Depression und Paarbeziehung

The close relationship between depressive disorders and couple relationships has been well proved empirically.Conflicts and problems within the couples'relationship can be a significant trigger for depression. In additition, the quality of the relationship is often markedly impaired by depressive disorders, in many cases far beyond the depressive phase.The couples'relationship also influences significantly the course of depressions, especially when the disorders are not yet chronic.The link between depression and couples'relationship seems to be stronger and more evident for women than for men. Furthermore there seem to be patterns of interaction in couples with a depressed partner, which differ from those in healthy or other clinical comparison groups or distressed couples without depression.These patterns need further exploration with regard to different subgroups of depressed patients and phases of depression.Couples' therapy has been proved to be effective in the treatment of depression on the symptomatic and on the relationship level.Conjoint assessment and counselling sessions with depressed patients and their partners should be conducted regularly.For patients suffering from an ‘anaclitic’,‘sociotropc’form of depression couples' therapy in a more narrow sense is usually indicated. In the treatment of depressives of the ‘autonomous’ ‘introjective’ type partners should be included into treatment for the assessment and the working through of specific conflicts concerning the relationship.     

Zwischen Tod und Urszene

Are there psychoanalytic ideas about what it means to be fully and creatively alive? Thoughts about this are prompted by Winnicott’s account of living by compliance or by creative apperception. A necessary aspect of independent, creative aliveness is a capacity to be interested in what disturbs our usual thought processes. Clinical examples show the truth of this for therapists in the clinical situation and it applies to life in general as well. Being fully alive involves a particular use of memory so as to move actively up and down one’s life experiences between past and present and also the ability to extend this imaginatively into the future, including particularly the experience of one’s own death which is ultimately and inescapably ‘uncanny’. Such freedom of internal movement makes it possible to see the present as a point of encounter between the past and the future. The past is bounded by the primal scene and the future by death, which represent the beginning and end of time. The present is thus also an encounter between time and timelessness. To tell a dream in an analytical session is to bring the timelessness of the unconscious into a time-bound framework. A clinical example shows how a sense of this crossover between time and timelessness helped a patient use his dream experience to develop a greater sense of aliveness. Vermeer’s painting of ‘The Kitchen Maid’ pouring milk is analysed as a visual representation of the intersection of time and timelessness. A case in a clinical seminar is described, which produced a disorienting sense of timelessness in the seminar group. The seminar leader then needed to help the discussion stay poised at a crossing-point between timelessness and time. A discussion of the myth of Orpheus considers Orpheus’ compulsion to look back at Eurydice as a failure of aliveness because he could not dream Eurydice at the intersection between the timelessness of the underworld and the linear temporality of everyday existence.     

A Puzzle About Reasons and Rationality

According to a guiding idea in metaethics, there is a necessary link between the concept of normative reasons and the concept of practical rationality. This notion brings up two issues: The exact nature of this link, and the nature of rationality. With regard to the first issue, the debate is dominated by a certain standard claim. With regard to the second issue, the debate is dominated by what I will refer to as ‘subjectivism’ and ‘objectivism’ about rationality, where the latter is assumed to be a necessary condition for the existence of categorical reasons. In this paper, it is argued that subjectivism is able capture an ordinary, non-technical, sense of ‘rational’ whereas objectivism is not. The basic reason is that objectivism fails to account for the essential connection between rationality, malfunctioning, and rational criticism. This means that we face a puzzle: While objectivism appears to be a necessary condition for the existence of categorical reasons, it fails to capture a central sense of ‘rational’. It is finally argued that this puzzle can be solved by abandoning the standard claim about the link between reasons and rationality.     

Addictive states of mind

This paper explores the meaning of the pregnancy of the therapist as a challenge to the maintenance of the setting for therapy. The patient I shall describe was born ‘black’ in a ‘white’ family and was thus a challenge to her father's sense of paternity and her parents as a couple. She was the visual evidence of an infidelity. The problem had been denied in various ways, going as far as the attempt to deny her very existence. The therapist's pregnancy signified a betrayal of the ideal of a stable setting which was compounded by an earlier absence through illness. This ‘breaking of rules or promises' was then the setting for a re-working of the patient's story.

Setting, it is argued, can helpfully be seen as the mental space created by the partnership within the therapist between maternal and paternal relating to the ‘baby’ of the therapy. This enables a sense of negotiation and relationship in the creation of setting, which can include disruptions and other babies. At the same time the therapy had to work with a fundamental issue of illegitimacy or lack of belonging and the therapist's response to this. The ‘rules' of setting are a means to ensure a place to belong or attach to, but this work emphasized ‘setting’ and belonging as issues of relationship supported and enabled by our rules of engagement, but not reducible to them.     

‘Paralysed associations’: countertransference difficulties in recognising meaning in the treatment of children on the autistic spectrum

Children with autism can have a paralysing effect on the clinician’s capacity to associate freely: connections that seem obvious on reflection may be impossible to notice in the child’s presence. The author argues that this situation can be reached by more than one pathway, and that the degree of the child’s bodily and emotional cohesion is an important factor. Children may seek to immobilise the therapist’s thought processes through projective identification, whether to communicate their own experience of paralysis or because these thought processes are equated with a parental intercourse that produces a ‘baby’ (as described by Bion and Britton). Vignettes are offered to illustrate how the therapist may be nudged into overlooking this baby as well as a potentially growing part of the child that is identified with it, with important consequences for development. A second possible pathway appears to involve the much more primitive mechanism of adhesive identification, in which the child’s sense of continuing existence depends on sticking to the therapist’s surface and any movement can lead to a sense of bodily disintegration. In the clinical illustration, the therapist felt physically constrained and unable to recognise links in the material: it is suggested that this was in resonance with the child’s fear that movement, whether physical or mental, meant losing parts of his body and must be avoided at all costs. These levels can mask each other, and it seems essential to attend to both in order to avoid impasse or the overlooking of essential aspects of the child’s experience.     

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.     

Where is the common ground? Interaction and transfer between European and Russian philosophical culture

In this paper, I discuss and analyze three instances of exchange and interaction between Russian (incl. Soviet) and (West) European philosophical culture: the correspondence between Merab Mamarda?vili and Louis Althusser, Jacques Derrida’s visit to Moscow in 1990, and a joint Russian–German publication by Nikolaj Plotnikov and Alexander Haardt. The focus is on the implicit mutual perception of philosophical cultures and on the ‘micro-politics’ of discourse that is at stake in their interaction. Also, it is shown how different contexts—labelled ‘philosophical culture’, though not in any deterministic sense—are at work in the mutual perception between individual thinkers. Even if philosophical thinking tends to transcend the parameters of ‘glocal’ situations, this involves a job that needs to be done, individually and collectively, by the philosophers involved. Consequently, this dimension has to be taken into account when analysing such instances of encounter.     

Is touch a valid therapeutic intervention? Early returns from a qualitative study of therapists' views

Findings are reported from six semi‐structured interviews with experienced psychotherapists, focusing on the reasons for using touch and the sort of touch used. They suggest that there is a distinction being made by therapists between ‘social space’ and ‘therapeutic space’, and a different view of touch taken if it is judged by the therapist to be ‘out of the therapeutic environment’. Whether or not touch was initiated by the therapist or the client would also appear to influence its further discussion by the therapist, either in processing it with the client or in supervision. What also emerged from the interviews was the finding that an exploration of touch in supervision was unusual. The implications for practice, supervision and training are discussed as areas for further exploration in the main survey, which will be conducted in the second year of the research.     

The self in the couple relationship: part 2

Part 1 of this paper examined some of the ways in which individual therapy, by assisting in the development of a more cohesive sense of self in the individual, inevitably has an impact on the individual's relationships, especially their relationship with a partner. This paper approaches the topic of the significance of ‘the self’ in the couple relationship from an alternative direction. It focuses on the significance of ‘the self’ for couples therapy, and argues that couples therapy may sometimes need to include therapeutic work with one partner to facilitate change in the relationship. In both parts of the paper, a conceptualization of the couple relationship as ‘a transitional space’ is central.     

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.     

The ‘Enforcer’ in Elite-Level Sport: A Conceptual Critique

The role of the ‘enforcer’ in elite-level sports contests is a familiar one. Simply, the role involves establishing or restoring a ‘moral balance’ to the sporting encounter when it is absent – usually when match officials are thought to be failing to apply the laws/rules of the game. How the enforcer secures this outcome is more morally contentious as it may involve deliberate violations of the laws/rules of the sport. In this paper we consider the role of the enforcer in rugby union. First we interrogate some of the extant sports ethics literature and explore the notion of ‘fairness’ in the well-played game, including the role of the enforcer. Second, we illustrate conceptually how the ethos of elite sport as a moral discourse creates a theoretical platform from which to assess the intervention of an enforcer. Third, we address the role of match officials as members of the practice community from an institutional sense (what the international governing body for rugby union makes explicit) and from an empirical sense (what actually occurs or might occur) in the circumstances that precipitate the intervention of ‘enforcers’. We conclude that the conceptual tension between the laws and the spirit (ethos) of the game is reflected in the choices facing players when playing the game.     

Client discourses on the process of seeking same-sex couple counselling

How same-sex couples manage the process of seeking help for their relationships is an under-researched area. Twelve semi-structured interviews were conducted with 16 people who had engaged in same-sex couple counselling, and were analysed using discourse analysis. The ways in which the couples positioned themselves as part of a ‘minority group’, or part of a generic group of couples struggling with relationship issues, impacted on how they discussed seeking help. We conclude that counsellors and psychotherapists need to be aware of the ways in which couples construct their relationships, and mindful of the tricky navigations around similarity to, and difference from, different-sex relationships. The impact of this on couples seeking therapeutic help is considered.     

Commentary: is collaboration a viable target for family therapists?

It is hoped that this commentary might serve to begin a discussion regarding collaboration, what is meant by it and whether it is a worthy goal for family therapists. I present the varying and sometimes contradictory meanings of the word, ‘collaboration’, as it is used in the therapy literature. Many of these meanings incorrectly imply an equality of the therapist–client relationship that only obscures the power differential that exists in the therapeutic relationship. A linguistic analysis of the primary meaning of ‘collaboration’ as ‘work with’ is presented. It is argued that equality between therapist and client cannot be achieved and need not be strived for. Therapists are encouraged to focus on the quality rather than the equality of their relationships.     

Attitudinal and consumption differences among traditional and nontraditional ‘childless’ couple households

This study develops a classification scheme that effectively separates delayed marriage and true childless couples from delayed empty nest couples, newlywed and traditional empty nest couples. Unlike extant traditional and ‘modernised’ life cycle models, this approach separates true childless and delayed marriage childless couple households from their traditional counterparts using the couples' length of marriage and wife's age. It also uses couples' ages at marriage to separate delayed from the traditional empty nest households. The findings clearly indicate that nontraditional ‘childless couples’ differ from their traditional counterparts in underlying values, sex role norms, and attitudes, as well as in food and beverage consumption and major durable acquisition patterns. Implications of this classification scheme for comprehensive life cycle models and future research and managerial applications of these findings are also discussed. Copyright © 2003 Henry Stewart Publications.     

Therapist Self-as-Context and the Curative Relationship

This article discusses how the way the therapist relates to his or her personal responses to client material during the session contributes to making the relationship with the client an effective tool for treatment. Ideas from third wave behavior therapy are used to describe aspects of therapist involvement in the relationship and modes of therapist awareness of inner responses. In two vignettes, negative client reactions to an intervention bring problematic therapist material to the fore. Both cases highlight how the stories the therapists spun about themselves as professionals and persons could easily have limited their effectiveness in responding to the material. The vignettes also illustrate how clinicians can overcome personal meanings and judgments to access a more productive mode of interacting with the feelings a critical incident in the relationship evokes in them. It is argued that observing their own content from a psychological distance makes it possible for clinicians to use their feelings without getting caught up in them. These same feelings may then help the therapist perceive how the incident relates to the client’s daily life problems. The therapist’s engagement in a sense of self-as-context is described as a therapeutic stance that provides the psychological distance needed to help overcome alliance ruptures and other potential gridlocks and which may transform the therapist’s inner response to client content into a tool for addressing important client issues.     

Scientific Realism Within Perspectivism and Perspectivism Within Scientific Realism

Perspectivism is often understood as a conception according to which subjective conditions inevitably affect our knowledge and, therefore, we are never confronted with reality and facts but only with interpretations. Hence, subjectivism and anti-realism are usually associated with perspectivism. The thesis of this paper is that, especially in the case of the sciences, perspectivism can be better understood as an appreciation of the cognitive attitude that consists in considering reality only from a certain ‘point of view’, in a way that can avoid subjectivism. Whereas the way of conceiving a notion is strictly subjective, the way of using it is open to intersubjective agreement, based on the practice of operations whose nature is neither mental nor linguistic. Therefore, intersubjectivity (that is a ‘weak’ sense of objectivity) is possible within perspectivism. Perspectivism can also help understand the notion of ‘scientific objects’ in a referential sense: they are those ‘things’ that become ‘objects’ of a certain science by being investigated from the ‘point of view’ of that science. They are ‘clipped out’ of things (and constitute the ‘domain of objects’ or the ‘regional ontology’ of that particular science) by means of standardized operations which turn out to be the same as those granting intersubjectivity. Therefore this ‘strong’ sense of objectivity, which is clearly realist, coincides with the ‘weak’ one. The notion of truth appears fully legitimate in the case of the sciences, being clearly defined for the regional ontology of each one of them and, since this truth can be extended in an analogical sense to the theories elaborated in each science, it follows that are real also the unobservable entities postulated by those theories.     

Die Wiederherstellung der Zeit in der ambulanten Psychotherapie mit Psychosekranken

In psychoanalytic psychotherapy with psychotic patients, a disturbance in time experience quite frequently turns out to be central to the psychotic experience as a whole. These patients experience disruptions in the flow of time that lead to a loss of temporal continuity. This loss of temporal structures causes damage in thinking functions: Relations like causality, finality and others which imply a temporal dimension, cannot be established any more. Parts of treatment histories serve to demonstrate the reconstruction of temporal continuity by the patient in psychotherapy. Object-relation-theory and Piaget’s experimental psychology provide the frame of reference for the understandig of the mental processes involved. At the beginning of the psychotherapy the patient experiences being together with the therapist and being separated from him as two discrete conditions of existing which have no links. The periodical reappearance of being together in combination with the awareness of the therapist’s continuous ongoing care encourages the patient to remember and to envisage the meetings with the therapist. The reliability of the alternation seems to stimulate a specific mental activity which creates connections allowing for transitions between the different conditions — in the sense of Winnicott’s transitional phenomena. Transitional phenomena which sometimes are quite concrete things bridge the gap between presence and future. Narrating serves as a link to the past. Through these creative ego-activities temporal continuity is regained providing the basis for strucured thinking and — very important — for the perception of one’s own personality and its continuity over time, thus generating a sense of identity. This process of reconstructing time is interesting in itself, because it sheds light on the psychodynamics of the restitutional processes after a psychotic illness. Moreover, it allows for hypotheses about the development of the inner time dimension in early childhood.     

An existential‐phenomenological counter‐theory of transference

The hypothesis of transference has become such a fundamental assumption for many therapeutic practitioners, that it is rarely questioned either in terms of its theoretical value or its function. This paper will critically examine the notion of transference from an existential‐phenomenological perspective and will argue the case for an alternative perspective. Further, it will seek to demonstrate that numerous and significant logical and applied problems arise with regard to the hypothesis of transference—problems which have a major negative impact upon the therapeutic relationship in general and upon the possibility of ‘encounter‘—or ‘meeting‘—between therapist and client. Finally, the paper will seek to show how, in many cases, the adoption of the hypothesis of transference can be seen as a defensive and power‐preserving (or enhancing) activity on the part of the therapist whose benefit to the client is, at best, questionable.