instances, this may be motivated out of a mother’s own need for regulation of emotion and arousal as we have shown in our empirical research. This article elaborates on clinical observations that, for the infant or young child to feel his traumatized mother’s affective presence, he must try to enter mother’s state of mind, while simultaneously, mother is seeking to self-regulate in the wake or the revival of trauma-associated memory traces, this at the expense of mutual regulation of emotion and arousal. We call this phenomenon traumatically skewed intersubjectivity. We find that children coconstruct with their traumatized mothers a new, shared traumatic experience by virtue of the toddler’s efforts to share an intersubjective experience with a mother who is acting in response to posttraumatic reexperiencing. The problem is that the infant or young child has no point of reference to decipher the traumatized mother’s social communication. And so, what is enacted leads to a new, shared traumatic event. Both the child’s anxiety and aggression can, in this setting, easily become dysregulated, further triggering mother’s anxiety and avoidance, leading thus to a vicious cycle that contributes to intergenerational transmission of trauma. Clinical examples and implications for psychoanalytically-oriented parent-infant psychotherapy will be discussed.     

Justice of give‐and‐take in the intimate relationship: When one partner of a couple is diagnosed with cancer

This study examined to what extent couples facing cancer (N= 55) and healthy couples (N= 74) perceived various distributions of give‐and‐take to be just or fair when occurring within a relationship of a cancer patient and his or her partner. Participants read one of three versions of a bogus interview with a couple facing cancer. In these scenarios, both partners were either equally well‐off in terms of give‐and‐take or one partner was better off than the other. In general, participants judged the equitable situation to be the fairest. Thus, even in a situation in which one partner of a couple has cancer, people generally judge a relationship in which both partners mutually support each other to be the fairest. Only in extreme situations (i.e., if the patient were in a bad condition) did participants regard a distribution according to need fairer than a distribution according to equity. Couples facing cancer and healthy couples did not differ in their judgments. In addition, emotional responses to the scenarios were studied. Consistent with equity theory, participants expected to feel most guilty in an overbenefited situation. In contrast with equity theory, however, participants did not expect to feel especially angry or sad in an underbenefited situation.     

Identification with the aggressor and the ‘normal traumas’: clinical implications

Ferenczi's (1933) surprisingly unknown concept of identification with the aggressor – an abuse victim's ‘eliminating’ her own subjectivity and ‘becoming’ precisely what an attacker needs her to be – has radical implications for our understanding of analytic technique. Its very frequent occurrence also forces us to broaden our understanding of what constitutes trauma. Ferenczi saw the experience of ‘traumatic aloneness’ or ‘emotional abandonment’ as the key element of trauma, since this is what enforces the traumatic responses of dissociation and identification with the aggressor. Identification with the aggressor operates in the analytic relationship in both patient and analyst. This has various consequences, including the structuring of the relationship through unconscious collusions – mutually coordinated, defensive identifications designed to help both participants feel secure. This view of the analytic relationship has clinical implications in at least four areas: the understanding of the patient's free associations, which may reflect the patient's compliance with the analyst's wishes rather than the contents of the patient's own unconscious; the need for some kind of mutuality of analysis; the traumatizing potential of the analyst's authority; and the tendency of some patients to take blame and responsibility reflexively, as a way of protecting the analyst.     

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.     

Back to a crossroad: Nietzsche,Freud, and the east

Nietzsche's work reveals a gradual reversal of his initial antipathy to Buddhism, coming to view the latter no longer as an anaesthetising religious neurosis, but as a methodology for negation that inspires a conquest over ressentiment, a healing of internalized division, and a celebrative existence. This trend was influenced by his relationship to Schopenhauer and Deussen, and his own personal maturation. Both the source of this philosophy and the reasons for Nietzsche's failure to realise it in his own life are traced to conflictual intrapsychic oppositions in his own parental internalizations. Freud's central concepts (the unconscious, instinctual repression, neurosis, internalized good and bad parental objects, and the discontents of civilization) were modeled on Nietzsche's thinking. Yet Freud rejected oriental mysticism and its somatic focus as regressive. His failure to take up Nietzsche's eventual insight into Buddhism, and his consequent pessimism, are attributable to his personal and theoretical resistance to the issue of the early symbiotic union of mother and infant.     

Early assessment of psychological risk factors: On the role of husband/father during pregnancy and in the early postnatal period

The earliest phases of the mother-infant relationship may markedly be influenced, for better or worse, by the emotional availability of the father. In our contemporary Western societies young expectant couples are often isolated psychologically. It is suggested that if such circumstances exist and the mother also has psychological risk factors stemming from her past history and/or from her experience with the pregnancy and delivery, the husband's ability to fulfill some special mothering functions toward his wife would tip the balance between adequate coping or manifest disturbance in the mother—infant relationship.     

You Must Have Thought This Book Was About You1: Reply to Daniel Dennett

Daniel Dennett's review 2 of my book, Human Nature and the Limits of Science, 3 was apparently conceived as part of a multiple review, anticipating an author's response, so I am grateful for the opportunity to satisfy this expectation. Indeed, Dennett uses this excuse to justify devoting his own contribution to responding to those parts of the book directed explicitly at his own work, leaving other imagined reviewers to take care of other issues. Since he has things to say about most of the topics in the book he evidently interpreted this remit widely, in fact taking the book as “presented as an antidote of sorts to [his] own world view” (p. 482). Let me begin, therefore, by reassuring Dennett that, while I certainly had some critical things to say about some of his views, the book most certainly was not intended as an ad hominem attack. The nine pages (out of 187) on which his work is cited fairly accurately reflects the extent to which his views figured in my thinking. Curiously, his ire seems most strongly aroused by my assault on his views on free will in which, apparently, I agree with nearly everything he says and, worse still, fail to cite him at all.     

Coordination of Emotions in Mother–Infant Dialogues

Eleven infant–mother dyads in Crete were videod during spontaneous interactions at home, from the second to the sixth month of life. Micro‐analysis was used to investigate‘coordination'and ‘non‐matching’ of facial expressions of emotion. ‘Emotional coordination’ was evaluated with four measures: matching of facial expressions, completion when one responded to the other with ‘pleasure’ or ‘interest’, synchrony by matching frequency of change or rhythm of emotional expressions, and attunement when shifts of emotional intensity of the two partners were in the same direction.‘Emotional non‐matching'was coded when neither the infant nor the mother showed interest in interacting with the other. In emotional coordination or non‐matching between mother and infant, who performed first was also recorded. We obtained evidence of emotional matching, synchrony, and attunement. Importantly, the probability of emotional non‐matching by the infant was higher than the probability of emotional matching and completion, indicating a tendency for thoughtful attention or playful rivalry in the responses of infants, who also initiated emotional matching, completion, and non‐matching more frequently than mothers. The probability of expression of emotional matching, completion, and non‐matching changed with age. Both mothers and infants act to obtain sympathetic complementarity of feelings and co‐operative inter‐synchrony of actions. Copyright © 2016 John Wiley & Sons, Ltd.     

James Astor in conversation with Warren Colman

In this interview with Warren Colman, James Astor speaks about his development as a Jungian analyst from his own experience of personal analysis in the 1960s to his recent retirement from clinical practice. The discussion covers his long association with Michael Fordham, the child analytic training at the SAP, the infant observation seminars with Fordham and Gianna Henry through which Fordham was able to make new discoveries about infant development, his experience of supervision with Donald Meltzer and the development of his own thinking through a series of papers on the analytic process, supervision and the relation between language and truth. The interview concludes with reflections about the legacy of Michael Fordham and the future of analytic work.     

The role of a parent's illness in the emotional experience of a child evidence from Klein's Narrative of a child analysis

Abstract

The analysis of Richard, described by Melanie Klein in Narrative of a Child Analysis, gives us some insight into the effect on a child of threats to the health of his parents. His mother was involved in a road accident when Richard was 2; his father collapsed during the time of the analysis when he was 10. This paper links these events with disturbances in Richard's relation to his father and to his mother, as well as with threats to his own integrity, as demonstrated in the analysis. Richard's reversal of roles with his father and mother is discussed, as are Klein's reaction to Richard's report of finding his father ‘ill and nearly fainting’ and Richard's response to her behaviour. The paper draws attention to the way in which a child's reaction to the ill health of one parent can affect relations with both parents, as well as disturbing his sense of himself.     

The Unseen Spouse: Pitfalls and Possibilities for the Individual Therapist

Individual therapists often hear a great deal about our patients' spouses or partners, and naturally develop ideas and beliefs about that unseen other and about the causes of any relationship difficulties the patient reports. Not uncommonly, therapists can lose touch with the fact that their impressions of an unseen spouse are constructions that have emerged from the transference/countertransference field, based on only partial or limited information—not veridical truths. They can then talk with the patient about his or her partner or relationship issues in ways that can ultimately do both patient and spouse a significant disservice and perhaps distract from the patient's own issues and analytic goals. This paper discusses several factors that seem to contribute to the development of this problematic dynamic, including various qualities of the transference/countertransference field, and offers suggestions for avoiding or reducing it. Clinical material is used to illustrate key points.     

Who was Pierre Rivière? Introduction to the special issue

Foucault's (1975) edited book, I, Pierre Rivière, having slaughtered my mother, my sister and my brother… A case of parricide in the 19th century, includes the court documents and newspaper reports from the 1835 trial of Pierre Rivière, Pierre Rivière's memoir written while in prison, and the “analytic notes” written by Foucault and his colleagues. Whereas the court focused on the question of whether Pierre Rivière was of sane mind or not, Foucault and his colleagues sought to avoid the closure that such categorical thinking invites the reader into. This paper introduces the story of Pierre Rivière, and opens up some of the questions to be addressed in this special issue. The papers examine the memoir, the accompanying documents, and Foucault's and his colleagues' take on them, and reopen discussion of the Pierre Rivière case and its contemporary twenty-first century relevance, using a combination of both philosophical ethnography and arts-based enquiry. These contemporary papers are based upon a series of interdisciplinary workshops and seminars that took place at the University of Bristol during 2010. In this introductory paper we ask what was the emotional geography of this young man who engaged in such an unthinkable act? And how did that geography intersect with the emotional geography of his village in France in 1835, and what does it still have to tell us about our own contemporary society?     

Behavior Modification in Marital Conflict: A Case Report

The ability of marital partners to directly change an unhappy marriage to a happy one may be a function of each individual's conscious awareness of the topography, frequency, and other parameters of his own behavior, as well as his awareness of the consequences these behaviors have on his spouse. This paper reports an attempt to combine the use of relevant behavioral awareness and a token economy to rehabilitate a marriage in crisis. An initial two-month follow-up indicated, both from the data and the couples' subjective report, that the relationship was now much more reinforcing and both partners were satisfied with the marriage.     

ESTABLISHING OPERATIONS: IMPLICATIONS FOR THE ASSESSMENT,TREATMENT, AND PREVENTION OF PROBLEM BEHAVIOR

This paper seeks to integrate Michael's (1982, 1993) discussion of the concept of the establishing operation (EO) with existing conceptual and empirical analyses of problem behavior in people with developmental disabilities. The paper begins with a summary of Michael (1993), which seeks to describe his concept of the EO and place it briefly in historical context. The role of EOs in evoking and establishing motivation for problem behavior is considered in some detail. A case is made for the greater consideration of EOs in the functional analysis of problem behavior, and specific suggestions for detecting the operation of conditioned establishing operations are offered. Turning to treatment, the paper considers the role played by EOs in existing procedures and discusses the development of treatment strategies that seek to modify EOs, extinguish EOs, and modify the responses evoked by EOs. Finally, consideration is given to the implications of EOs for the more systemic treatment and prevention of problem behavior.     

Clinical Commentary

Abstract

This paper is the narrative of a first-time father with a son born seven weeks early by Caesarean section. Against the anxiety and trauma of his infant's birth and his wife's illness, another inner darker drama is being relived. Michael shows all the wounds of a battered child. He asks two awesome questions - Will I be to my son as my father was to me? Will my son be to me as I was to my father? Fearful and at first unvoiced questions, the developing interviews gave them a voice. We respected Michael's sharing of the early and fearful days and nights when his infant first came home. We sometimes found it hard to empathize with his running away to hide in work, until we understood what he was hiding from. Most poignant was his struggle with his anger and hurt with his father and his desire to understand, ‘Why?’, so that he would not be like this to his son. We saw a sensitive revelation of life being born inside him anew, as he made contact with his real infant and his psychic infant within. Of particular interest was the therapeutic use of the research interview space and the interviewer.     

Maternal self‐perceptions and reactions to infant crying among intrusive and withdrawn depressed mothers

This study compared intrusive (N =15) and withdrawn (N = 10) mothers' ratings of their own interaction styles with their infants and the behaviors of videotaped models of intrusive and withdrawn mothers. Withdrawn mothers rated themselves as less withdrawn than the model withdrawn mother. Intrusive mothers viewed themselves as more intrusive than the model intrusive mother. Both groups viewed their own infants as more outgoing than the infants of the model intrusive and withdrawn mothers. The withdrawn mothers reported feeling more distressed when they observed an infant (of an intrusive or withdrawn mother) crying, suggesting that they feel more empathy than the intrusive mothers. © 2001 Michigan Association for Infant Mental Health.     

Jonah's Crisis: Commentary on Paper by Avivah Gottlieb Zornberg

In discussing Zornberg's paper, Jonah's Flight, the author uses Zornberg's multifaceted midrashic analysis as a portal to offer an alternative reading of the Jonah text. Using Relational and British Object Relations psychoanalytic theories, the author explores Jonah's state of mind, focusing on his profound despair. Most notably she finds that his despair is indicative of traumatic disappointment stemming from the sense of not being recognized by God, experiencing an acute disconnection. Jonah is then seen as being in crisis: incapable of self-reflection, caught in a dissociated self-state, and unable to inhabit and struggle with his own feelings. The result is alienation from himself, incapacity to feel concern for others and estrangement from God. Using the spiritual writings of Rabbi Abraham Joshua Heschel, who believes that God is in search of man, the author suggests that it is the need for an intersubjective relationship with God that is at the core of this Biblical story.     

The analyst: His professional novel1

The psychoanalyst needs to be in touch with a community of colleagues; he needs to feel part of a group with which he can share cognitive tension and therapeutic knowledge. Yet group ties are an aspect we analysts seldom discuss. The author defi nes the analyst's ‘professional novel’ as the emotional vicissitudes with the group that have marked the professional itinerary of every analyst; his relationship with institutions and with theories, and the emotional nuance of these relationships. The analyst's professional novel is the narrative elaboration of his professional autobiography. It is capable of transforming the individual's need to belong and the paths of identifi cation and deidentifi cation. Experience of the oedipal confi guration allows the analyst to begin psychic work aimed at gaining spaces of separateness in his relationship with the group. This passage is marked by the work on mourning that separation involves, but also of mourning implicit in the awareness of the representative limits of our theories. Right from the start of analysis, the patient observes the emotional nuance of the analyst's connection to his group and theories; the patient notices how much this connection is governed by rigid needs to belong, and how much freedom of thought and exploration it allows the analyst. The author uses clinical examples to illustrate these hypotheses.     

Durkheim,Sellars, and the Origins of Collective Intentionality

Wilfrid Sellars read and annotated Celestine Bouglé’s Evolution of Values, translated by his mother with an introduction by his father (1926). The book expounded Émile Durkheim's account of morality and elaborated his account of origins of value in collective social life. Sellars replaced elements of this account in constructing his own conception of the relationship between the normative and community, but preserved a central one: the idea that conflicting collective and individual intentions could be found in the same person. These notoriously opaque arguments, which seek to save an element of rationalism from social explanation while granting the claims of behavioural science, are illuminated by comparing them to their original Durkheimian form.