Psychoanalyse mit Traumatisierten

Extreme and complex traumatisation represents a severe problem in today’s world. There is a need to develop treatment approaches that are efficient for traumatised persons who often live under very difficult circumstances. There are moreover certain societal conditions that are important for the treatment and rehabilitation of the traumatised patient. The paper will discuss how psychoanalytic therapy may be helpful for severely traumatised patients and what are the mechanisms of change in the therapeutic process. A focus is on how traumatic experiences are actualised in the transference and brings the analyst in a situation where enactments inevitably occur. It will be demonstrated how these processes may lead to symbolisation of these traumatic experiences. What are the therapeutic and societal preconditions for treating traumatised patients?     

Psychoanalytic psychotherapy and student counselling

This paper explores the experience of a psychotherapist working in a university counselling service, indicating the contribution I think a psychoanalytic orientation can make to this kind of work. The exposed ‘coal face’ nature of the work is illustrated, and some of the psychotherapeutic implications of working within a large organisation discussed. There is an exploration of institutional dynamics which bear directly upon the psychotherapist, in terms of what it is possible to provide, and of professional self-preservation and self-esteem. Analysis of the uses made of the counselling service is seen as a contribution towards enabling the service to represent properly itself and its concerns within the institution.     

Sources and management of resistance in child treatment

This paper traces the analytic work with a severely traumatised two-and-a-half-year-old girl Phoebe, whose early life was marked by chronic abuse and a violent murder she witnessed a few months prior to the beginning of treatment. Bringing the trauma in the room in a dissociative form, in line with post-traumatic stress disorder presentation, was Phoebe's unconscious means of communicating her pre-verbal encounters by projecting onto me the rage, shock and helplessness of her predicament. Thus, countertransference responses were a helpful window into her internal world, which was governed by cataclysmic losses and primitive states of fear. The importance of containment of the complex feelings aroused in the work and protecting against potential re-enactment of the abusive elements the patient, the family and often the professional network brought in the therapy is highlighted. The author hopes that this paper will encourage the offering of psychoanalytic psychotherapy to traumatised children particularly the under fives.     

From Pathological Merger to a Reflective,Triangular Space: Parent-Infant Psychotherapy with a Mother with Borderline Personality Disorder

This article looks at Parent-Infant Psychotherapy work with a mother with Borderline Personality Disorder and her infant son. Mother had suffered a traumatic childhood and, when her son was born, withdrew into a delusion of merger with him, avoiding what she experienced as a violent, threatening and confusing world. Drawing on psychoanalytic and attachment-mentalization theories and neuroscientific and developmental research, this article explores mother’s difficulties in acknowledging her baby as a separate being, and the impact this had on baby, who was slowly turning toward an autistic way of functioning. The article discusses the therapeutic challenges in creating a reflective, triangular space where both mother’s and baby’s experiences could be thought about and understood. Finally, the author considers an interpretative stance that includes both mother’s and baby’s shared and their separate experiences.     

The conceptual distinction between projective identification (Klein) and container-contained (Bion)

This paper describes the use of play in the psychotherapy of a latency child from a severely traumatised background. It considers the meaning of play in relation to the role of the psychotherapist and to psychotherapeutic technique and explores its functions in terms of the child's development. The paper documents the psychotherapist's learning experience about the difficulty of trying to make the ‘right’ interpretations and her consequent realisation of the intrinsic value of play in psychotherapy. In considering these themes, the author explores how, by placing interpretation secondary to play, the therapy enabled the development of the child's creativity and self-agency, facilitating a movement from primarily paranoid–schizoid defences towards the beginnings of a depressive position.     

The Latin American contribution to the psychoanalytic concept of phantasy

The author argues that the ubiquity of phantasies at various levels of mental functioning is undisputed in the current schools of psychoanalytic thought; however, she demonstrates some variations in their understanding of how the psychotherapeutic access to different configurations occurs. In the process of examining and acknowledging the central role played by unconscious phantasies in his patients’ symptoms, Freud gradually broadened the vernacular meaning of the German word ‘Phantasie’ that refers to imagination and the world of imagination, conferring on it the specific features that came to characterize its use in the psychoanalytic vocabulary. Later, the expansion of the concept derived from Melanie Klein’s clinical material obtained from child analyses gave rise to important debates. The author discusses the main points of disagreement that led to these debates, as well as their various theoretical and technical implications. Psychoanalytic associations in Latin America were strongly influenced by Klein and her followers. Thus, most of their scientific writings use the concept of unconscious phantasy put forward by the Kleinian school. Taking Kleinian principles as their starting point, Baranger and Baranger made the most original Latin American contribution to the concept of unconscious phantasy with their works on the unconscious phantasies generated by the analytic pair.     

Seeing ‘the dark passenger’ – Reflections on the emotional trauma of conducting post-disaster research

This paper acknowledges ‘the [my] dark passenger’ of emotional vicarious trauma associated with conducting post-disaster research. Post-disaster research is tightly bounded by ethics and professional codes of conduct requiring us to be vigilant about the impact of our work on our participants. However, as a disaster researcher, I have been affected by vicarious trauma. ‘Direct personal’ vicarious trauma is where I experienced trauma associated with witnessing devastation making a professional separation from my objective subjects impossible. ‘Indirect professional’ vicarious trauma occurred when PhD students and others under my supervision that I sent to disaster affected places, experienced significant negative emotional responses and trauma as they interviewed their participants. In these situations, I became traumatised by my lack of training and reflected on how the emphasis on the participants came at the expense of the researcher in my care. Limited literature exists that focuses on the vicarious trauma experienced by researchers, and their supervisors working in post-disaster places and this paper is a contribution to that body of scholarship. In acknowledging and exploring the emotions and vicarious trauma of researchers embedded in landscapes of disaster, it becomes possible for future researchers to pre-empt this phenomenon and to consider ways that they might manage this.     

On presence in the psychoanalytic relation

This paper discusses presence in the psychoanalytic relation, the analysand’s and the analyst’s. Clinical situations with different qualities of presence will be considered focusing on what kind of interplay between analysand and analyst they may lead to. As examples, I have chosen three different clinical situations: In the first there is an interplay between the analysand’s free associations and the analyst’s ‘evenly suspended attention’. In connection with this I will discuss Bion’s concepts of ‘reverie’ and of ‘O’. In the second there is where the interaction is characterised by what Meltzer calls ‘geographical confusion’. In the third there is a ‘transference delusion’ in the psychoanalysis of breakdown as Winnicott describes it.     

Biographical truths and their clinical consequences: Understanding ‘embodied memories’ in a third psychoanalysis with a traumatized patient recovered from severe poliomyelitis

The relationship between ‘narrative’ and ‘historical–biographical truth’ in psychoanalytic treatment has become the subject of many controversial debates in recent years. Findings of contemporary memory research have lead to great scepticism as to whether therapists are able objectively and reliably to reconstruct biographical events on the basis of their observations in the therapeutic situation. Some authors even claim that psychoanalysts should concentrate exclusively on observing the here and now of the patient′s behaviour within the transference relationship to the analyst. In this paper it will be discussed whether the baby has been thrown out with the bathwater in this debate. Centred around the insights from a third psychoanalysis with a patient who suffered from a severe case of childhood polio, the hypothesis will be discussed that working through the traumatic experience in the transference with the analyst, as well as the reconstruction of the biographical–historical reality of the trauma suffered, prove to be indispensable for a lasting structural change. Integration of the trauma into one′s own personal history and identity is and remains one of the main aims of a psychoanalytic treatment with severely traumatized patients. The reconstruction of the original trauma is indispensable in helping the patient to understand the ‘language of the body’ and to connect it with visualizations, images and verbalizations. The irreversable wounds and vulnerability of his body as the ‘signs of his specific traumatic history’ have to be recognized, emotionally accepted and understood in order to live with them and not deny them any longer. Another important aspect in psychoanalysis is to develop the capability to mentalize, in other words, to understand the intentions of central (primary) objects related to the trauma. The concept of ‘embodied memory’ might be helpful in understanding precisely in what way ‘early trauma is remembered by the body’. Observing in detail the sensory‐motor coordinations in the analytic relationship enables one to decode the inappropriate intensity of affects and fantasies which match the original traumatic interaction and are revealed as inappropriate reactions in the present, new relationship to the analyst.     

Performative and enactive features of psychoanalytic witnessing: The transference as the scene of address

This paper will attempt to broaden the conception of witnessing in analytic work with traumatized patients by extending the idea to incorporate the patient’s developing and varied capacity for witnessing, as well as a witnessing that occurs within the analytic relationship itself. Actions occuring as part of traumatic repetition are understood to represent memory phenomena and are distinguised from dissociated self‐state experience. These experiences are not therapeutically intended to be symbolized, but rather lived‐through with the analyst, thus transforming the patient’s own relation to the experience. I suggest that the scene in which this living‐through takes place is the transference–countertransference matrix, and that it is the analytic encounter that allows traumatic repetition to take on the quality of a communication, an address to another, rather than remain meaningless reproduction. A clinical vignette illustrates the turning of trauma’s imperative for witnessing into an address in the analytic encounter.     

The relationship of the inner and the outer in psychoanalysis

What is internal and what is external according to psychoanalytic theory? This is a surprisingly complicated question. The terminology is often ambiguous and inconsistent as, for instance, in the use of terms like ‘object’ and ‘other’. The relationship between internal and external in psychoanalysis is analysed from a philosophical, concept analytical, developmental psychological, methodological and trauma versus internal dynamics point of view. It is argued that psychoanalytical writing is influenced by the authors’ need to create their personal psychoanalytic theory and language. This is seen as one of the main reasons for the terminological variety and ambiguity in psychoanalytic writing. It is also argued that one particular reason for difficulties concerning the internal–external terminology is the existential anxiety awakened by the threat of the essential aloneness of man. The consciousness of this has a tendency to fade and lead to unclear terminology. The importance of the transitional world as a resting place from the hard reality of this essential aloneness is emphasized. The transitional world is also seen as a necessary part of psychoanalytical practice, as an aid in striving for the truth and reality, important goals of psychoanalysis.     

A brief introduction to the work of Jean Laplanche

The author proposes an introduction to the work of Jean Laplanche, a well‐known figure of psychoanalysis who recently passed away. He foregrounds what he views as the three main axes of Laplanche's work: firstly, a critical reading method applied to Freud's texts; secondly, a model of psychic functioning based on translation; and, thirdly, a theory of general seduction. Far from being an abstract superstructure, the theory of general seduction is firmly rooted in the analytic situation, as the provocation of transference by the analyst best illustrates. The analytic situation indeed consists in a revival and a reopening of the ‘fundamental anthropological situation’ which, according to Laplanche, is the lot of every human baby born in a world where he or she is necessarily exposed to the enigmatic and ‘compromised’ messages of the adult other. Thanks to the process of analytic de‐translation, the analysand is therefore granted an opportunity to carry out new translations of the other's enigma – translations or symbolizations that might be more inclusive and less rigid than the pre‐existing ones. Incidentally, such a model brings together the purely psychoanalytic and the psychotherapeutic aspects of the treatment.     

The infant and the infinite: On psychoanalytic faith – Bion,Meltzer and Kierkegaard

This paper discusses the meaning of psychoanalytic faith as a useful developmental concept, which applies to the therapeutic process in the consulting room as to other intimate educational experiences. Faith is a concept which has been little considered in relation to psychoanalysis, partly owing to semantic confusion with ‘the Faith’ as in religious or psychoanalytic dogma, and partly owing to the difficulty of defining or describing what it is, outside accepted jargon. Yet, faith is traditionally the gateway to experiencing the unknown – a psychoanalytic goal-demanding negative capability. It is suggested that philosophy and poetry, where the concept is more familiar, can provide psychoanalytic parallels for this particular type of learning from experience. The viewpoints of Bion, Meltzer and Kierkegaard are taken as contributing to a picture of how, in the psychoanalytic session, there may be a developmental encounter between the infant (patient) and the infinite (the transference process, rather than the analyst as a person).     

Playing with reality

The authors explore the interpersonal aspects of the early development of an experience of external reality and the roots of this experience in primary intersubjectivity. They suggest some implications that this has for psychoanalytic work with the patient's experience of external reality. They argue that the external world is not an independently existing 'given', for the infant to discover, as is sometimes implicitly assumed. Infants acquire knowledge about the world not just through their own explorations of it but by using other minds as teachers. The experience of external reality is invariably shaped through subjectivities. The authors argue that at first the infant assumes that his knowledge is knowledge held by all, that what he knows is known by others and that what is known by others is accessible to him. Only slowly does the uniqueness of his own perspective differentiate so that a sense of mental self can develop. In clinical work we frequently observe the undoing of this process of differentiation, and understanding the underlying mechanisms can be helpful in managing the transference and countertransference consequences when the process has been derailed.     

Finding unconscious phantasy in the session: Recognizing form

The concept of unconscious phantasy has played – and still does play – a central role in psychoanalytic thinking. The author discusses the various forms by which unconscious phantasies manifest themselves in the analytic session as they are lived out and enacted in the transference relationship. This paper also aims at expanding the kleinian theory of symbol formation by exploring the impact that emotional aspects connected to early “raw’, “pre‐symbolic’ phantasies have in the analysis and how their corporeal elements interlock with the signifying process. The author follows the expressive forms of primitive unconscious phantasies as they appear in a psychoanalytic session and proposes that the emotional effect that can be experienced in the communication between patient and analyst depends in great measure on “semiotic’ aspects linked to primitive phantasies that are felt and lived out in embodied ways. Rather than a move from unconscious phantasies that typify symbolic equations to those showing proper symbolization, these can coexist and simultaneously find their way to what is communicated to the analyst. As early phantasies bear an intimate connection to the body and to unprocessed emotions when they are projected into the analyst they can produce a powerful resonance, sometimes also experienced in a physical way and forming an integral part of the analyst's counter‐transference.     

Where we live: some dilemmas and technical issues for the child psychotherapist in interpretative work with looked-after and adopted children

This paper addresses, from a Kleinian perspective, some of the dilemmas and technical issues faced by the child psychotherapist in work with looked-after and adopted children. A selective review of psychoanalytic literature focusing on the use of transference and countertransference is given. Clinical material provides some examples of different kinds of interpretation, and of the importance of timing and emotional resonance in the interpretations.     

Object-Relations and Cultural Narratives in the Analysis of Racism: Theorizing Subjectivity After Klein and Lacan

This paper discusses two approaches to racism in the psychoanalytic literature—one based on Kleinian object-relations, and another based on Lacan’s theory of language as central to subjectivity. It is argued that the Kleinian method relies on drawing parallels between object-relations at the psychological level and social relations in the external world, and this limits its understanding to a narrow catalogue of psychoanalytic concepts. A Lacanian/post-Lacanian approach begins from the structure of cultural narratives and is more sensitive to social variations. Using examples from anthropology, it is argued that both theories are crucial for a robust analysis of racism.     

Psychoanalysis is a two‐way street

The paper discusses psychoanalysis as a mutual exchange between the analyst and analysand. A number of questions are raised: What was Ferenczi's and the early psychoanalysts' contribution to the interpersonal relational dynamics of psychoanalytic treatment? Why did countertransference become an indispensable tool in relationship‐based psychoanalysis? Why is the transference‐countertransference dynamic seen as a special dialogue between the analyst and analysand? What was Ferenczi's paradigm shift in the trauma theory? How did he combine the object relation approach with Freud's original trauma theory? The paper illustrates through some case study vignettes the intersubjective and intrapsychic dynamic in the process of traumatization. We can look at countertransference as an indicator of the patient's basic interpersonal experiences and traumas. Finally the paper discusses countertransference in the light of attachment theory, connecting the early initiatives of inter‐relational approaches in psychoanalysis with recent research.