Working with and ‘seeing through’ the sexual transference in the psychotherapy of an adolescent boy

This paper explores the challenges and developmental opportunities of working with the sexual transference in psychotherapy with adolescents. Psychoanalytic contributions investigating the nature of adolescent sexuality and the developmental move from a narcissistic organisation to a capacity to form intimate relationships are reviewed, and the question of what happens when there is a lack of containment in infancy is addressed. The way in which unintegrated sexual impulses and phantasies can invade the therapeutic relationship is further discussed through the account of the weekly psychotherapy of a 16-year-old boy who formed a powerful sexual transference to his female therapist. The paper highlights how working through the sexual transference enabled this young man to face his developmental paralysis and begin to use the therapy as an opportunity for psychic growth.     

‘Am I a Ceadas child?’: exploring the nature and experience of shame in the psychotherapy of an adolescent boy

Although shame is a central affect running through all phases of psychosexual and social development, it is usually masked by guilt and therefore it is not readily recognised, explored, and understood within the therapeutic situation. Moreover, there is a tendency to treat all shame manifestations as if they operate at the same level. The author proposes the need to distinguish between two qualitatively discrete manifestations of shame states which, albeit intertwined, operate at different levels and require different understanding and technique: a primary, unconscious kind based on psychobiological survival and triggered by a condition of psychic and physical danger, and a secondary, social shame, mainly conscious, based heavily on vision and evoked in social situations. The natural, primary form of shame becomes pathological after catastrophic chronic exposure of the primitive ego to unthinkable anxieties. Such premature rupture of primary skin containment may result in omnipotence-based pathological organisations impeding or precluding acceptance of guilt and need for reparation. Pathological primary shame predisposes the individual to states of pathological secondary shame. When initial traumatic conditions are re-activated and re-experienced in therapy, they may trigger re-enactments and, possibly, a negative therapeutic reaction. Recognising variations and mixed states of primary and secondary shame states, especially when shame is compounded with guilt, can provide guidance in the assessment of the fragility of the ego, and therefore inform our technique and the therapeutic process. This theoretical position is discussed with the help of clinical material from a twice-weekly psychotherapy of a 16-year-old boy imbued with shame compounded with guilt, related to transgenerational objectification and dehumanising experiences.     

Student clinicians’ and clients’ perceptions of the therapeutic alliance and outcomes in stuttering treatment

PurposeThe purpose of this study was to examine how the therapeutic alliances (TA) of graduate student clinicians and adult clients who stutter relate to perceived treatment outcomes.MethodsStudent clinicians (N = 42) and adult clients who stutter (N = 22) completed a survey assessing their TA strength and perception of treatment outcomes. Responses were analyzed to determine similarities and differences in how clinicians and clients relate the TA to perceptions of treatment effectiveness, progress, and outcome satisfaction.ResultsResults suggest that clinicians and clients who stutter both relate the TA to treatment outcome, but in different ways. While clinicians associate the TA most with treatment effectiveness and client progress, clients relate the TA most to outcome satisfaction.ConclusionClinicians should be aware that for adult clients who stutter, outcome satisfaction is related to the degree of shared understanding, agreement on daily tasks, and bond they experience with their clinician. To ensure a strong TA and client satisfaction, clinicians should actively seek their clients’ perspective regarding TA status.     

Recording supervision: Educational,therapeutic, and enhances the supervisory working alliance?

Aims: To explore the impact of listening to an audio‐recording of their latest supervision session on supervisees. Method: Participants recorded a supervision session, listened to it and were interviewed about this experience of listening to it within seven days of listening to the recording. The phenomenological interviews informed by the researcher's knowledge were analysed using grounded theory. Participants: Fifteen participants with 0–20 years’ experience, representing person‐centred, CBT, psychodynamic and integrative approaches, and qualifications ranging from student to doctorate formed the theoretical sample. Findings: Listening to the audio‐recording allowed participants to re‐experience their thoughts and emotions. Participants recalled and re‐experienced events which had been forgotten, unnoticed or (arguably) repressed. This re‐experiencing was usually less emotive than in real‐time; but suppressed emotions could be more intense. As participants integrated both these noticed and unnoticed events, they were able to accept what had been unacceptable, gaining self‐awareness, which was potentially therapeutic. Noticing what had been unnoticed permitted insights into many aspects of therapy and supervision, which was more than just ‘reflection‐on‐action’. Conclusion: Listening to an audio‐recording of the latest supervision may be educational for any supervisee; it may be therapeutic by facilitating challenge of maladaptive beliefs and behaviours; and it also seems to strengthen the supervisory working alliance.     

The butterfly dream as ‘creative dream:’ dreaming and subjectivity in Zhuangzi and María Zambrano

The ‘dream of the butterfly,’ which seals the second chapter of the Zhuangzi, is often interpreted as undergirded by the bipolarity of dreaming and awakening or by the elusive interchange of identities between Zhuangzi and the butterfly, dreamer and dreamed. In this paper I argue that the underlying structure of the story may be better interpreted as exhibiting not two, but three stages of development, consistently echoing other tripartite parables in the Zhuangzi. In my reinterpretation I rely on the phenomenology of dreams proposed by the Spanish philosopher María Zambrano, which distinguishes among three states: the primal dream, characterized by atemporality and wholeness; wakefulness, characterized by temporality and analytic thinking; and the creative dream, in which reality discloses itself as a meaningful, holistic unity. I suggest that Zhuangzi’s parable describes a similar self-transformative threefold process culminating in the joyous freedom of a shifting multifaceted subjectivity centered in the timeless pivot of the Dao.     

‘Un-certainty’: working therapeutically with a transgender young person and learning to bear the unknown

Abstract

The rate of referrals to mental health services for children and young people for whom gender dysphoria is the identified clinical issue has increased significantly over the last ten years. Debates around the classifications of gender identity disorder, gender dysphoria or gender incongruence, as well as the involvement of child and adolescent mental health services with this group of children and young people seem to be re-enacting the societal gender binary world view where we see acceptance versus rejection, open-mindedness versus conservative, trans-phobic thinking. In this paper the author will attempt to shed some light on the work with these young people in a clinical setting by reflecting on a year of therapeutic work with a female to male young person. Through the therapist’s reflections upon these binary preconceptions, along with the use of developmental and object relations theory, an in-depth account of the work is given. It is suggested that in some cases the therapist’s capacity to bear the unknown, while gradually observing and mirroring the un-integrated inner self of the patient, can gradually bring the fragments together, even if not in a perfect fit, and that this in turn provides a sense of relief.     

Sikh millennials of the ‘kirtan generation’ in the making of an ‘American Sikhism’

ABSTRACT

This essay focuses on the millennial generation of Sikhs in the United States. Based on extended ethnographic research in Sikh communities, the author explores the role of Sikh millennials in the making of an ‘American Sikhism’, the contours of which are taking shape having followed after the explosive growth of gurdwara communities – and the educational, social, and other resources they provide – which were largely made possible by the affluence of Sikh communities beginning with the previous ‘Brain Drain’ generation. In particular, the author discusses this ‘kirtan generation’ of Sikhs, educated in gurdwara schools, and their growing leadership of Sikh communities.     

‘My mother messed with me’ The legacy of abuse by his mother for a 10-year-old boy

This paper seeks to explore some of the effects of abuse by a mother on her very young son. It considers how the primitive capacity for coping with anxiety by splitting and projection has been rendered ineffectual, and how the structures that have evolved to compensate have profoundly affected the boy's emotional and mental capacities. In the first fifteen months of therapy, the boy has begun to make some tentative moves towards effective splitting and projection, with its hope of healthier growth. This hope is hard for him to bear, involving, as it must, searing depressive pain. There is consequently a powerful pull towards a pathological organization where omnipotence and omniscience offer, disastrously, an exciting and pain-free alternative. The boy's therapy and his therapist are exposed to the full impact of the omnipotent onslaught, and evolving ways of bearing this and continuing to think was not only essential for survival but, also, a major tool of the therapy.     

‘At the level of the word: Nurturing justice in therapeutic conversations’

The issue of social justice and how it unfolds in the lives of persons seeking counselling has been steadily gaining attention in recent times. This development marks a departure from an individualistic perspective that construes problems as functions of personal deficits, thereby overlooking the many social inequities that contribute to the challenges people face. The turn towards social justice manifests primarily in a call for advocacy on behalf of therapy clients. While celebrating these developments, this article suggests that it is not just in interactions outside the consulting room that injustices may be perpetrated. The author invites attention to the ways in which social justice, or the lack thereof, can be understood to unfold within counselling conversations.     

Offering a ‘therapeutic presence’ in schools and education settings

Abstract

In this essay I present the clinical work with a client that I have been working with for 9 months now. The essay is divided into sections, each one indicative of one phase of the counselling relationship. In each of them I present the therapeutic process (my client's and myself) by highlighting some newly-acquired psychodynamic concepts, sharing some difficulties encountered, the learning gained though supervision and the progress of the client.     

‘With healing in her wings…’: Integration and repair in a self-destructive adolescent

This paper describes certain Jungian concepts related to integration and repair. Fundamental to this is Jung's concept of the self, which Fordham has made the basis of his model of development. To Jung's notion of the self as an integrator and organizer of experience, Fordham has added the idea that the self divides up, or deintegrates. Three corollaries of Fordham's model, pertaining to whole and part objects and the depressive position, are amplified through infant studies.

Clinical material from the treatment of a pigeon-phobic adolescent is presented, which attempts to demonstrate that a significant part of what the phobia represented was an infantile state of projective and introjective identification with an anxious mother. Treatment facilitated actions of the self that contributed to the integration of the experiences represented by the pigeons, so that what had been split off became a deintegrate capable of being reintegrated.

The focus of this paper is on the developmental as well as the pathological. Both are conceived in relation to the treatment.     

What’s the object of object working memory in infancy? Unraveling ‘what’ and ‘how many’

Infants have a bandwidth-limited object working memory (WM) that can both individuate and identify objects in a scene, (answering ‘how many?’ or ‘what?’, respectively). Studies of infants’ WM for objects have typically looked for limits on either ‘how many’ or ‘what’, yielding different estimates of infant capacity. Infants can keep track of about three individuals (regardless of identity), but appear to be much more limited in the number of specific identities they can recall. Why are the limits on ‘how many’ and ‘what’ different? Are the limits entirely separate, do they interact, or are they simply two different aspects of the same underlying limit?We sought to unravel these limits in a series of experiments which tested 9- and 12-month-olds’ WM for object identities under varying degrees of difficulty. In a violation-of-expectation looking-time task, we hid objects one at a time behind separate screens, and then probed infants’ WM for the shape identity of the penultimate object in the sequence. We manipulated the difficulty of the task by varying both the number of objects in hiding locations and the number of means by which infants could detect a shape change to the probed object. We found that 9-month-olds’ WM for identities was limited by the number of hiding locations: when the probed object was one of two objects hidden (one in each of two locations), 9-month-olds succeeded, and they did so even though they were given only one means to detect the change. However, when the probed object was one of three objects hidden (one in each of three locations), they failed, even when they were given two means to detect the shape change. Twelve-month-olds, by contrast, succeeded at the most difficult task level.Results show that WM for ‘how many’ and for ‘what’ are not entirely separate. Individuated objects are tracked relatively cheaply. Maintaining bindings between indexed objects and identifying featural information incurs a greater attentional/memory cost. This cost reduces with development. We conclude that infant WM supports a small number of featureless object representations that index the current locations of objects. These can have featural information bound to them, but only at substantial cost.     

Trainee therapists’ views on the alliance in psychotherapy and supervision: a longitudinal study

The shape of alliance in psychotherapy and supervision using growth curve modeling was examined for clinically inexperienced trainee therapists, who were engaged in long-term cognitive behavioral - or psychodynamic individual psychotherapy at a Psychology Clinic in Sweden. Trainee therapists rated their view of the alliance with their clients and their supervisors on the Working Alliance Inventory at five time points. The alliance to the client show a consistent, positive development throughout the therapy. The alliance to the supervisors show initially a decrease, followed by an increase, and then again, the rate of increase in the supervisory alliance ratings slowed down indicating a more complex view of the supervisory alliance compared to the view of the alliance in psychotherapy.     

From biography to theory: the role of Anna Freud in the emergence of the ‘adolescent process’

Some aspects of Anna Freud’s life reveal the existence of specifically adolescent conflicts, which can be tied to some of her theoretical and clinical discoveries in the field of adolescent psychoanalysis. Her historical input in the gradual construction of a theoretical corpus on adolescence has often been ignored. These links between biography and theory gave rise to a movement of conceptualisation, making it possible to develop a psychoanalytic metapsychology of adolescence: indeed, emerged such notions as asceticism, intellectualisation in relationship with anorexia and the struggle against the genitalisation of the adolescent body. Today, the Annafreudian school of thought has remained the main source of investigation and theoretical transmission of what is now called the adolescent process.     

Counsellors’ and psychologists’ experience of working with male survivors of sexual trauma: a pilot study

A qualitative study was undertaken to enhance awareness of the therapeutic needs of the male survivor of sexual trauma through exploration of counsellors’ and psychologists’ experience of working with this client group. The participants were 32 counsellors and psychologists who work for an NHS Trust department. Interpretative Phenomenological Analysis was used to analyse the data which was gathered by means of a postal questionnaire. Six categories emerged from the analysis that highlighted prevalent experience. These were: (a) that the therapist's gender was important, (b) professional concerns, (c) the importance of the relationship, (d) transference/counter transference, (e) that male and female abusive experiences are the same and (f) attention to client's presenting problems. The main conclusions derived from these results and implications for practice are considered.