Toward an understanding of the obese person

Attitudes, feelings, and family backgrounds of seven very obese women were studied by means of a religious history questionnaire. Some comments are made about this research tool. Three very prominent characteristics of these women were feelings of helplessness and powerlessness, a craving for love, and strong guilt feelings. A possible psychogenic factor in morbid obestity was observed in the backgrounds of five women; pertinent information on the other two was lacking. This factor is a dual dynamic of harshness and indulgence. The onset of obesity seemed to occur when indulgence became the dominating influence over harshness.     

Psychoanalytic aspects of inpatient treatment

This paper looks at the experience of inpatient hospital treatment at the Cassel Hospital and how formal psychoanalytic psychotherapy, with its emphasis on the transference and the inner world, fits into that context and orientates itself to some of the realities of the setting. It outlines how psychotherapy and nursing can work to inform and enrich each other, and what is psychoanalytic about the overall work. A bridge of understanding is built using the patients' perceptions of, adjustment to and conflict about the inpatient setting, and the affective impact of the processes on patients and staff alike. Two clinical examples of severe child abuse family cases are given, the first of Munchhausen syndrome by proxy, the second in which a baby sibling had been killed. They show how in-depth psychoanalytic work with mother and child and individual psychotherapy of the child can be combined with psychotherapy of the parents and intensive work in the therapeutic community. Such a combination can contribute, even in cases of severe pathology, to the development of the relationship between mother and child and promote successful rehabilitation in the outside community.     

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.     

Psychoanalytic treatment of a woman with anxiety attacks and conversion

This case study describes the psychoanalytic treatment of a young woman presenting with symptoms of overwhelming anxiety, panic, and conversion. The emphasis is on technique with detailed reporting on the psychoanalytic process. Attention is paid to transference-countertransference paradigms at critical junctures in the treatment. The role of clinical supervision in the unfolding of the process is described also. This patient developed an identifiable transference neurosis during the course of the treatment, which became the focus of the analysis. Follow-up observations on this patient are also presented, as she returned for a brief course of treatment 4 years following initial termination.     

Psychoanalytic Companioning

In this paper I offer an integration of object relations and relational conceptions of clinical interaction and suggest a register of psychoanalytic companioning. I suggest that when working with patients and states where there is no self-other definition and therefore no mutuality, the path to healing and growth is via companioning the patient into the darker, more regressed and unformed states of illusion and merger rather than via the promotion of separateness and relatedness, which, I propose, will accrue from within the companioning register. The analyst works from within an unobtrusive relational position. I offer a case example of my work in this register and suggest that this offers a different register of the use of the analyst’s subjectivity: one that is receptive, “cooperative” (Trevarthen) and responsive to the patient’s internal world and objects, rather than analytic and knowing. I consider the dimensions of intersubjectivity that cohere with the dimensions and levels of the patient’s mentalization as outlined by Leciurs and Bouchard (1997).     

Psychoanalytic observation

The recent focus on empathy as the essential activity in psychoanalytic data gathering has underemphasized the complexity of psychoanalytic observation and has failed to identify what truly makes it unique among modes of psychological investigation. It is a process that includes introspection and empathy. However, it also includes the analyst's observation of the patient's behavior, and particularly verbal behavior, in a way that is not necessarily empathic. The psychoanalytic use of introspection and behavioral observation together, as they are modified by the analysand's free association and the analyst's evenly hovering attention, provides a unique method of data gathering. The transient, mutually related regressions of analyst and analysand which partly constitute the analyzing instrument modify the field of observation available to both, providing better access to derivatives of the analysand's unconscious mental functioning. This more complex concept of psychoanalytic observation, as opposed to that in which empathy is predominant, has important implications for psychoanalytic training, clinical work, and theory.     

Psychoanalytic process

Differing concepts of psychoanalytic process and views of its "locale" are related to how essential the interactivity of the analyst is judged to be. Scientific scrutiny of clinical psychoanalysis requires that the interactive nature of the process be recognized. In this endeavor the concept of "process model" is helpful, as is the view of psychoanalysis as a form of treatment in which therapeutic process and therapeutic agent are distinguished.     

Roles in the Psychoanalytic Relationship

Who we are depends on the situation we are in. Psychoanalysis, like any other recurrent social activity, is conducted under the influence of implicit social roles. Our technical emphasis on free association and other unstructured aspects of the analytic setup tends to minimize awareness of the degree to which both analyst and patient orient around role expectations. The analyst's role is the result of enculturation during training and after; the patient's role is a product of character, transference, and analytic influence. This paper explores the way in which the alternation and tension between role and nonrole aspects of the psychoanalytic relationship is at the center of therapeutic process and change. The author illustrates the way in which role and nonrole aspects of process appear in a case study, both over longer stretches of time and in particular moments. Understanding the importance of analytic roles clarifies some dilemmas and contradictions in older discussions of technique and modern relational theory.