Embracing darkness: clinical work with adolescents and young adults addicted to sexual enactments

This paper described common themes and transitions in the treatment of adolescents and young adults presenting as addicted to sexual enactments. Central to their experience is a highly addictive reliance on a bad object, which both enables and relies upon sexually perverse enactments. The paper follows the therapeutic process with patients seen in either group or individual long-term psychotherapy. Their experience is understood in the context of theories central to the work at the Portman Clinic relating to perversion and addiction, combined with some ideas from the field of criminology. Patients usually start by noticing their relationship with their compulsive behaviour, moving from a passive stance to a perception of themselves as active agents. They discover moments that are described as ‘pressing a button’, at which they move from passivity to taking perverse action. Those insights lead to a slowing down of the addictive cycle and emergence of phantasies, core complex anxieties and even hopes, all desperately avoided by taking sexualised action. The paper follows a pathway of change and transformation, which when successful enables patients to reduce or cease addictive behaviours by coming in contact with a good object, enabling both emotional pain and the experience of potency and hope.     

Psychoanalytic action explanation

Psychoanalysis is concerned with neurotic behaviour that counts as an action if one takes into account “repressed” mental states. Freud's paradigmatic examples are a challenge for philosophical theories of action explanation. The main problem is that such symptomatic behaviour is, in a characteristic way, irrational. In line with standard interpretations, I will recap that psychoanalytic action explanation is not in accordance with Davidson's classical reason-explanation model, and I will recall that Freud's unconsciousness is not a second mind with its own rationality but that it is non-propositional in character. However, I then will argue that this characterization is not discriminating enough to explain the dynamical unconscious and overlooks the crucial role of “counter-cathexis”. With counter-cathexis the relevant desire turns out to be a complex with two inseparable aspects (“double-aspect view”), so that the causing belief–desire pair is still part of the space of reasons, although it cannot rationalize the behaviour. Psychoanalytic action explanation is hence still Davidsonian, albeit in a modified way.     

An Attachment Perspective on Reunions in Couple Psychoanalytic Psychotherapy

Psychoanalysis has been slow to acknowledge attachment theory as one of its own. Yet traditions of observational and representational research associated with it have much to offer in shedding light on intrapsychic as well as interpersonal phenomena. This paper explores these traditions and their potential clinical utility for couple psychoanalytic psychotherapy. In particular, attention is drawn to behaviour and representations associated with the experience of reunion in therapy sessions.     

Perversion from the medical-legal perspective

Abstract

The medical-legal view of perversion is strictly concerned with the sexual aspect. This is the result of a controversial historical process full of moralism with respect to sexuality. Psychoanalysis questions this reductionist view, offering itself as instrument of special importance in the characterization of perversion as a complex of structures in human beings.

Alves KC und Prado de Sousa S. Perversion aus der medizin-rechtlichen Perspektive

Die medizin-rechtliche Sicht der Perversion ist strikt mit dem sexuellen Aspekt befaßt. Dies ist das Ergebnis eines kontrovers historischen Prozesses, der ganz mit Moralismus im Hinblick auf Sexualität angefüllt ist. Psychoanalyse stellt diese reduktionistische Sicht in Frage und bietet sich selbst als Instrument von besonderer Bedeutung an, die Perversion als einen Komplex von Strukturen bei Menschen zu charakterisieren.

Alves KC y Prado de Sousa. Perversión desde la perspectiva médico-legal.

El punto de vista médico-legal de la perversión esta estrictamente relacionado con el aspecto sexual. Este es el resultado de un proceso controvertido moral histórico con respecto a la sexualidad. El Psicoanálisis cuestiona este punto de vista reduccionista, ofreciéndose como instrumento de especial importancia en la caracterización de la perversión como una complejidad estructural en los seres humanos.     

Discussion: Application of Psychoanalytic Developmental Understanding to Three Early Intervention Programs

Discussion is made of the application of psychoanalytic developmental understanding to three early intervention programs. One program that was highly ambitious in its aim of preventing aggressive behavior in children attending elementary school was effective but may have attempted to achieve too much. One, involving an assistance program in a public school for boys who had lost their fathers, was extremely successful in helping the boys to express and deal with their feelings verbally rather than through undesirable behavior. The third program provided services for very young children that developmentally were extremely useful to them. Discussion is made of the value of these programs not only to the children involved but also to the teachers and mental health care personnel who worked with them.     

Two Systems of Self-Regulation and the Differential Application of Psychoanalytic Technique

Out of our work over the years on child development, clinical technique, and sadomasochism, we have begun to formulate a model of development that describes two possible ways of responding to feelings of helplessness in the face of the challenges of internal and external experience. Any psychoanalytic model has implications for how we think about technique and can be tested on the basis of its utility in generating technical ideas and enhancing our therapeutic repertoire. At this juncture in the history of our field, it is crucial for us to demonstrate that psychoanalytic techniques are effective in helping people enter treatment, change, and finish in a way that consolidates their gains. In this paper we explore the utility of our two-systems model for expanding the discourse about psychoanalytic technique.     

试析对象关系学派的精神分析思想

对象关系学派是在英国发展起来的精神分析学的分支,它把对象关系特别是亲子关系置于理论和临床的视野中心,形成独特的对象关系理论。这一理论代表与传统驱力结构模式相对应的关系结构模式,是精神分析的一种新范式。Klein发展起来的游戏疗法是这一理论的重要临床技术。     

Structure with Engagement: Toward an Integration of Trauma and Relational Psychoanalytic Models in the Treatment of Dissociative Disorders

Trauma model approaches to the treatment of dissociative disorders may provide containment and direction and yet, these same approaches may be constricting and limit exploration. However, relational psychoanalytic approaches may allow for engagement and exploration while potentially failing to provide containment and structure. This article provides an overview of key elements of both models and considers the question of whether it is possible to creatively resolve theoretical and clinical tensions between trauma model and relational psychoanalytic responses to dissociation. A review of the history of the study of dissociation in the field of psychoanalysis and concerns about psychoanalytic practice in the context of dissociation is followed by comparing contrasting conceptualizations of the assumptions of normality, definitions of dissociation, theories of etiology, goals of treatment, and theorized mechanisms of action. The review ends with a discussion of potential possibilities for clinical integration.     

From the Couch to the Chair: Applying Psychoanalytic Theory and Practice in Counseling

In this article, the authors offer a contemporary perspective on psychoanalytic theory. The authors present a clinical vignette that illustrates how one analyst applied the principles of transference, countertransference, and resistance in a modern clinical setting. The authors describe how analysis is similar to and different from humanistic counseling and conclude by describing how analytic insights might be applied in the clinical practice of counselors.     

Oscillations: Zen & Psychoanalytic Versions

The author provides a personal and experiential account of Zen Buddhism and psychoanalysis. The notion of oscillations serves as an organizing structure. Drawing from the British psychoanalyst Wilfred Bion and the American Zen teacher Robert Aitken, the notion of suffering, meaning here to permit, is considered as the central motivating force and organizing principle for both disciplines. As a critique of traditional psychoanalytic writing an experiment in dialogue is offered that draws from a variety of writing styles including prose, poetry, free-association, stream of consciousness, traditional teaching stories and case material to discuss various experiential states such as linearity, circularity, resistance, ambivalence, passion, rage and the potential for a mutually supportive dynamic between Zen and psychoanalysis.     

The Experience of the Holy: A Relational Psychoanalytic Analysis

The title of this paper, The Experience of the Holy is a direct reference to Rudolf Otto's book Das Heilige. The paper begins with Otto because he lays out many of the important issues involved in a psychological investigation of the experience of the holy, especially the question of whether the sacred is a unique object of experience, or a characteristic of our experience of ordinary objects. The paper then discusses three contemporary relational psychoanalysts (D.W. Winnicott, Hans Loewald, and Christopher Bollas), and the ways in which their theorizing illuminates the psychology of the sacred.     

Psychoanalytic perspectives on the treatment of early adolescent girls

Psychotherapy of girls between the ages of 10and 14 years presents specific difficulties which originate in the rapid physiological changes and intrapsychic demands for psychological differentiation, causing considerable anxiety and inner turmoil. The introduction of therapeutic intervention at this juncture is discussed along with its risks, benefits, limitations, possibilities, and implications for psychoanalytic theory.     

Clinical Flexibility in the Psychoanalytic Situation: The Elasticity Principle

Abstract

This paper explores the development of the Elasticity Principle, first introduced by Ferenczi based upon his clinical observations. This important shift away from classical neutrality was inspired by Ferenczi's human approach to psychoanalysis. Learning from his analysands, he not only determined that in order to reduce resistances the analyst should present any interpretations in a tactful, empathetic manner, but also that the analytic work should bend or yield toward the analysand. The paper traces the evolution of the Elasticity Principle to The Grand Experiment, which was Ferenczi's analysis of Elizabeth Severn utilizing provision as an analytic tool. The paper follows the contemporary extensions of the Elasticity Principle in the development of Self Psychology and in the Relational perspective. A clinical example illuminates aspects of the Elasticity Principle in the work with a difficult analysand.     

Working Through Physical Disability in Psychoanalytic Psychotherapy With an Adolescent Boy

The narcissistic injury that may be caused by physical disability in infancy and the possible familial traumatization may block the integration of the infant's body and self-image, and can consequently hinder the child's identity formation. This article presents how an adolescent boy with cerebral palsy in short-term psychoanalytic psychotherapy works through the mental impact of his physical disability using a story. Transference and countertransference reactions are discussed. The positive impact of short-term psychoanalytic psychotherapy highlights the importance of caring for the mental health of children with physical impairments.     

Psychoanalytic and musical perspectives on shame in Donizetti's Lucia Di Lammermoor

Two disciplines, psychoanalysis and music, are synthesized here with an eye to the origins and vicissitudes of shame and guilt as seen in the emotional disintegration of the eponymous heroine of Donizetti's opera Lucia di Lammermoor. Lucia's affects and her intrapsychic and interpersonal dynamics are heard in the music itself. A psychoanalytic and musical analysis of the opera, taking Lucia's dynamics as a quasi-substitute for clinical material, illuminates the intersections between certain theoretical aspects of the two disciplines. Both manifest and latent themes are expressed through the music of Donizetti's score.     

The Products of the Imagination: Psychoanalytic Theory and Postmodern Literary Criticism

This article considers some of the affinities between postmodern literary theory and the psychoanalytic theories concerned with intersubjective phenomena. Postmodern literary theory is described briefly, and it is argued that one of its major concerns is the nature of, and the political and cultural influences on, subjectivity and identity. Despite that, postmodernism generally, and literary postmodernism in particular, can be said to lack a theory of the psychological and interpersonal dimensions of the experience of self. This article contends that the more relational schools of psychoanalytic theory can provide an example of the construction of selfhood that is of importance to contemporary and postmodern literary criticism. The academy has, to a considerable extent identified psychoanalysis with the work of Jacques Lacan, but since the 1980s the work of such theorists as Jane Flax and Jessica Benjamin, building on the work of Nancy Chodorow, have increasingly opened up the possibilities of relational and object relations theory for literary studies. The relational psychoanalytic theories operate in the same epistemological universe as postmodern literary criticism, congruent with the postmodern idea of truth as constructed and relational, and selfhood as shifting, contingent, and always-in-process. Particular attention is paid to the work of Wilfred Bion, whose understanding of self provides an account both of the failure of meaning, and of the development of mind. Some examples of a relational approach to literary analysis are provided.