Dreaming up the patient in supervision: from the concrete to the symbolic*

This paper discusses the importance of parallel processes within the therapeutic and the supervisory context of therapy with an eight-year-old boy diagnosed with Asperger’s syndrome. During the first months of the therapy, through powerful projective identification, the therapist found herself in the ‘clothes’ of the ‘dead mother’. She was unable to think and feel in the sessions. Deadness could not be symbolised – it was enacted in the sessions. The therapeutic encounter had to start elsewhere: the supervisor’s reverie brought to life the patient’s material in the context of the supervision, allowing thinking to occur, first within the supervisory relationship and only then in the therapeutic relationship. In the context of supervision, the encounter of two mentally alive people could contain anxieties, metabolise them and open the way to mental connections. This encounter facilitated the development of creative thinking of both the therapist and the young patient in the consulting room, which allowed the child to become the subject of his existence and to evolve.     

The symbolic and concrete: Psychotic adolescents in psychoanalytic psychotherapy

Unique disturbances in symbolisation are characteristic of the pathology of schizophrenia. Drawing on the case vignette of a psychotic adolescent, the author discusses theoretical problems in the symbolisation process in general and then in psychosis, in particular the relation between 'concretism' as a thought disorder and other psychotic defences. The ability to symbolise on the one hand and to maintain sufficiently stable ego boundaries on the other hand are examined in their relation. The author's clinical experience supports her hypothesis that there is a close relationship between the impairment of the symbolisation process in the adolescent or adult psychotic patient and his/her inability to engage in symbolic play as a child. Special attention is paid to the role of early trauma and consequent pathology of object relations for disturbances of symbolic play in childhood. Regression to concrete thinking is understood as the chance of the psychotic patient to give some meaning to reality in an unreal, delusional world and as his/her last chance to communicate at all. Conclusions are drawn for psychoanalytic techniques in the treatment of patients who are deeply regressed in this respect. Special attention is given to the particular circumstances and challenges of adolescence and to providing psychoanalytic psychotherapy to adolescent psychotic patients.     

The story of a ghost

SUMMARY

This paper is concerned with the relationship between psychotherapy and general psychiatry. This relationship is examined from historical, clinical and theoretical perspectives. Psychotherapy is an integral part of psychiatric practice imparting to it a means of participating in, as well as observing, the patient's subjective experiences. Mental illnesses, whatever their nature have fundamental elements in common. This common ground is most apparent when mental illnesses are conceptualised in psychological terms. Such an approach in no way undervalues the importance of the hereditary and somatic influences which contribute to the predisposition to mental illnesses. Viewed in this psychobiological way it is not difficult to discern what is common to neuroses, psychoses and disturbances of the personality. The clinical phenomena provide the basis for a developmental theory which portrays the essential unity of mental illnesses. The paper concludes with a discussion of why psychotherapy is being gradually divorced from clinical psychiatry. The dangers which this separation hold for the clinical tradition in psychiatry are emphasised.     

Feature integration is not the whole story of the sequence effects of symbolic cueing

ABSTRACT

Sequential modulations in symbolic cueing tasks have been attributed to complete versus partial repetition/alternation of stimulus features between consecutive trials. This feature-integration hypothesis is questioned by recent findings and further investigated in the present study. In the first two experiments, when the cueing axes switched between trials, only complete alternation of cue directions and target locations existed. Nevertheless, significant sequence effects were still found in this condition, which did not support the feature-integration hypothesis. Furthermore, although sequence effects were still significant when stimulus identities were manipulated in Experiment 3, it was abolished when different cue categories (gaze and arrow) were presented as cues in Experiment 4. The findings suggest that the integration of stimulus features is not the only source of the sequential effect and some higher level cognitive mechanisms, possibly as described in the task-file or task organization hypotheses, are involved in the sequential modulations of symbolic cueing.     

The dream of dreams

Abstract

This paper investigates the relationship between the therapist's use of the dream and the patient's use of the dream, both inside and outside the formal therapeutic setting.     

A process research approach to the development of method in group dream work

This paper describes the development of a procedure for group work that is purely oriented toward the interpretation of dreams. Whereas other group dream work methods have tended to be unsystematic or atheoretical, the present method is operationalized in clearly defined steps and is derived from the analytical psychology of Jung. In an ongoing research process, procedural refinements have been indicated, and a step that focuses on the affective component of the dream has been incorporated. The therapeutic advantages of the new additions to the method are described. Generally the research indicates that the method is therapeutically beneficial and is not prone to deleterious effects. This paper demonstrates the value of a process research approach to the development of method in group dream work.A version of this paper was presented at the 25th International Congress of Psychology, Brussels, July 1992. Preparation of this article was assisted by a Rhodes University research grant.     

The manifest dream in psychoanalysis: a clarification

Controversies about the value of the manifest dream in psychoanalysis are usually a matter of semantics. The author concludes that two clinically meaningful questions about the manifest dream can be asked: Is the patient's report of a dream useful in formulating an interpretation if no formal associations to the dream elements are given? Inasmuch as such reports always include some kind of associations, and the analyst always possesses considerable knowledge about the patient, the answer to this question would seem to be "Yes, at least at times." In what ways can the manifest dream contribute to our understanding of the dream and the dreamer? Both the literature and clinical experience indicate that there are many ways; these are summarized in an appendix. One approach, the direct decoding of manifest dream elements, is discussed in some detail. Several examples of the undisguised appearance of memories of childhood traumatic experiences in the manifest dream are presented.