Closely observed texts

This paper discusses a central theme of the novel What Maisie Knew by Henry James, namely the development of a child's consciousness and internal world in a hostile psychological environment. It explores the way in which the novel dramatizes the problems for a child, in such circumstances, of knowing and understanding her own experience and the adult world. The paper charts the difficulties for Maisie in negotiating a child's ordinary tasks and stages of psychic growth, and in particular the Oedipal situation. It also explores the parallel in the novel between the child's attempts to know and the attempts of the reader of fiction to know, and the use of reading as a metaphor for perception and learning.     

The Impact of Insecure Attachment on Mothering: A New Mother’s Story

This article describes the treatment of a first-time mother and her daughter. The mother’s impoverished primary relationships and the fragility of her early attachments contribute to her challenges with motherhood. Through parent-infant treatment she is gradually developing the capacity to reflect upon her experience and beginning to make discoveries about her attitudes toward herself and others. My work with Leslie has deepened my appreciation for Daniel Stern’s notion of “the motherhood constellation” and for the power of insecure attachment to destabilize the parent and consequently the parent-child relationship. During the treatment, I used the Newborn Behavioral Observations system as an adjunct to therapy to help demonstrate to this distressed new mother her infant’s competencies. Later, I also used the Adult Attachment Interview to enhance her curiosity about her own childhood, and in particular her relationship to her mother and the impact of that relationship on her own mothering.     

Gray Matters: A Deployed Physician’s Perspective on Combat Medicine in Iraq

A female physician who was serving as a first-year medicine resident in Manhattan in September 2001 writes this paper. It details her experience of signing up for military service as a result of the September 11th attack on the United States. She lays out the surroundings, atmosphere, and reactions of those around her during the attack and details her own personal motivations for joining the military, her need to take control and help those in need heal while also trying to heal herself. Grateful, yet haunted by her experience, she provides an intimate glimpse into her time serving as a combat physician at a trauma hospital in Balad, Iraq during the 2007 military surge. A trained geriatrician and palliative care physician she recounts the stories of several patients that have forever shaped her life and explores the contradictions and ethical challenges she faced while caring for them ultimately struggling with the uncertainty of whether what she was truly doing was good for those she served or herself.     

Logotherapy in the Care of the Terminally Ill

SUMMARY

Logotherapy is very useful in dealing with a person with a terminal illness in that such a person often feels that life is meaningless. Viktor Frankl asserts that each person's life has a unique meaning even when the person is confronted with a terminal condition over which he/she seemingly has little control. It is the role of the logotherapist to help the person to discover that unique meaning within himself/herself. The logotherapist does not provide the meaning, but rather assists the person in discovering his/her own meaning. This article explores the various ways by which meaning may be discovered through the methods of logotherapy.     

Mother and child. A psychobiographical portrait of Mary Cassatt

The noted American impressionist, Mary Cassatt is remembered for her intimate portrayal of women, children, and the mother-child relationship. In this paper I have attempted to highlight some of the psychological forces impinging upon the artist, feeling that the artist's work is highly overdetermined. Mention was made of some of the difficulties that a psychobiographical study engenders. Nevertheless, it is hoped that such a study leads to enhanced understanding and appreciation of the artist, her work, and her rich inner world. An examination of the artist's life indicates that difficulties in the family of origin impinged upon her and deeply influenced her work. The loss of several siblings during critical developmental subphases may have produced intense survival guilt in Mary, motivating her to "recreate" her siblings on canvas and to devote her life to care of survivors. Lack of confirmation of Mary's talents by her father may have hindered her development, propelling the child toward a profoundly libidinalized and enmeshed relationship with the mother. Mary's intense relationship with her mother may have led the artist to develop particular stylistic nuances in her productions, contributed to her inability to become a wife and mother herself, and led to frequent episodes of depression. A case was made that Mary suffered from narcissistic disturbance, never completing the recognition of herself as a person outside of the orbit of her mother. Finally, the role of Edgar Degas in the artist's life was described. He seems to have played a major role in the evolution of Mary's style as well as being an important influence in her making a partial separation from her mother in adulthood. In spite of Mary's deep personal suffering, she was able to epitomize in her paintings the most tender and nurturant of relationships. By painting the mother-child theme, she sublimated her own wishes to become a mother as creator of art. Within her family system, she appropriated the position of mother; as the artist, she became the interpreter of this experience. By developing her talent, she communicated her wish to be a mother, and expressed the need to find, if only on canvas, a more truly empathic mother. In essence, her work allowed her to conceive of a life different from the one external reality imposed upon her. It also served as an indispensable adaptive function, allowing the artist to communicate with others, achieve recognition, and play.(ABSTRACT TRUNCATED AT 400 WORDS)     

ON LOVE AND MELANCHOLIA IN MARGUERITE DURAS'S AUTOFICTION

In the Durassian melancholic atmosphere, past and present, fantasy and reality come together as one. This paper addresses the themes of love and destruction in Marguerite Duras's life that pervade her oeuvre, allowing us to discern a melancholic structure within her autofiction. Writing down her melancholia—the impossible mourning of a loved object—Duras captures nothingness and loss—in order not to die of love. In a constant exchange with her readers, she searches for herself and delivers herself to her readers. This renewable creative process of writing enables her to engage in an ongoing experience of identity reconstruction, in a way similar to the patient in psychoanalysis re‐creating his/her life's fiction.     

Destruction reconceived: On Winnicott's ‘The Use of an Object and Relating through Identifications’

‘The Use of an Object and Relating through Identifications’ is a landmark contribution that I find very difficult to write about because so much of what lies at its core is merely suggested. It is necessary for the reader not only to read the paper, but also to write it. In my reading/writing of the paper, the mother becomes real for the infant in the process of his actually destroying her as an external object (destroying her sense of herself as an adequate mother), and his perceiving that destruction. She also becomes a real external object for the infant in the process of his experiencing the psychological work involved in surviving destruction, a form of work that does not occur in the world of fantasied objects. The analyst or mother may not be able to survive destruction. It is essential that the analyst be able to acknowledge to himself his inability to survive and, if necessary, to end the analysis because of the very damaging effects for both patient and analyst of prolonged experience of this sort. The author presents clinical discussions of analyses in which the analyst survives destruction and is unable to survive destruction.     

Emotional Communication in the Case of Antonio

ABSTRACT

In describing her work with her traumatized patient Antonio, Dr. Jane Lewis focuses on Barthes’s (1981) notion of a photograph as having the symbolic linking function of an umbilical cord, and emphasizes the notion of the punctum, the specific personal wounding detail in an image that connects to the viewer’s experience. This article discusses these ideas, which appear mystical to Lewis, in the contexts of the theory of multiple coding and the referential process, as well as recent advances in the fields of social neuroscience and embodied communication. In the early Arousal phase of the referential process, emotion schemas associated with painful events of the past are activated for both participants, in subsymbolic, embodied form. Antonio is largely mute and frozen; Lewis also feels herself freezing and disappearing. In the Symbolizing phase, Antonio begins to connect to dreaded experience of his past, and to tell memories, fantasies and dreams. Memories and images of her past, related emotionally to Antonio’s experience, are awakened for Lewis as well. Through their embodied communication and shared imagery, the therapist’s ability to find emotional meaning for her own painful experience appears to support the patient’s beginning to provide some meaning for his pain and dread. Related observations by Bollas and Arlow, and parallels to a case reported by Ogden are discussed.     

People are not cabbages: reflections on patient and analyst change

The author describes how her own internal change was a vital part of transformation between herself and two patients. She draws on Loewald's work as she discusses how change in her own internal relationship with her father was part of a lifelong emotional reorganization of Oedipal relations. She describes a process of mutual change whereby her and her patients' unconscious growth each stimulated the other. She suggests that the analyst's own emotional growth is a vital, not an incidental, part of psychoanalysis, as it brings new life to the work for patients as well as analysts themselves.     

Change,Vulnerability, Fear,and Taking Risks–An Interview with Virginia Satir

SUMMARY

The author addresses the mythic characters of Ulysses and Penelope as archetypes for herself. She reviews divergent attitudes, beliefs and aspirations of her life by detailing an internal conflict between her identification with Ulysses1 adventuresomeness and her reluctant realization that Penelope can also represent her, however much she rejected her for seeming dull and repetitve

In this process the author notes how she constricted her own creativity when she took on uncritically the patriarchal beliefs about the roles of wives and mothers. Nevertheless she wonders whether present-day women's liberation from archaic notions about women inadvertently sacrifices the optimal development of children because of the rigid demands of the work-place.

Finally she experiences the symbolic reunion of Penelope's and Ulysses' different images within herself, and considers how what each represents can have renewed meaning for her as she moves towards the end of her life.     

Breakdown in communication: On finding the child in the analysis of an adult

SUMMARY

In this paper a patient is described in whom communication with parts of herself and with her objects, internal and external, had broken down. I suggest that her way of communicating was achieved by projective identification, as described by Klein (1946) and Bion (1962). The only way she could deal with and communicate her own very “bothered” feelings was to “put them” into the analyst. In this way she “bothered” the maternal or analytic mind in such a way as to make the analyst experience feeling like a “bothered” child.

I have tried to show how the analyst holds or contains these feelings, and to show the gradual establishment in the patient of a different way of communicating with the analyst and with the more primitive parts of herself.     

Trauma Triangles and Parallel Processes: Geometry and the Supervisor/Trainee/Patient Triad

Relational psychoanalytic literature is filled with discussion regarding how the concept of intersubjectivity has enhanced the space between and within patients and analysts. As the relationship between the dyad expands and contracts, prior traumatic experiences become ripe for reenactment. What happens when the therapist is a trainee and her supervisor reenacts the abuse experienced by the patient onto her? When the enactment extends beyond the dyad and moves into the triad, how can the trainee use this shared experience to create agency for both herself and the patient? And how does the institutionalized authority of the training environment expand or collapse the transitional space required for trainees to create their own analyst identity? This paper explicates a case in which the trainee was able to use a rupture in the supervisory relationship to further enter the subjugated space of the patient, ultimately empowering both to develop a new way of relating to each other that moved them out of such constricted complimentary roles.     

Emotion-Focused Therapy: A Synopsis

The basic principles of an emotion-focused approach to therapy (EFT) are presented. In this view, emotion is seen as foundational in the construction of the self and is a key determinant of self-organization. As well as simply having emotion, people also live in a constant process of making sense of their emotions. Personal meaning emerges by the self-organization and explication of one’s own emotional experience, and optimal adaptation involves an integration of reason and emotion. In EFT, distinctions between different types of emotion (i.e., primary versus secondary, adaptive versus maladaptive) provide therapists with a map for differential intervention. Therapists are viewed as emotion coaches who help people become aware of, accept, and make sense of their emotional experience. Four major empirically supported principles of emotion awareness, emotion regulation, emotion transformation and reflection on emotion guide emotion coaching and serve as the goals of treatment. A case example illustrates how the principles of EFT helped a young woman to overcome her core maladaptive fears and mobilize her ability to protect herself.     

On mirroring in group psychotherapy

“A woman has two images. There is a magical person seen or remembered by those who love her, her finest qualities are flesh and spirit illuminated. She herself knows this ideal self; she projects it, if she is confident; or she daydreams her ideal self; or she recognizes it with gratitude in the admiring eye of others. There is at the same time a second image; the woman as seen by those who dislike or fear her. This cruel picture has an all too powerful mirror in her own negative idea of herself. She sees with fear her own ravaging impulses and most painful of all, a graceless, freakish, and unlovable physical self, this was the mirror her parents held before Edith. Her brothers saw her with love. She herself knew both images. Her life, and her poetry, constituted a flight from the second one.”     

Unplanned pregnancies and abortion counselling. Some thoughts on unconscious motivations

In a climate where the numbers of abortions and repeat abortions are increasing, it is necessary to improve our understanding of the dynamics that motivate the behavior of abortion seekers. While genuine contraceptive failures do exist, many unwanted pregnancies result from unresolved conflicts carried over from the woman's early relationship with her mother. The management of any pregnancy is often accompanied by feelings of ambivalence, and abortion itself is an expression of ambivalence reflecting a previously unconscious wish for a baby and a conscious wish to end the pregnancy. How these issues are handled also reflects the position the woman occupies in her life cycle. Examination of the early mother-child relationship may shed light on what unconscious needs are being expressed through the "acting out" mechanism of repeat abortion. If the mother-child relationship failed to establish an internal representation of a caretaking function, the child will lack the capacity for self-care and may seek abortion as a deliberate mechanism of self harm. Until such conflicts are resolved, abortions may be repeated. The abortion experience may also reflect a desire for a woman to individuate from her mother. Abortion counseling offers women an opportunity to understand and work through the damage resulting from their relationship with their own mothers. One case study, of a 25-year-old undergoing her fifth abortion, provides an example of acting out psychic pain resulting from a damaging maternal relationship. This woman lacked the capacity for self-care and could only tolerate counseling sessions until she overcame the acute vulnerability imposed by her most recent abortion. Another case study, of a 27-year-old seeking counseling after experiencing overwhelming feelings of guilt, shame, and inadequacy, provides an example of a woman seeking individuation and unconditional love. This woman used counseling successfully to develop a better understanding of herself and a certainty that she could be loved despite her flaws. Such dynamics do not always inform the abortion experience, but abortion is always a distressing experience, and counseling should always be available. Abortion counselors must come to terms with their own ambivalent feelings and unconscious conflicts in order to serve their clients.     

Thinking about and working with depressed mothers in the early months of their infant's life

This paper illustrates how my work has developed over the years and informed my thinking about, and work with, depressed mothers. It also describes the work of the Parent Infant Foundation in Sydney where pregnant women and mothers with infants and toddlers are seen in groups and individually through home visits. The relevance of the support of a peer group when doing such difficult work is described. The paper draws on a central theme: the depressed mother, returning to her own infant beginnings through pregnancy and birth, confronts a dead mother-dead infant dyad. Trauma from the mother's own infancy is seen to have created an internal, autistic, deadened, psychic space. It is argued that behind this deadness lies the primeval pain of abandonment and loss. The associated rage, previously repressed but now awakened by her alive infant and his powerful primitive demands, invade the mother's psyche. The internal deadness freezes her alive processes as mother to her baby. Unbearable pain is awakened - and she may be in terror and unable to move, or she may experience herself as drowning in something catastrophic. SUMMARY This paper illustrates how my work has developed over the     

Short‐term and working memory: Past,progress, and prospects

Abstract

The role of current personal experience in understanding of word meaning was investigated in a patient, WM, who suffers from semantic dementia. The study was prompted by the observation that WM, despite being severely impaired on formal tests of word comprehension and naming, retained a range of vocabulary pertaining to her daily life. If autobiographical experience has a general facilitatory effect, then this should affect which concepts are retained and which lost, but not influence the quality of that conceptual knowledge. Conversely, if personal autobiography has a direct role in investing concepts with meaning, then WM's understanding of nominal terms that she uses spontaneously in conversation ought not to be normal, but should be constrained by the autobiographical context in which she uses those terms. WM could define nouns and noun phrases drawn from her conversational vocabulary, but her definitions had a markedly autobiographical quality. Moreover, WM was extremely impaired in her ability to define new noun phrases, constructed by combining words from her conversational vocabulary (e.g. “dog licence”, constructed from “driving licence” and “dog” “oil field” constructed from “oil” and “field”). It was concluded that WM does not have normal conceptual understanding of nouns and noun phrases that she uses appropriately in conversation. Her understanding is narrow and autobiographically constrained. The findings, which suggest an interactive relationship between autobiographical and semantic memory, have implications for understanding of the progressive breakdown of semantic knowledge.     

Incognito or not? the patient's subjective experience of the analyst's private life

This paper examines the meaning for the patient of the analyst's personal life and personality which are ostensibly banished from the consulting room. The therapist has a not‐always‐so‐secret “secret life”; that the patient is supposed to “not know”; about. Yet, more or less unconscious perceptions, impressions, and fantasies about extratherapeutic aspects of the analyst are omnipresent and significantly color the psychoanalytic enterprise.

Moreover the analyst as a person generally plays a critical and underacknowledged role in the patient's experience of the endeavor. Constructing multiple overlapping images of the analyst and of the analytic relationship, the patient discovers himself or herself in the matrix of these relationships with various images of the analytic other. The analysand is motivated to make sense of the analyst as wholly as possible, the better to place into context the analyst's interventions. The patient's resulting view of the analyst's subjective experience acts as a lens that filters and subtly alters the meaning of the analyst's communications.

I illustrate these points by relating my work with a patient whose dreams uncannily picked up on a (consciously) unknown aspect of my private life—my having a handicapped son. The treatment thereafter centered on the patient's identification with my child (as someone “disabled") and on the meaning of her having dreamt something so personal about her therapist.     

The development of a dream from concrete realization to symbolic story

This paper is based on material from an analysis with a girl who was four years old at the time she started analysis. I relate how we worked with her feeling of vacillating, between invading and being invaded by the object, and how she was finally able to let go of her omnipotent control to a higher degree than before. Inspired by Hanna Segal and Donald Winnicott, I trace our progress from; (1) a denial of separation; (2) the analysand establishes a certain sense of separation by creating her own “space”. Through splitting and projective identification, she rids herself of feeling dependent and helpless, feelings that she cannot bear to acknowledge. The analyst receives, contains and names these feelings; to a stage where (3) the relationship established through the agency of projective identification is dissolved, and makes way for an ability to experience dependence as well as a recognition of the analyst as a separate person whom the analysand needs and can use.