Recovery from trauma: identification with the 'octor-monter' (doctor monster) – a description of psychotherapy with a 3½-year-old boy who had come close to death at 10 days old

This paper describes intensive psychotherapy with a 3½-year-old boy who had come close to death at 10 days old, with urinary reflux and meningitis. The paper describes the way in which Jamie protected himself from unbearable terrors by being in identification with a builder. It tracks the way in which containment in the therapy allowed him to begin a process of experimenting with different identities through engaging in pretend play. The latter part of the paper looks at Jamie's subsequent development and examines the links between trauma and inconsistencies in his capacity for symbolic thought.     

Therapeutic moments are the key: foster children give clues to their past experience of infant trauma and neglect

Foster parents often despair over the lack of information about the past experience of the children in their care, particularly with children who have experienced infant trauma and neglect. In the context of family therapy these unknowns pose both a challenge and an opportunity. The author proposes that foster children gives clues to their past experiences in therapeutic moments, which the therapist may recognize as a result of her own inner conversation. In conjunction with a sound theoretical knowledge of infant trauma and neglect, these moments have the capacity to open a dialogue in the relationships between therapist, child and foster family. This dialogical process offers an opportunity for the child's past experience of infant trauma and neglect to be expressed in silence, and the foster parent's present experience to be heard in stillness, opening for them a way to go on beyond the family therapy sessions.     

Changes in studying abilities as perceived by students attending psychotherapy

In rehabilitative psychotherapy, the goal is to support and improve the person's working and studying capacity and to secure his/her staying in or entering the workforce. In this qualitative study, the aim was to describe the changes students experienced in their studying ability and the advancement of their studies as a result of the therapy process. The results of this study showed many kinds of positive changes in the psychological resources and studying ability of students participating in psychotherapy. The results also show that when psychotherapy is arranged with the aim to support the study process, good connections between psychotherapy, study tutoring and career guidance are needed.     

Like a phoenix: the journey toward core-self restoration following paediatric skin-burn injury: a psychoanalytic perspective

Severe and sudden injury to the skin during childhood may damage both the child’s outer appearance and mental state. Such a trauma can provoke a complete and utter breakdown of the core-self and regression to an ‘unintegrated’ state. We present the case of 11-year-old Michael, who played with matches, set a fire and sustained severe burn trauma. Michael was treated in our rehabilitation ward over several months and received skin treatment, physical therapy and psychotherapy. Paediatric burn injury is not only a physical struggle but is often accompanied by intense emotional distress of the child and his family. In describing Michael’s therapeutic process, we show how the restoration of the core-self, alongside the healing of the outer skin, provoke issues concerning early infantile skin formation, normative age-related conflicts and vulnerabilities specific to the child. By integrating psychoanalytic thinking into the clinical work of skin rehabilitation, following burn injury, we demonstrate how the significant relationship between the skin and the self manifest in different practice.     

Toward a Developmentally Informed Narrative Therapy

Narrative approaches to psychotherapy emphasize the impact of the stories or narratives we construct on our reality and behavior. However, little effort has been made to elucidate how individuals' differential capacities for meaning-making influence the process of re-storying lives. The present article introduces to family therapy a model of the changing nature of individuals' ability to create meaning. The model, referred to as developmental-constructivism ( 10 ), suggests that, in addition to contextual factors, individual differences in the capacity for organizing experience will influence therapeutic efforts to generate new and more adaptive narratives. The model is also presented as a heuristic for comparing and integrating two influential approaches to narrative therapy: the externalizing approach of Michael White and the solution-focused approach of Steve de Shazer.     

Values and the psychotherapist

One cannot live without encountering the problem of values. Certainly, one cannot go through psychotherapy without becoming involved implicitly and explicitly in the problem. Nor can one engage in psychotherapy as a therapist without bringing certain convictions about values into one's work. These convictions may or may not be specifically communicated to the patient, but they underlie the therapist's activity; they help determine the goal he sets for himself and his patient; and they are consciously or unconsciously reflected in his questions, statements or other reactions.“^1,p.1     

Mindful Parenting: a group approach to enhancing reflective capacity in parents and infants

In this paper, the process of ending therapy is likened to the ordinary developmental task of ‘letting go’ that parents have to undertake, to help their child to grow up. ‘Letting go’ is contrasted with the process of ‘holding’ the child in mind that is so central to the therapeutic and parental task Following thoughts about some of the external issues that play a part in the decision to end a child's treatment, this developmental perspective of psychoanalytic psychotherapy is discussed through a clinical illustration of the ending of a 5-year-old boy's treatment. Different strands of the therapeutic relationship as highlighted during the ending phase of therapy are distinguished and attention is drawn to the role of the ‘new relationship’ between therapist and child and how this differs from the transference relationship. Countertransference issues in their broadest form are also considered.     

Let's Not Talk About It: Commentary on Michael Shoshani (Rosenbaum's) Dare to be Human

As an outsider, I found myself engaged and at times mystified as I wondered about the unasked and the unspoken in Michael Shoshani (Rosenbaum's) portrayal of an analysis in his book Dare to Be Human. While conceding that every therapy and every representation of therapy must touch on some issues and omit others, and that at times intimate experience can be deadened by conversation, I was curious about the ways Shoshani (Rosenbaum) appeared at times to retreat from talking with his patient about certain areas of relatedness, particularly about varieties of possible erotic transferences. While Dr. Shoshani (Rosenbaum) makes a case for the therapeutic value of the unsaid, I wonder whether in this relationship talking about this complex area might have been a means to further joint attention and an opportunity for co-inquiry and collaboration around significant subject/object and subject/subject forms of relatedness. I ask whether talking about experience may enliven and deepen mutual experience rather than deaden it, by limning mutuality and difference, and nurturing curiosity about process and relationship.     

Report on ‘A conversation about unintegration,disintegration and integration’ with papers by Anne Alvarez and Edna O'Shaughnessy,chaired by Margot Waddell, 25 february 2005 1

This paper attempts to explore the nature and consequences of trauma in infancy by an exploration of a prototype of trauma when babies are born addicted to heroin. The trauma not only involves a painful withdrawal from the drug and invasive medical procedures carried out in isolation in a special care baby unit, but often also an ongoing cumulative trauma of the lack of availability of a receptive containing parent. The paper raises specific issues about these babies as well as about trauma in general. It examines current psychoanalytic, attachment and other theories about trauma and resilience, and includes an infant observation of a baby in a special care baby unit who was born addicted. A detailed case is presented, illustrated by sequences of drawings by an 11-year-old boy who had been born addicted. These show how the lack of containment of any sort in infancy had profound effects on the child's ability to process his emotional experience in any meaningful way. An attempt is made to evaluate the effectiveness of the psychotherapy using criteria derived from Mary Main's work on disordered/chaotic infants. This involves a shift from disintegration and a lack of resolution of any crisis towards the emergence of the possibility of a hopeful outcome.     

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.     

The Art of Living in Otto Rank’s Will Therapy

Otto Rank's approach to psychotherapy, developed after his separation from Freud, encourages living life fully in spite of death and limitation. In his emphasis on the here and now, new experience in the therapeutic relationship, and collaboration and creativity in the therapy process, Rank was ahead of his time. As a theorist of personality and of creativity, his work is well known, but his influence on the practices of humanistic, existential, and post-psychoanalytic relational therapists is largely unacknowledged. Rank's creative legacy is an approach to psychotherapy that calls forth artistry and collaboration between therapist and client.     

Preliminary Findings from a Qualitative Study of Trauma Survivors in Treatment: Changes in Personal Narratives

This article seeks to document the characteristics and themes of later trauma recovery using a grounded theory analysis of interviews with trauma survivors enrolled in outpatient treatment. Little research exists that speaks to patients’ own accounts of the process of trauma recovery. Such accounts might elucidate how psychotherapy helps survivors make and remake meaning of their lives, their experience of traumatic events, and the resources they might call on in psychotherapy to secure recovery. This study examined narrative material gathered in a series of interviews with trauma survivors (n?=?14) who had been in treatment for an average of 8 months and could be described as in a later phase of the recovery process. Two significant themes emerged from the analysis: (a) greater coherence to the trauma narrative, and (b) the emergence of a more reflective and observational stance with respect to one's history. Implications for trauma-informed therapy are discussed.     

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.     

J.L. Moreno: An Unrecognized Pioneer of Family Therapy

J.L. Moreno's fundamental and pioneering contributions to the development of group therapy, encounter, transactional analysis, and especially psychodrama are well known. However, most family therapists seem unacquainted with the fact that from his earliest writings in 1923 J.L. Moreno developed an interactional view of psychotherapy that in 1973 already resulted in formulations of a true systems orientation and very concrete ideas about marital therapy, family therapy, and network therapy. He probably is the first (1937!) therapist that actually involved a husband's lover in conjoint marital therapy. His general theoretical formulations about the pathology of interpersonal relations as well as his practical suggestions for the therapy of the interpersonal relations seem to be insufficiently known to workers and researchers in the field of family therapy.     

Countertransference,enactment and sexual abuse

This paper examines the development of a therapeutic relationship with a sexually abused latency girl who, in the course of her two years of four times weekly psychotherapy, was placed in two different foster-homes. It is argued that the child's re-enactment of the abuse in the consulting room allowed her to move from a seductive relationship with the therapist to one characterized by basic trust. This was paralleled by her development of a capacity to think and to tolerate affect states. The use of an imaginary twin by the child and the use of powerful countertransference feelings in the therapist are seen as the main therapeutic tools in the treatment. The premature termination of the treatment – due to the therapist's departure – enabled the child to articulate for the first time her feelings, in the transference, about the trauma and the traumatizing agent. The child's progressing moves in the therapy are also presented.     

Revisioning Fordham's ‘Defences of the self’ in light of modern relational theory and contemporary neuroscience

This paper explores the evolution of Michael Fordham's ideas concerning ‘defences of the self’, including his application of this concept to a group of ‘difficult’ adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a ‘self‐care system’ in the psychological material of early trauma patients (Kalsched 1996 ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a ‘real person’ to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.     

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.