Safety behaviour: a reconsideration

There is ample evidence that the use of safety behaviour can interfere with the progress of therapy, particularly if exposure is involved. As a result, it is widely asserted that safety behaviour is anti-therapeutic. However, an unqualified rejection of safety behaviour should be reconsidered because we now have theoretical justification, experimental evidence and clinical observations showing that the judicious use of safety behaviour, especially in the early stages of treatment, can be facilitative. Experiments in which escape behaviour facilitated fear reduction, and others in which the use of safety gear facilitated fear reduction, are reviewed. It also appears that safety behaviour does not necessarily prevent disconfirmatory experiences. We propose that additional investigations of the judicious use of safety behaviour will help to elucidate therapeutic uses of safety behaviour in the treatment of anxious and related types of psychopathology.     

Changing psychic structure through treatment: criteria for change

The author outlines his clinical observations during the "middle game" of psychoanalysis, leading to recognition that structural change is taking place. "Middle game," "structure," process, and content are defined and critically discussed. Illustrative clinical vignettes are offered. The presentation emphasizes the importance of an active and resolving transference "struggle"; in addition, more traditionally noted criteria are briefly touched on, e.g., development of observing ego and treatment alliance, changes in dream function and communication, and the reviewing of the neurosis and transference during the termination phase as instances of mourning and working through. The concept of optimal psychobiological function in the service of a homeostatic principle is discussed.     

Abnormal and normal obsessions: a reconsideration

Contemporary cognitive approaches to obsession assume that the content of clinical obsessions does not differ from non-clinical obsessive intrusions. This assumption goes back to a classic study by Rachman and De Silva [(1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16, 233-248]. In the present paper, it is argued that Rachman and De Silva did not postulate a complete indifference between clinical and non-clinical obsessions. Study 1 is a simple statistical analysis of data presented by Rachman and De Silva. This analysis suggested that psychologists are able to discriminate clinical and non-clinical obsessions beyond chance level, merely by looking at the content of obsessions. In study 2, a list of 23 clinical and 47 non-clinical obsessions was presented to 11 psychotherapists and 90 psychology undergraduates. Both therapists and students were able to distinguish clinical and non-clinical obsession beyond chance level. It is concluded that some clinical obsessions can be identified as being evidently abnormal, and that additional theory and research is needed to identify the causes of these recognisable obsessions.     

Little Hans: a centennial review and reconsideration

Freud's "Analysis of a Phobia in a Five-year-old Boy" has stimulated interminable "reanalysis." The case of Little Hans, an unprecedented experimental child analytic treatment, is reexamined in the light of newer theory and newly derestricted documents. The understanding of the complex overdetermination of Hans's phobia was not possible in the heroic age of psychoanalysis. Current analytic thought, as well as distance de-idealization vis-à-vis the pioneering past, has potentiated a reformation of the case. The severe disturbance of his mother had an adverse impact on Little Hans and his family. Her abuse of Hans's infant sister has been overlooked by generations of analysts. Trauma, child abuse, parental strife, and the preoedipal mother-child relationship emerge as important issues that intensified Hans's pathogenic oedipal conflicts and trauma. With limited, yet remarkable help from his father and Freud, Little Hans nevertheless had the ego strength and resilience to resolve his phobia, resume progressive development, and forge a successful creative career.     

Psychoanalytic developmental theory: a contemporary reconsideration

Psychoanalytic developmental theory has never enjoyed a broad consensus among psychoanalytic thinkers. In today's postmodern era, its relevance and basic premises are even more in question as a legitimate part of psychoanalytic theorizing. Part of the problem has been (1) the serious errors perpetrated historically in the name of psychoanalytic developmental theory and (2) its current state of disarray in the wake of piecemeal efforts to rectify these errors. Nonetheless, its presence is discernible in every psychoanalyst's theory and clinical work, whether or not it is acknowledged or brought into a cohesive theoretical frame. The point of view of "intersubjective ego psychology" (Chodorow 2004), embraced by a growing number of analysts interested in development, offers a more flexible and inclusive paradigm for psychoanalytic developmental thinking in order to preserve its rightful place in contemporary psychoanalysis.     

Unconscious fantasy: a reconsideration of the concept

Despite general agreement about the clinical importance of unconscious fantasy, the concept itself has remained unclear. After reviewing Freud's work on the subject, the conceptual dilemma is specified: where in current psychoanalytic theory do we place this important, dynamically repressed, structuralized mental content? Three conceptual paths have been followed in attempting to deal with this problem. The first emphasizes the structural, tripartite model, discarding topographic concepts. The second replaces the structural model with a schema model borrowed from academic psychology. The third combines the structural and topographic models. None of these approaches is entirely satisfactory and without problems. Because of their central role in mental life, unconscious fantasies deserve careful definition. They should be distinguished from conscious fantasies and daydreams as well as from the process of fantasizing. They are differentiated from other varieties of unconscious content by their enduring quality and their organized, storylike quality reflecting the distortions typical of the primary process. As dynamically unconscious templates from the childhood past, they shape subsequent compromise formations and are relatively impervious to new experience. The development of psychoanalytic theory from a macrostructural to a microstructural emphasis is discussed in relation to the unconscious fantasy concept.     

Phantom narratives and the uncanny in cultural life: psychic presences and their shadows

Abstract

In this paper the author explores the emotional factors that are activated at the level of the cultural unconscious, that produce experiences of the uncanny that are expressed through Phantom Narratives. Phantom Narratives as a hybridized term is the author’s way of linking personal and social activity of unconscious story formation through psychic presences (images). Phantom Narratives are expressions of the unconscious at the level of the group that shows the psyche’s way of narrating its relationship to the group, through the expressions of cultural, social, and political issues. The uncanny, at the level of the social, is seen as those disturbances of feelings that alienate us from the familiar social world of others. What is uncanny about Phantom Narratives is how group emotional dynamics are represented as psychic presences. Making use of the author’s own subjectivity (i.e. psychoanalytic literary genre) he uses an approach from analytic psychology (Jungian) called amplification, which allows for the elaboration of symbolic processes, to create a meaningful (semantic) context for exploration.     

A reconsideration of Freud's essays on sexuality and their clinical implications

This paper considers some of the concisely presented material of the second of Freud's Three Essays on the Theory of Sexuality (1905a), on "Infantile Sexuality." The author puts forward the view that infantile sexuality may be thought of not simply as an immature stage that must be passed through, but also as a pool of psychic experiences upon which mature personality organization can continually draw, in dynamic oscillation among different mental positions. The link between infantile sexuality and the structuring of the psychic apparatus, discussed in the first and third of the Three Essays ("The Sexual Aberrations" and "The Transformations of Puberty"), raises questions that are still open to further research.     

Level of object representation and psychic structure deficit in obese persons

The structural deficit and external regulation hypotheses of addiction state that addicts do not have adequate psychic structure with which to regulate painful affects internally. They instead use their drug of choice as an external regulator to self-medicate painful affects. This study tests whether the hypotheses can be applied to obese persons, for whom food may be the drug of choice. The level of object representation of 22 moderately obese and 24 normal weight subjects was compared using the Blatt Family Interaction Questionnaire. The mean level of object representation of both parents was lower for the obese subjects than for the normal-weight subjects. This finding supports the structural deficit and external regulation hypotheses of food addiction.     

Within or without: negotiating psychic space with an adolescent at risk of developing a narcissistic personality structure

This paper examines a 22-month once weekly psychotherapy with an adolescent young man. My patient was one of a group of adolescents who, due in part to excessive aggression, envy, anxiety or confusion, has chronically evaded the intimate and dependent psychic contact with others that is necessary for psychological development. In my view, this comes about through a combination of external factors and internal predisposition, with the quality of care received during infancy playing a crucial role. These adolescents appear to be developing narcissistic modes of being in the world which if allowed to persist into adulthood would be seen as deeply entrenched clinical psychopathology. Managing separation and loss is one of the central aspects of adolescence, but these young people tend to intrude or merge with others with such aggressive force that recognising difference between self and other becomes difficult. In psychotherapy, this often takes the form of the patient’s inability to tolerate experiencing the therapist as a separate person, and when knowledge of the therapist as separate impinges on their view, they frequently react in a variety of primitively destructive ways. This paper seeks to explore these central ideas through a detailed examination of psychotherapy with a young man in whom such struggles predominate.     

Maternal provision of structure in a deliberate memory task in relation to their preschool children's recall

Strategic remembering emerges gradually during the preschool years. Socialization practices, specifically mother–child social interactions, might provide the foundation for the development of skills necessary for effective organization of information in memory. In the current study, 48 mothers and their 40-month-olds were engaged in the process of remembering (i.e., study and recall) categorically related picture stimuli in a laboratory context. Children’s recall was reliably predicted by the way in which mothers structured both the study and recall periods of the deliberate memory task. Specifically, maternal verbal and physical behaviors that focused on organization of items, such as sorting items into distinct groups and providing the name of a category, were most beneficial in supporting children’s memory. Moreover, some mothers employed a number of different mnemonic techniques that emphasized categorical connections among items, suggesting systematic approaches in the manner in which mothers help children to learn effective ways of remembering.