Case history of Farida: A year of psychotherapy with a girl who said she was sexually abused

This paper discusses how thinking about a playroom involves our thinking about the setting in psychoanalytical work with children in general - the physical as well as the human aspects - and how this encourages us to rethink some of the basic aims in psychoanalytic work. The paper describes the importance of the setting being such as to help the therapist to have the freedom to think and to feel what is going on in the child and himself. Links are then made with aspects of transference and counter-transference, and brief examples given.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

Editorial

This paper discusses contraindications to psychoanalysis and psychoanalytic training. From Freud onwards, there has been a clear understanding that not all patients are helped by psychoanalysis, but there has been considerable controversy as to who might benefit from treatment, and whether this depends on the diagnosis, the personality or the rather vague concept of “analysability". Increasing emphasis has been placed on the analyst-patient relationship and its characteristics, without this clearly solving the dilemma. Moreover, while psychoanalysis was previously perceived rather uniformly in its classical version, treating mainly neurotics, increasing differentiation between psychoanalytic schools has appeared in the last fifty years, which would seem to give grounds for a widening of indications. This development has increased the need for rational criteria for indications and contraindications. In this article, research findings relating to outcome and process and the therapeutic relationship will be examined in parallel with clinical experience. As the therapeutic relationship is probably decisive for the outcome of the treatment, scrutiny of who is suited to be a psychoanalyst should have been an important focus of research. This has not been the case. Available research on this issue and the experiences of practitioners in the evaluation of candidates will be discussed in the following.     

Psychoanalytic case presentations in a weaving thoughts group: On countertransference and group dynamics

This article summarizes experiences of psychoanalytic case presentations in weaving thoughts (WT) peer groups. The format is presented and illustrated using a session with a group of analysts. In this setting, the frame of the presentation is guaranteed by the moderator. One aim is to create a group setting with many parallels to the analytic situation. A second aim is to discourage members from becoming enmeshed in destructive group functioning, such as internal disputes that may block a deeper understanding of the material. Classical psychoanalysis permits the analyst to reflect behind the patient on the transference-countertransference interplay. However, such reflections may be marred by undetected countertransference problems. Different supervision formats have different ways of helping the analyst with them. The WT format 'copies' the analytic session to the group, hence each member associates to the material in peace. Meanwhile the presenter looks, metaphorically speaking, at the web of their associations at his or her own pace. This may help him or her to confront and reflect on unresolved countertransference issues. This article indicates the method's similarities and differences compared with other formats. Arguments are supported by a child psychotherapy session, but the method is equally suitable for adult case material.     

Effectiveness of child psychoanalytic psychotherapy in a clinical outpatient setting

The objective of this study was to evaluate the outcome of child psychoanalytic psychotherapy in a clinical outpatient setting in a city in southern Brazil. Three psychological tests (Rorschach, Bender and WISC III) were administered to 23 children, aged 6–11 years old, and the Child Behaviour Check List (CBCL) was completed by the parents. All testing was completed before the beginning of the individual psychoanalytic psychotherapy. The same measures were repeated after 12 months of intervention. The 23 children who received individual psychoanalytic psychotherapy were compared with a control group who did not receive any kind of intervention. In the clinical group, the results indicated a statistically significant reduction of anxiety symptoms (0.002) and school problems (0.031), improvement in interpersonal relationships (0.022), and positive change in the following CBCL scales: withdrawn (0.010), thought problems (0.022), anxiety and depression (0.017), internalising (0.008) and total (0.003). An effect size of 0.696 was calculated based on the CBCL total scale before and after the intervention. The results revealed that child psychoanalytical psychotherapy is mostly effective in the treatment of female children who present internalising disorders.     

Cultural function and psychological transformation in psychoanalysis and psychoanalytic psychotherapy

Cultural experience of silence and individual vicissitudes between talking and being silent infl uence the way individuals form an alliance and pursue the analytic process. This is of relevance both for the patient and for the psychoanalyst/therapist. The author describes a patient, whose silent phase occurred in the fi fth and sixth year of intensive psychoanalytic psychotherapy. She suggests that a) the silence functioned as a protection of a space for the core self and promoted inner transformation and psychologicaldevelopment;b)thesilenceinvolvedatransference-countertransference matrix with projective identifi cations of the patient's internalized mother- and father-related objects that caused a tenuous balance between maintaining and erasing the relationship between the patient and the author; c) the silence phase was highly infl uenced by the author's own cultural background and what she brought into the relationship of tolerance of being silent in the presence of another, and understanding of the many complex functions of silence. During the silent phase the patient moved from simply describing and naming her affects and inner experiences or expressing them as somatic processes, to being able to internally access and verbally convey her own affects and experiences in the therapeutic alliance. This process involved both affect desomatization, affect differentiation, and affect verbalization.     

Supportive psychoanalytic psychotherapy for borderline patients: an empirical approach

The author describes a reformulation for research purposes of a supportive psychoanalytic therapy for patients with borderline personality disorder. The major influences on the thinking that led to the modification of prior formulations and the historical background of treatment manuals are described. Supportive treatment is contrasted with transference-focused psychotherapy and dialectic behavior therapy in the interest of creating a clear comparison that lends itself to empirical study.     

Infantile defences in parent‐infant psychotherapy: The example of gaze avoidance

Findings from parent‐infant observational research have stimulated the development of intersubjective models of psychotherapeutic action. These models have brought out the infant as an interactive partner with the parent. Conversely, interest in describing the individual psyche of the baby has decreased, especially the unconscious levels of his/her experiences and representations. In parallel, clinicians and researchers have been less prone to apply classical psychoanalytic concepts when describing the internal world of the infant. The author argues that this is inconsistent with the fact that psychoanalytic theory, from its inception, was founded on speculations of the infant's mind. He investigates one such concept from classical theory; the defence. Specifically, he investigates if selective gaze avoidance in young babies may be described as a defence or even a defence mechanism. The investigation links with Selma Fraiberg's discussion of the phenomenon and also with Freud's conception of defence. The author also compares his views on the baby as a subject with those suggested by infant researchers, for example, Stern and Beebe. The discussion is illustrated by vignettes from a psychoanalytic therapy with a 3 month‐old girl and her mother.     

A successful trial utilizing the Leuzinger-Bohleber methodology for evaluation of psychoanalytic treatment: Preliminary report

Utilizing audio-recorded psychoanalytic interviews of both patients and their analysts, group discussions of these interviews, and the application of questionnaires commonly used in psychotherapy research, the authors investigate the potential use of the Leuzinger-Bohleber methodology as an objective evaluative instrument to assess the quality of psychoanalytic treatment. Preliminary study results were obtained through interviews conducted with seven analysts and their respective patients, three of whom were treated with psychoanalysis (three or more sessions per week, for a duration of no less than one year) and four with psychotherapy (one or two sessions per week, for a duration of no less than one year). Patients were found to be eager to participate, and no adverse experiences were reported by analysts, patients or the research team. In addition to the interviews, further data were obtained through review of mailed-in questionnaires completed by 21 patients. The authors present both preliminary observations regarding the methodology as a whole, as well as the detailed results of one specifi c case subject treated with psychotherapy. Review of study fi ndings supports the utilization of this methodology as an evaluative instrument which may ultimately advance current knowledge of the process and outcome of psychoanalytic treatment.     

“They hate me now but where was everyone when I needed them?”: Mass incarceration,projective identification,and social work praxis

Mass incarceration has been thoroughly explored as a racial, social, and economic project. A psychoanalytic lens makes visible another dimension: the ways in which the dehumanization and criminalization of certain members of society forces them to function as repositories for the unbearable aspects of our otherwise shared humanity. In this article, I take a psychodynamic social work perspective and explore how the creation and maintenance of traumatogenic conditions, and the criminalization of the adaptations that people make to them, enables the logic of mass incarceration by taking a problem in the environment—one that implicates the collective—and relocates it inside the individual—as a person to be punished. Applying the concept of projective identification to these social-level dynamics, I argue that mass incarceration serves an important psychological function for society related to anxieties about racial and economic inequality and, as such, we continue to invest in mass incarceration despite its failure. I discuss its implications for social work praxis, emphasizing the need for both meaningful thought and effective action. I take an interdisciplinary approach and rely on psychoanalysis, sociology, criminology, and critical race studies in the hope of making clear the pernicious hold that mass incarceration has on the United States, and the work we must do as a collective to wrest ourselves from it.     

Keeping mother alive: psychotherapy with a teenage mother following human trafficking

The power of new traumatic events to reignite memories and the distress of traumatic experiences earlier in life is well known to psychotherapists. When the recent trauma has been extreme, the task of assisting the patient to understand their response in the light of their earlier experience can be doubly challenging. This paper describes the therapy with an adolescent girl and her infant daughter, following the girl's escape from illegal detention, physical abuse and forced prostitution, after she was trafficked to the UK from Eastern Europe. The discussion works towards developing an understanding of the emotional interchange between the mother and infant, and the influence of the mother's traumatic experiences, on that interchange. Projective identification could be seen to occur from the mother, into her daughter, in a reversal of the situation traditionally described. The function of this for the mother and the impact on the developing infant, are considered.     

The talking cure: Wittgenstein's therapeutic method for psychotherapy,by John M. Heaton

This paper offers an outline of the challenges particular to intersubjective approaches to psychoanalytic psychotherapy in South Africa. Past experiences of deeply entrenched and racialized divisions between communities continue to shape the negotiation of power in therapeutic spaces, and affect participants’ capacity to engage freely with the exploration of unconscious communication. Examples are given of the ways in which race, class and gender difference may complicate, hinder or enrich intersubjective psychoanalytic psychotherapy. Some suggestions are made about the kinds of reflective work that need to be undertaken by psychotherapists in order to assume fully the burdens of history and to appreciate fully the opportunities offered by a society in transformation.     

Psychoanalytic witnessing as a prerequisite to psychotherapy with a severely sexually abused young adolescent male ex-inner city gang member

This paper discusses psychoanalytic witnessing as the prerequisite for psychoanalytic psychotherapy with a severely sexually traumatised young adolescent boy, Dean. This form of witnessing acted as a prior stage for treatment through the psychotherapist acknowledging Dean’s trauma, without seeking to symbolise its registration in the psychotherapeutic relationship. As sexual abuse is about something done to the person, this acknowledging crucially conveys belief in the truth of what has happened to the patient at the hands of the external world. My work with Dean taught me that such acknowledgment allows for such traumatised patients to then feel more able to accept interpretations based upon what they are doing to the external world, encapsulated in the transference to their psychotherapist. Because trauma is often so deeply felt, and leaves patients dissociated or fragmented, seeking evidence of its presence needs keen observation. Here the paper discusses an experience of bodily countertransference that alerted me to the location of Dean’s trauma’s registration in our relationship. Overall, the paper seeks to demonstrate the importance of psychoanalytic witnessing as a form of containment in itself, and the essential basis for psychotherapeutic work using symbolisation and the transference.     

Relational dynamics between psychotherapy clients and clinic administrative staff: A pilot study

Extensive empirical research has established therapeutic alliance as one of the most stable predictors of psychotherapy outcomes. Nearly all the contemporary empirical literature on therapeutic alliance focuses on the therapist-client dyad without attending to the relational experiences many clients in outpatient clinics have with administrative staff. Literatures from the fields of social work, psychiatric nursing and milieu therapy suggest there are more systemic relational and environmental dynamics that impact treatment beyond the therapist-client dyad, although these issues have been considered primarily in inpatient settings. A relational ecology framework has been developed drawing upon relational psychoanalysis, attachment theory and symbolic anthropology to help conceptualise the broader relational dynamics beyond the therapist-client dyad that may impact a more systemic therapeutic alliance in certain outpatient contexts. In an initial cross-sectional pilot study with a sample of clients (N = 107) receiving psychotherapy at a community mental health clinic in the Northeastern United States, the present study found client ratings of both (a) the therapeutic alliance with their therapists and (b) their alliance with administrative staff each significantly positively predicted client ratings of treatment. Thus, ratings of administrative alliance predicted client ratings of treatment over and above the effects of the therapist-client therapeutic alliance. These findings provide preliminary support for further investigation of the relational ecology of outpatient psychotherapy and suggest that client experiences of relational and environmental dynamics with administrative staff may be important contributors to psychotherapy outcomes. Limitations of the present study and implications for future research and practice are discussed.     

On the nature and standing of psychoanalytic psychotherapy

In this paper, I offer some reflections on the standing of psychoanalytic psychotherapy in the National Health Service (NHS), with special reference to contemporary forms of evidence-based thinking. I consider what may follow when a narrow view of science or psychotherapeutic practice becomes conventional wisdom and assumes dominance. I place stress on the potential loss to NHS psychology and psychiatry if psychoanalytic psychotherapy becomes increasingly marginalized on the one hand, or overly standardized on the other.     

Parent‐infant‐psychotherapy and psychoanalytic treatment: contradiction or mutual inspiration?

Psychoanalysis and parent‐infant‐psychotherapy are compared. Although parent‐infant‐psychotherapy developed from psychoanalysis, it appears at first glance not to be “analytic” with its aim of dealing quickly with the symptoms presented and also with its different setting. The author shows that an analytic approach in understanding the multi‐facetted net of relationships between family members and the infant in its “phantasmic interaction” and a consideration of the implication for analysis of the empirical research carried out in conjunction with parent‐infant‐therapy can lead to a fruitful exchange of ideas. One example of this is research into the correlation between attachment patterns and the processing of conflicts. Furthermore a dialogue between these two disciplines can remind psychoanalysts that a critical discussion of the external circumstances of their methods does not immediately call into question their fundamental approach to therapy: the work in transference on relationship fantasies.     

The analytic process in psychoanalysis and psychotherapy: from the interpersonal to the intrapsychic level

The current debate over the conflicting interpersonal and intrapsychic views of the analytic process may or may not help us to distinguish between psychoanalysis and analytic psychotherapy. A comparison of psychoanalysis in the English-speaking world--especially in the United States--with French psychoanalysis reveals the features that unite and at the same time divide these different psychoanalytical tendencies, both of which are the heirs to Freud's thought, in terms, in particular, of the setting (couch and chair) and of technique (interpretation, transference analysis and technical neutrality). Whereas all psychoanalytic work belongs within the framework of an interpersonal relationship, that relationship becomes meaningful only when linked to the intrapsychic dimension, which alone can open the way to the unconscious and to infantile sexuality.     

PSYCHOANALYSIS IN CHINA: AN ESSAY ON THE RECENT LITERATURE IN ENGLISH

Using extensive quotation, the author reviews the introduction and current state of psychoanalysis and psychoanalytic psychotherapy in China from the vantage point of recent publications in English. Psychoanalysis was briefly introduced to China before the Communist era, then forbidden, and has experienced an accelerated reintroduction since the late 1980s. The author briefly summarizes the cultural and historical background of China relevant to the introduction of psychoanalysis, the traumatic history of China, and the deep structure of thought and philosophical differences from Western culture that challenge a simple imposition of psychoanalytic ideas and practice, and some psychological effects of rapid cultural change throughout China. Training programs in China, the general enthusiasm for analysis among the Chinese, and a number of notable contributions by Western and Chinese authors are discussed. Also surveyed are the use of distance technology for training and treatment, the personal experience of Chinese senior and junior colleagues, and ongoing challenges to the continuing growth of psychoanalysis and analytic psychotherapy in China.