Psychoanalytische Neurosenlehre: Eine Einführung (Psychoanalytic Theory of Neuroses. An Introduction)

Abstract

Courage–a mental act that involves a decision to face and deal with emotional pain as honestly as possible without any guarantee of a positive outcome–resides at the heart of the therapeutic alliance and the work of psychodynamic group therapy. The author’s experience suggests that group therapists tend to take for granted or underestimate the courage required to join and participate in a psychodynamic therapy group. Written from the perspective of self-psychology, this article provides a theoretical rationale for courage recognition as a central and crucial leadership function. Examples of courage are presented and contrasted with behaviors that appear courageous but are not. A detailed case example discusses the courage it takes for dyads to work through reciprocal negative transferences. Suggestions are offered to assist the group therapist in recognizing and calling attention to courageous behaviors.

The author discusses some of the pitfalls of our profession’s preference for value–free language and then shows how and why the occasional and judicious use of non–neutral language, courage being an example, can facilitate and deepen group work.     

The courage of the group therapist

This report strives to legitimize for the field of psychodynamic group therapy the reflection on and study of courage. The authors surveyed group therapy leaders, asking them to describe courageous moments in their own group practice, and then explored the common themes arising in these examples, including openly confronting their mistakes, facing their own and group members' anger, and dealing with unexpected moments in group sessions. Attending to courageous leader moments-and the feelings of hope and pride that they engender-help to neutralize the negative emotions that group leaders are constantly invited to contain. Paradoxically, accessing courageous moments can also evoke feelings of shame in the leader. If we are to require ourselves to embrace the sometimes terrifying challenge of journeying into the unknown with our patients, we must learn to be honest not just about our mistakes and our weaknesses, but also about our successes and our strengths.     

Recalling courage: An initial test of a brief writing intervention to activate a ‘courageous mindset’ and courageous behavior

ABSTRACT

Though theoretical models propose that courage can be ‘activated,’ little experimental work exists to support this idea. The current study examines a writing intervention that asks individuals to reflect on experiences in which they faced their fears (thus demonstrating courage) to determine if such reflection would promote more approach-oriented cognition (Study 1) and behavioral intentions (Study 2). As expected, when asked to decide if they could/would engage in various approach behaviors related to their fear, participants in the courage condition chose ‘yes’ more often and were comparatively faster to choose ‘yes’ and slower to choose ‘no.’ Furthermore, participants in the courage condition demonstrated greater intentions of approach behavior toward feared situations in the laboratory. These results, though small in effect, suggest that the writing intervention can activate a ‘courageous mindset’ and can promote more courageous behavioral intentions.     

Fear and Courage in Children: Two Sides of the Same Coin?

This study further investigated the construct of courage in children. Children aged 8–13 years (n = 51) were interviewed about the most courageous action that they had ever performed during their life, and to retrospectively rate their level of fear and courage experienced during that event. On a separate occasion, children also completed the Courage Measure for Children (CM-C) as an index of children’s general level of personal courage, as well as scales for assessing anxiety symptoms and sensation seeking. Results indicated that almost all children (i.e., 94%) indicated that they had carried out a courageous action at some point during their life, although the levels of fear and courage associated with these acts varied considerably. Further, there was no relation between fear and courage reported for the courageous action, but these variables were significantly correlated with respectively anxiety symptoms and personal courage as indexed by the CM-C. Finally, a significant positive correlation was observed between sensation seeking and personal courage, indicating that children who are more thrill and adventure seeking are generally also more courageous. It is concluded that fear and courage in children are largely unrelated and not just two sides of the same coin. The implications of these results for the etiology and treatment of childhood anxiety problems are discussed.     

Applying the approach/avoidance framework to understand the relationships between social courage,workplace outcomes,and well-being outcomes

ABSTRACT

The current article heeds three prior calls to advance the study of courage. First, we replicate prior findings regarding the relationship of social courage and work outcomes, but we also investigate, for the first time, the relationship between social courage and well-being outcomes. Second, we apply the approach/avoidance framework to understand how social courage influences these outcomes. Third, approach and avoidance motivations are tested as mediators of the relationships of social courage with outcomes while controlling for established aspects of personality, conscientiousness and neuroticism. Two longitudinal studies show that approach motivation is a robust mediator between courage and both workplace and well-being outcomes, suggesting that courageous individuals achieve positive outcomes because they particularly value the benefits in such actions. Avoidance motivation was a less consistent mediator. Implications are discussed, but it should be emphasized that broader relationships of social courage can now be identified by applying the approach/avoidance framework.     

Aquinas’s Transformation of the Virtue of Courage

Courage is an important moral virtue for both Aristotle and Aquinas. For Aristotle, courage is a virtue that belongs to warriors who are ready for a noble death on the battlefield. As a Christian theologian as well as an Aristotelian expert, Aquinas aims to give this Aristotelian moral virtue a fully theological expression. This paper analyzes the differences between Aquinas’s conception of courage and Aristotle’s, as well as explores Aquinas’s transformation of Aristotelian courage through a three part process. Firstly, based on Aristotle’s paradigm of courageous warriors in battle, Aquinas extends the scope of “battle” from the military sense to a broader one. By doing so, Aquinas expands the range of application of courage. Secondly, Aquinas explicitly defines endurance as the chief act of courage based on the reason that endurance is more difficult than aggression, thereby shifting our attention from the attack aspect of courage to the endurance aspect. Finally, Aquinas defines the principal act of perfect courage as martyrdom thereby pointing to Christ, who was the perfect martyr, as the paradigm of a courageous person. The result of this transformation is a successful theological virtue of courage.     

Catching the wrong leopard: courage and masochism in the psychoanalytic situation

This paper introduces the subject of courage into the psychoanalytic discourse about masochism and also demonstrates that ordinary ethical and axiological concerns can and should be included in our psychoanalytic language and practice. At each stage of a psychoanalysis, it may be helpful to consider whether the patient's experience might be that taking a step deeper into the psychoanalytic relationship is both courageous and masochistic. This consideration can open the door to exploration of conscious beliefs and how they are related to unconscious fantasies and assumptions. Considering the possibility that even a sadomasochistic enactment may simultaneously represent a courageous attempt to rework conflict or trauma can enrich the way analysts listen to both manifest and latent material.     

Courageous acts or courageous actors?

The title question was addressed by relating psychometric, psychiatric and field-performance measures obtained from a group of military bomb-disposal operators. The outstandingly successful operators in this highly competent group of soldiers were found to have some distinctive features. The excellent performance and personal stability of the group as a whole was noteworthy and may have precluded the emergence of more distinctive features of courage. Evidence was obtained of acts of courage and of courageous actors.     

Children's and Adults' Understanding of the Feeling Experience of Courage

Children's and adults' feeling experience of courage was investigated using an interview technique for younger children and an open-ended questionnaire method for adolescents and adults. There were 80 subjects in four age groups, 6, 9, 14 years, and adults, with 20 subjects and equal numbers of males and females per age group. Six-year-olds described courage in terms of an internal state corresponding to behaviour, whereas with increasing age courage was described as a multifaceted internal state experience, centring on fear and overcoming fear. Increasingly with age, subjects believed that control over the complex experience of courage could be gained by psychological strategies, such as concentrating on one's abilities and allowing all one's feelings and thoughts. Child age groups viewed courageous activity in terms of physical risk-taking but older subjects focused on psychological risk-taking. Results are interpreted in terms of an increasingly mentalistic understanding of courage.     

我国古籍中“勇”的心理学探析

在830部古籍中检索“勇”,形成包含836个句段的语料库,对语料逐条进行内容分析。结果如下：“勇”的内涵主要体现为威猛强悍、临危不惧、坚定笃志、果敢决断、大义担当、知耻革新六个方面,大致分为义理之勇和血气之勇两类,具有维护国家安全、优化人格等功能。最后,对勇气的传统性与现代性、跨文化的一致性与差异性进行了讨论,并提出勇气是一种既继承了优秀的中国文化传统,又能适应当下心理学国际化需要的心理品质。     

How Homeric is the Aristotelian Conception of Courage?

When Aristotle limits the manifestation of true courage to the military context only, his primary target is an overly inclusive conception of courage presented by Plato in the Laches. At the same time, Aristotle explicitly tries to demarcate his ideal of genuine courage from the paradigmatic examples of courageous actions derived from the Homeric epics. It remains questionable, though, whether Aristotle is truly earnest in his efforts to distance himself from Homer. It will be argued that Aristotle's attempt to associate with Homer the two forms of specious courage—courage of the citizen troops and spirit‐caused courage—fails to provide sufficient criteria for the demarcation in question. All the essential elements of the Aristotelian account of courage, such as a voluntary choice, a noble goal, and a thumos‐driven reaction guided by reason are exemplified by a number of Homeric characters as well. It is thus likely that the philosopher's account of courage largely incorporates the poetic tradition at a new level, rather than supersedes it.     

Worte wägen

Interventions relating to cognition without the intention of interpretation occur in classical psychodynamic therapy; however, the application is less elaborated than in cognitive behavior therapy. It can often also be observed that “dysfunctional” cognition is accepted over a long time by psychodynamic therapists without any reflection. This article discusses specific work on this topic and the use of functional cognition and this is recommended for structurally disturbed and traumatized patients.     

An exploration of courage in Chinese individuals

Definitional studies of courage have been performed by Western psychologists, but little research has examined Chinese folk courage. Two studies examined conceptions of courage in Chinese culture. In Study 1, the definitions, forms, inner traits, and reactions of courage were described by 307 individuals in China. A content analysis revealed that courage was divided into two forms: individually oriented and socially oriented; and the virtue was composed of persistence, responsibility, and breakthrough. Study 2 conducted in-depth interviews with 27 Chinese participants to explore the nature of courage further. The results suggested similar components; anger, self-confidence, support network, and social atmosphere were most likely to inspire courage; and trying something difficult was the most frequently experienced courageous event. Collectively, persistence and breakthrough were common components of both the current studies and the existing Western literature on courage, while responsibility may be more uniquely Chinese. Implications for prospective training programs are discussed.     

The left side of courage: Three exploratory studies on the antecedents of social courage

Abstract

Courage has been linked to important workplace outcomes, but little is known about the antecedents of courage. To identify possible methods to develop a more courageous workforce, the current article provides initial evidence regarding the antecedents of behavioral social courage from five broad categories: personality, job characteristics, leadership, culture, and demographic characteristics. Three exploratory studies show that certain antecedents from these categories have a significant relationship with behavioral social courage, including grit, proactive personality (personality), social support (job characteristics), empowering leadership (leadership), power distance (culture), and age (demographics). Perceived courage benefits and risks did not mediate the effect of most antecedents on behavioral social courage. These results suggest that certain antecedents may influence behavioral social courage, but the mediators of these relationships remain unknown. Further implications and directions for future research are discussed.     

Refusing to be excluded: finding ways of integrating psychotherapeutic modalities to the emerging needs of a Pupil Referral Unit

This paper describes the application of child psychotherapy, its theory and practice, in a Pupil Referral Unit (PRU). It examines the importance of a flexible approach to outreach work and the implementation of interventions that take into consideration both the internal and the external world of the adolescent. Furthermore, the process of development of a psychodynamic group with PRU students is described and illustrated. Additionally, it explores the importance of developing psychodynamic models of working with allied professionals in supervision and collaborative efforts in general. The paper explores the usefulness of the concept of mentalisation when working in the context of schools as well as the need to develop an accessible psychodynamic language that enables multidisciplinary collaboration. Overall, this paper reflects on the importance of holding in mind the challenge of balancing the needs of the external and the internal world, which becomes very evident in the process of outreach work.     

Videotaping as a therapeutic tool in psychodynamic infant– parent therapy

This paper describes an infant–parent therapy technique that involves the videotaping of the sessions, with subsequent reviewing and discussion with the mother. The technique has been designed as a part of psychodynamic therapeutic work with infant–parent dyads. It is based on a concept of the centrality of maternal past and current experience and associated representations in the pathogenesis of the relational pathology. Videotape replay provides an accelerated access to early maternal memories and promotes enlightening awareness of the links between maternal past experience and present behaviors with her child, which can lead to insight and therapeutic change. The technique advances the development of the therapeutic alliance and thus facilitates successful use of other dyadic treatment modalities that can be used along with psychodynamic therapy. It lessens maternal feelings of being criticized by a therapist and, therefore, can be helpful when the maternal ability to develop a trusting relationship with a therapist is of particular concern. Pertinent theoretical and practical issues are discussed. The method is illustrated by excerpts from therapeutic work with a six‐month‐old boy and his mother. © 2000 Michigan Association for Infant Mental Health.     

Learning and teaching (briefly)

This paper was given as the Annual Ellen Noonan Counselling Lecture on July 2012 and retains some of the spoken style of the lecture. It uses examples of Ellen Noonan’s work to examine aspects of the process of teaching and learning psychodynamic practice. The difficulties of how to embed theoretical knowledge with its clinical application are discussed and the question of what are the key skills of the self-reflective practitioner is raised with reference to whether, and how, they can be taught or learnt. It is suggested that part of this process consists in helping students, and their teachers, to be more comfortable with not knowing, a concept that is both counter intuitive and counter cultural. From this aspects of contemporary therapeutic practice, with specific reference to psychodynamic short-term therapy, are addressed. The paper looks at the ambivalence felt by many psychodynamic clinicians towards working within a short-term paradigm in current workplace settings and how this might be addressed. The paper discusses the intrinsic qualities of a psychodynamic short-term approach and its relation to contemporary therapeutic modalities. It is suggested that the increasing managerial culture, leading to the ascendance of protocol driven, manualised and structured therapies, represents an attack on the relational and must be challenged.     

The Value of Integration: Psychoanalytic Psychotherapy Meets Ego Psychology in a Psychotherapy Group for Children

ABSTRACT

Psychotherapy integration requires us to look beyond the confines of a particular theoretical or technical approach towards other perspectives. Integrative work with children, in particular, meets the socio-emotional needs of the child while simultaneously modeling behaviors and skills. This paper presents an explicitly integrative approach to child group psychotherapy: Relationships. Individuals. Skills. Engagement (RISE) Group. We begin with an in-depth discussion of the RISE group structure illustrated by clinical examples (the “what”) followed by a review of the theory and treatment modalities that inform the approach (the “why” and “how”). The RISE group is grounded in two theoretical perspectives (psychoanalytic principles and ego psychology) and draws upon clinical techniques from multiple treatment modalities (including cognitive behavior therapy, psychodynamic play therapy and dialectical behavior therapy). Combined, the merger of these perspectives results in a multilevel intervention that forges pathways to mastery and competence within the child. Finally, we discuss the value and limitations of integration as applied to group psychotherapy for children.     

New Windows on Understanding Addictive Vulnerability: Commentary on Papers by Lisa Director and Noelle Burton

The author discusses papers by Director and Burton, placing their work in a context of contemporary psychoanalytic models for understanding addictive behavior. Whereas early psychoanalytic models stressed drive theory and a topographic model of the mind, the contemporary models discussed here emphasize themes of dissociation—integration, helplessness—omnipotence, self-organization, and relational therapy. The author considers how these modern themes resonate with psychoanalytic formulations of addictive vulnerability that have considered disturbances in affect recognition/tolerance, self-esteem, relationships, and self-care. The author concludes by suggesting that the dyadic paradigms advanced by Director and Burton likely have implications for psychodynamic group treatments.     

Integrating Individual and Family Systems Psychotherapy to Treat Borderline Personality Disorder

This paper focuses on two areas. The first is the framework for psychotherapy integration used by Unified Therapy, a psychotherapy approach that is an integration of psychodynamic, cognitive–behavioral, and family systems therapy. The second is the use of this treatment paradigm in the psychotherapy of adults with borderline personality disorder. The theory posits that continuing and recurrent interpersonal behavior patterns within the patient's family of origin serve as behavioral triggers to typical acting-out behaviors. Therapy is geared toward planning strategies to alter these destructive patterns. A case example is presented to demonstrate the use of the therapy's theories and techniques.