Using Dreams in Treating Couples' Sexual Issues

The authors demonstrate use of couples' dreams in couple therapy for problems with intimacy, sexuality, and fidelity. Condensation, symbolization, and projective identification are mechanisms that result in the conversion of emotional and relational pain into sexual symptomatology. Dreams use similar processes to hide and at the same time convey emotional issues, and so dream analysis with couples is particularly useful in exploring and treating dysfunctional sexual relationships. As in individual psychoanalysis and psychotherapy, dreams in couple therapy express the transference. The authors show how dream analysis renders the couple's shared transference for resolution in the treatment process.     

Editorial

Group dynamics are the elements that make group psychotherapy unique. When applied to the inpatient group, they illuminate various aspects of milieu treatment. Because of this linkage, the therapy group can be used to educate trainees about (1) systems dynamics on the psychiatric unit and their administrative implications, (2) the vicissitudes of the patient's treatment alliance with the hospital staff, and (3) the psychodynamics of severe psychopathology. In the group, individual defensive operations stand out with special clarity. Their expression is fueled by the group's dynamics. Here, internal object relations are reenacted and the defense of projective identification becomes vivid. The focus of this paper is not on the teaching of group psychotherapy itself, but rather on the use of this modality for the general training of future professionals.     

The Meaningfulness of Helping Others: Loren Eiseley's “The Star Thrower”

Freud and Klein describe projective processes—projection, projective identification, and the repetition compulsion—that cause interpersonal distortions not only in the psychotherapy relationship but in adult intimate relationships as well. Winnicott's theory of the use of an object describes a way of relating that is free of the distortions of projection, opening up the possibility of differentiation between intimate partners. Two case examples illustrate how addressing projective processes assisted one patient in extricating herself from a psychologically abusive relationship and helped a couple in treatment to move from object relating to object use. It is argued that the use of these psychoanalytic theories has an important role within a modern relational social work practice.     

From Passive Psyche to Dynamic Dasein

This article is a study in contrasts between Freudian psychoanalytic metapsychology, shaped by the physical–mechanistic scientific model of the Helmholtz School of Medicine, and Boss's Daseinanalytic psychotherapy, formed by the human science model derived from the Heidegger's analysis of Dasein. It begins with Binswanger's initial attempt to replace the Freudian metapsychology with Heidegger's analytic of the human being as an active agent in the world. Following this path, the article shows the radical new direction Boss gives to psychotherapy by shifting the focus of therapy from the analysis of an abstract and disembodied psyche driven by forces toward an analysis of the person as a free and responsible agent engaged in the world. Although Boss maintains a high regard for Freud's great achievement, I suggest that he failed to appreciate fully the true magnitude of his new contribution and, due to his hermeneutic of generosity toward psychoanalysis, underestimated the reciprocal influence between Freud's metapsychology and his therapeutic advice and techniques. It is my basic contention that a radical shift of a psychotherapy's philosophical anthropology transforms the entire theory, as a whole, in all its dimensions.     

Psychotherapy as one form of rehabilitation provided by the Finnish Social Insurance Institution

One of the several methods whereby patients in Finland may receive subsidised psychotherapy is as a component of rehabilitation, in order to improve a person's working and functional capacity. The Finnish Social Insurance Institution has carefully documented and monitored the effects of this intervention on patients. It is well known that it is difficult to measure the success of psychotherapy, but it appears that the results of psychotherapy (mainly psychoanalytic) are good, both according to the patients' own assessment and as indicated by the changes in the their functional capacities. More than 80 per cent benefited and about one third became free of symptoms of functional deficiency. The neurotic group appeared to have derived the greatest benefit from therapy.     

Law and grace in Saint Augustine: a fresh perspective on mindfulness and spirituality in behaviour therapy

The secular, acceptance-based philosophy of third wave behaviour therapy has easily absorbed the notion of mindfulness that originated in Eastern spirituality, entailing a secularised approach to transcendence. The present article seeks to connect mindfulness with existing efforts to integrate the Western client's spirituality into psychotherapy. For that purpose, we show how Christian grace theology and mindfulness theory overlap in the way they construe transcendence and self. Both approaches enhance openness to experience and deemphasise verbal control as a tool for personal progress. It is argued that awareness of this overlap can make it easier for the therapist to understand and appreciate the client's religious perspective. It can also help turn a client's spirituality into a relevant personal strength for therapy. Finally, explaining the overlap can enhance the credibility of mindfulness interventions with traditional Christian clients and make these interventions relevant to their spiritual concerns.     

Comparison of Dreams in Individual and Group Psychotherapy

This article gives specific reasons and evidence why group psychotherapy is the treatment of choice for addictions. Utilizing object relations theory and the self-psychology of Kohut, the authors present a model of group psychotherapy that combines these perspectives with those of Yalom's interactional group psychotherapy. Agreeing with Kohut and other object relation theorists, the authors view addiction as a condition that is the result of a person's misguided attempts at self-repair because of deficits in psychic structure. Vulnerability of self is the consequence of developmental failures and deprivation. Substance abuse only exacerbates this condition leading to exaggerated difficulty in regulation of affect, self-care, and characterological pathology. Abstinence is usually required as the first step in arresting this process and establishing a treatment regimen that will allow the vulnerabilities of the self to be altered and restored. This article suggests that this recovery and treatment process is best accomplished in a group therapy setting that is conducted within the guidelines of the principles of object relations theory and a modified version of Yalom's interactional group therapy format.     

Martin Mayman's early memories technique: bridging the gap between personality assessment and psychotherapy

In this article, we describe Martin Mayman's approach to early childhood memories as a projective technique, beginning with his scientific interest in learning theory, coupled with his interest in ego psychology and object relations theory. We describe Mayman's contributions to the use of the early memories technique to inform the psychotherapy process, tying assessment closely to psychotherapy and making assessment more useful in treatment. In this article, we describe a representative sample of research studies that demonstrate the reliability and validity of early memories, followed by case examples in which the early memories informed the therapy process, including issues of transference and countertransference.     

Identification as a Focal Point in Couple Therapy

It is impossible to speak meaningfully about a couple's relationship without giving full consideration to the way the partners' childhood experiences have influenced their identities. Each partner is affected by his or her relationships with both parents and by intimacy beliefs shaped through observations of the parents' marriage. Often, unconscious identifications underlie the interactions that lead distressed couples to seek therapy. This paper explores two concepts that can assist therapists in repairing the present in the context of the past—projective identification and disidentification. Consideration is given to the power of the parents' marriage and to identifications based on individual parents.     

A Practical Guide to the MMPI (Book)

The projective imagery, artwork, and behavior of an artistically trained psychiatric patient are presented 10 years after having committed a murder. The case is examined to see whether the Rorschach responses and the artist's choice of subject matter demonstrate the repetition compulsion familiarly associated with trauma. Additionally, does psychotherapy in which the crime is remembered serve as a stimulus to these other forms of repetition? Our case shows evidence of a continuing psychological struggle to express or deny his involvement in the murder, with phases of limited resolution.     

Assessment of Subjective Client Agency in Psychotherapy: A Review

Theoretical accounts of psychotherapy, especially of a constructivist or humanistic sort, often assert the importance of the client's active efforts in “making therapy work.” Psychotherapy research also supports the importance of the client's contribution to therapy outcomes. Research on subjective client agency, defined as a client's expectations for taking an active role in psychotherapy, is limited, however. This review describes and evaluates the psychometric qualities of six measures of this construct and provides recommendations for future research. Three of these measures are particularly suitable for further work by constructivist investigators of therapy process and outcome, a topic too rarely studied in the literature to date. Those studies that exist suggest that agency is positively related to the therapeutic alliance but does not directly affect therapy outcome. Additional process-outcomes studies in this area are warranted and could benefit from placing client agency in a broader framework that views therapy, and even therapy supervision, as an active process of mutual inquiry.     

On Empty Bathtubs: A Reply to Meehl

In the present state of ambiguity, negative studies of the validity of psychodiagnostic tests can easily be generated. But such studies throw little light upon the capacities of the tests and are confounded by the utilization of clinical interpretations. It would be most advisable to deal first with the central problems: the need for an integrated theory delineating tests in terms of the areas of optimum assessment and levels tapped; and, the development of realistic expectations on the part of clinicians. The studies frequently cited as throwing question upon the validity of projective tools are rejected on three grounds: the unrealistic wording of the hypotheses (i.e., are these tests valid or invalid, rather than under what circumstances and in what areas are the tests valid); the failure to consider the populations and the background experience of the clinician; and the methodological weaknesses in the designs of the studies. While the author admits that in the long run Meehl may turn out to be correct in suggesting that projective techniques have little value, at the present time Meehl's case for such a conclusion seems weak and should not serve as a deterrent for further investigations and proper utilization of projective techniques.     

Challenges of patient‐led mental health services to psychoanalytic clinicians

This paper considers implications to psychoanalytic psychotherapy of the British Government's decision to implement a patient choice agenda for state‐funded mental health services in England and Wales. It places the patient choice agenda in the context of consumerist society and argues that the complex nature of psychoanalytic psychotherapy leaves it more vulnerable than other psychological therapy modalities to compete in the current reality of ‘consumer’‐led public mental health, which, in turn reflects a profoundly changed social context from that to which psychoanalysis traces its roots. Unless psychoanalytic clinicians recognize and find ways to adjust to this context they will jeopardize the survival of psychoanalytic psychotherapy in an increasingly market‐orientated model of mental healthcare provision in the public sector, eager to promote more ‘consumer friendly’ psychological therapy models.     

The Edge of Chaos: Enactment,Disruption, and Emergence in Group Psychotherapy

The author outlines his approach to the theory and practice of group psychotherapy. The emphasis is on therapy by the group rather than therapy in the group. The therapist's task is to help the group itself become the agent of change. The group is conceived as being composed of many multiple selves. The process of group psychotherapy unfolds through enactments that involve the whole group and the group therapist entering into the grip of repetitive and unmentalized self-states. These enactments are resolved when the group members, with the therapist's help and containment, can access alternative self-states that allow for new and unformulated experience to emerge. This dialectical movement between the rigid “familiar chaos” of enactment and the reflective and related working through is compared to the dynamic systems theory articulation of the tension between rigidity and chaos captured by Kauffman's notion that “life exists at the edge of chaos.” A group session is described that involves a painful enactment. It illustrates how the therapist allows the enactment to unfold by holding and containing intense affect and how the group members are helped to find their own meaning and new experience in interaction with each other.     

Drawing out resistance: The use of the house-tree-person test to facilitate communication in verbal therapy groups

Resistance as an impediment in both individual and group therapy is discussed, and the special resistances common to groups are described through a review of the literature. An adaptation of John Buck's House-Tree-Person projective test is suggested as a method for overcoming resistance that can be used by group therapists, including those unfamiliar with art therapy techniques. Case examples are presented of a group session in which resistance is a prominent deterrent to progress and another in which the use of the projective drawing technique facilitates the dissolution of resistance.     

The conceptual distinction between projective identification (Klein) and container-contained (Bion)

This paper describes the use of play in the psychotherapy of a latency child from a severely traumatised background. It considers the meaning of play in relation to the role of the psychotherapist and to psychotherapeutic technique and explores its functions in terms of the child's development. The paper documents the psychotherapist's learning experience about the difficulty of trying to make the ‘right’ interpretations and her consequent realisation of the intrinsic value of play in psychotherapy. In considering these themes, the author explores how, by placing interpretation secondary to play, the therapy enabled the development of the child's creativity and self-agency, facilitating a movement from primarily paranoid–schizoid defences towards the beginnings of a depressive position.     

Infant-parent psychotherapy with an autistic toddler

This paper describes the 3½ -year treatment of an autistic toddler, who by age 5 showed normal social relationships and only minor residual cognitive features of the disorder. The treatment approach integrated infant-parent psychotherapy with techniques of special education and involved a two-person team that worked simultaneously in the family's home. The early work focused on discovering ways to mediate environmental stimulation so as to enhance the child's availability for social interaction. The treatment helped the parents understand this and explored and interpreted misconceptions about their son that interfered with parental feelings and functions. Multiple issues in the parent-child relationship and in the child's social and cognitive development eventually were addressed. This case illustrates one scenario in the development of relationships when an infant lacks the biological fittedness for social interaction. It demonstrates the possibility of ameliorating the autistic condition through a modification of infant-parent psychotherapy. The successful outcome of the case seems to be the result of several factors: The child's age at the beginning of treatment, his areas of cognitive strength, and his parents' exceptional ability to use and extend the therapy.