Assessing Specific Effects of Inpatient Group Psychotherapy

Abstract

This article will examine how the psychoanalytic idea of containing can be used in group therapy to form a conceptual bridge such that the group dynamics are not simplistically reduced to individual dynamics, nor that the individual is lost in the “group–as–a–whole” concept. I take the concept of “containing” as versatile in the sense that Bion (1970) meant it to be—that is, the psychological phenomenon of containment is manifest at various system levels: intrapsychic, interpersonal, group, and societal. This article will explore how far this “bridging concept” can be pursued to understand groups theoretically. The article will review various forms of containing, following Bion’s ideas, and in particular a therapeutic, or flexible, form in contrast to rigid and fragile forms.     

Questions and Answers in The Practice of Family Therapy,Vol. II

Abstract

This paper describes an attempt to influence school atmosphere through a large group in an elementary school. Another goal was to increase the students’ feeling of responsibility for the school environment through training in democratic processes. A third goal was to explore how applicable the group dynamics of the large group are for 1st to 6th graders. Method: All students and school staff met in a weekly large group for five consecutive weeks. Results/conclusion: The level of participation steadily increased during the five sessions, and clearly 1st to 6th graders were able to make use of the large group method. Positive changes in school atmosphere occurred and may even have had a long-term effect. The understanding of democratic processes increased.     

The framework of psychoanalytically oriented psychotherapy with traumatised patients and the institution

Abstract

Lindbom-Jakobson M, Lindgren L. The Framework of Psychoanalytically Oriented Psychotherapy with Traumatised Patients and the Institution. Int Forum Psychoanal 1997;6:217-224. ISSN 0803-706X.

Psychotherapies performed at multidisciplinary institutions will be influenced by the ongoing dynamics and inevitable group processes of the institution. The difficulties of these processes become extremely hard to handle when the patient category is a severely traumatised one. The prerequisite of psychoanalytically oriented psychotherapy, the illusion of the sealed room and fixed framework, gets disturbed by the information flow in an institution. The institutions for these patients tend to become stages on which the patients as well as staff can perform and repeat their intrapsychic and interpersonal conflicts, non-adaptive defences and disturbed object relations. The predominant dynamic that arises around tortured refugees as a patient category is sado-masochistic relating.     

From exclusion to inclusion; supporting Special Educational Needs Co-ordinators to keep children in mainstream education: a qualitative psychoanalytic research project

This paper draws on my doctoral research study based on consulting work with three primary school Special Educational Needs Co-ordinators (SENCos) that took place in 2008. The study examined the interactions that arose in the consultations with the SENCos and their staff. The findings that emerged from the application of Grounded Theory research methodology showed that the consultant, the SENCos and the children for whom they were responsible all felt on the edge of school life. SENCos and their staff were subject on a daily basis to powerful projections from children who were unable to tolerate difficult feelings and they were at risk of becoming identified with these feelings. The consultant in turn was the recipient of powerful projections from the SENCos. These complex dynamics of projective identification are examined in the study. The question of how SENCos and staff can better support children on the edge of exclusion with these unregulated feeling states is discussed. It is proposed that senior management teams and policy makers are essential in putting the SENCo role more at the centre of schools, both physically and in terms of how it is perceived. The need for access to a consultant who can help SENCos to understand and process extreme feelings is recommended as a way forward.     

From psychic holes to psychic representations

Abstract

In this essay, I will explore the term “psychic hole,” and compare it to similar terms from the world of astrophysics and terms used in the psychoanalytic literature. I will then present my own conception of the “psychic hole” in cases of Holocaust survivors' offspring. I will explain how this “hole” is created, and describe a particular aspect of the “psychic hole” that is unique to Holocaust survivors' offspring, namely the enactments (termed “concretization” by Bergman) generated by the negated traumatic themes that reside in it. I will illustrate these enactments using clinical material taken from case studies of Holocaust survivors' offspring that I have previously published. The clinical vignettes reveal the transgenerational impact of the memory hole resulting from negation of survivor parents on the lives of their offspring, up to the third generation. They also show the painful journey from enactments to psychic representations, a journey which exposes the traumatic events that have been denied or repressed, and facilitates the work of mourning and the eventual achievement of a better integrated self. Finally, I will offer technical suggestions for analysts to help patients transform psychic holes into psychic representations.     

The Proof is in the Pudding: Commentary on Papers Updating Anna Freud’s Diagnostic Profile

ABSTRACT

This fine collection of articles documents efforts to bring Anna Freud’s diagnostic profile (1965) up to date by integrating more recent theory and research in attachment theory, inter-subjective theory, and theories deriving from the work of Bion on the process of “containing” (Bion, 1988). While some of the articles present the theoretical context for this integrative effort, Melandri’s (this issue) thoughtful and comprehensive clinical case shows us how an updated diagnostic profile can be put to work in the consulting room.     

The creative process and psychoanalytic insight

The paper looks at the prevalence of audio-visual culture and how it is endemic in our everyday lives. It explores how popular culture emerges in the consulting room and some of the dilemmas posed for the therapist. It goes on to consider how popular culture connects to narratives, dreams and the formation of images in the clinical context. Some clinical vignettes explore audio-visual material in relation to their possible therapeutic message. One suggestion is made that the prevalence of popular culture could intensify anxieties associated with watching and looking and at the same time increase our desires to dismiss and submerge these anxieties. Popular culture in the consulting room reflects a world outside. Psychodynamic psychotherapy and the Media Arts can bring each other into ‘mutual illumination’.     

Our Immigration and Human Rights Work Group in Action: Psychoanalysts Evaluating Asylum Seekers,Trauma and Family Devastation

ABSTRACT

This paper presents the story of a family of four refugees from Central America seeking asylum in the United States, and of the experience of a group of psychoanalysts, members of the New York University Postdoctoral Program Immigration and Human Rights Work Group, who evaluated each member of the family and wrote affidavits in support of their applications for asylum. The work described provides an example of how clinicians can apply their skills and understandings outside the consulting room to address the dire needs of refugees who have fled from their homes. We discuss the process of refugees seeking asylum and the role of a psychological evaluation in the asylum process. We elaborate on the content and process of the evaluations of each member of the family with a focus on the trauma suffered and its sequelae on two school-aged children, their adolescent aunt, and their courageous and protective mother. We also address the analysts’ experience of doing psychological evaluations and writing affidavits for asylum seekers who have experienced trauma.     

Sibling rivalry at work; from family to groups

Sibling relationships are ambivalent. They are full of love and hate, and therefore, our most basic wish cannot simply be to get rid of our siblings. Many of the conflicts we find ourselves in, either with friends or within institutions, may need a complex and subtle understanding of sibling dynamics. The famous Controversial Discussions that nearly destroyed the Institute of Psychoanalysis in the early forties could be partly attributed to the unacknowledged and unconscious dynamics of the sibling transferences that swirled around Melanie Klein, Anna Freud and Freud. One of the tasks of therapists is to explore how we all must live within a society, with our contemporaries. This difficulty involves observing that sometimes in therapy we are part of the nursery quarrel itself, rather than superior. And so in adult sibling conflict within an institution, there may be a need for an outside moderator, like a parent, to sort out the quarrel; for when sibling passions are revived at work or in the consulting room, they can knock one sideways with the unmeditated quality of the encounter.     

The Influence of Individual Attachment Styles on Group Members’ Experience of Therapist Transitions

Abstract

Attachment theory has recently been applied to clinical practice in an effort to improve understanding and treatment of the maladaptive relational patterns clients bring to therapy. While most of this research has focused on individual therapy, interest in the application of attachment theory to group psychotherapy is growing. This paper will explore the impact of clients’ attachment styles on their experiences of co-therapist transition in an ongoing psychodynamic therapy group. This discussion will elucidate how knowledge of attachment theory and an understanding of clients’ individual attachment styles can be useful in predicting responses to therapist-initiated terminations and transitions.     

Making room: Developing reflective capacity through group analytic psychotherapy – in the analyst and in the group. Part one

Abstract

This paper is in two parts. This, the first part, traces the inter-related development of trainee group analyst and training group during the first nine months of the group's life. The influence that personal group analytic psychotherapy, supervision and theoretical learning have on the trainee are also considered in relation to the development of the group and its members, many of whom suffer from narcissistic and borderline disorders. The metaphor of ‘making room’ is used to explore the efforts of analyst and group to contain the chaotic, confused and unbounded projective identifications of its members. In this way, amidst the crowded turbulence of the group, a space begins to open up in which, slowly and painfully, the capacity for reflection may emerge.     

An Analyst Has a Birthday - Can Forgiveness Heal?

Forgiveness is a challenging endeavor in human experience and in clinical work. Is it an important and/or legitimate analytic concept? Long the province of theologians and philosophers, forgiveness has had little theoretical place in the psychoanalytic lexicon. This paper considers the analytic place of forgiveness through a treatment that was shadowed by two lost mothers – the patient’s and analyst’s - in the consulting room. The patient’s question, “must we forgive to heal?” will be examined in this story of healing for both him and his analyst.     

A History Which Began to Be Told: A Clinical Case

This article aims to reflect on the possible contributions of psychoanalysis in relation to severely disturbed patients by means of the presentation of a clinical case. Beginning with the family history, the evolutionary process of the symptoms and identification movements of the patient are analysed. The observation of the transference dynamics is emphasised, showing how the desire of the analyst and his privileged listening will allow the patient some level of possible subjective structure.     

Cross-cultural Psychoanalysis and the Interpersonal Perspective

From its beginning Interpersonal Psychoanalysis was eminently suited to address theoretical and clinically issues when working with patients from different cultures. The open-ended quality of the detailed inquiry was a particularly useful tool to get to know the "stranger," as American social scientists of the fifties and sixties were quick to acknowledge. It therefore comes as a surprise how few interpersonalists have addressed themselves to cross-cultural issues. Particularly lacking has been attention to countertransferential problems in analyzing patients from other cultures. In addition the impact of the cultural climate on the analytic process itself has rarely been explored. As cross-cultural contacts in the consulting room have become more frequent it is important for analysts to consider that developmental sequences, family relationships, interpersonal distance, concepts of time and openness to emotional sharing may differ from what Western psychoanalysis considers to be "normal."     

The clinical language of Sándor Ferenczi: Introductory and methodological considerations

Abstract

Reflecting in the present paper on the legitimacy of a work to collect together the ideas, concepts, and terms of Sándor Ferenczi, the author will explore, through a series of questions and answers, the following points: why it is so clear-cut that Ferenczi should be included in the company of those great psychoanalytic authors who might be deemed entitled to such a study; whether Ferenczi possessed his own language, and if this was the case, when and how he acquired it; what we mean when we refer to Ferenczi’s idiomatic language, and how we can profitably identify this language and bring it into focus; how, in practice, such a text should be organized; what its audience and function would be; and how it would be used by readers and students of Ferenczi.     

Soul pain and the therapeutic use of ritual

Abstract

This paper will explore the relationship between ritual and transformation. It will show how a therapist and a monk work together to create sacred spaces in which individuals can experience transformation of and through their personal histories, linking their past, present and future to address their soul pain through ritual.

It is illustrated with case studies which will demonstrate the phases of ritual work which are collectively important as part of the psycho-dynamic therapeutic process.     

Conclusion

Abstract

The influence of culture within a parent-child activity group is analyzed in order to explore how leaders of parent-child activity groups can use knowledge of group culture to design effective interventions. This chapter concludes with the author describing revisions to her original guidelines for parent-child activity group intervention which developed through her reflections on the findings of her qualitative study about one parent-child activity group.     

Discussion of “Hysteria and Humiliation”: Commentary on Paper by Sam Gerson

This commentary describes certain differences in how Relational and Contemporary Freudian analysts approach both the conceptual dynamics of hysterical functioning and its clinical management. The discussion shows how, despite considerable agreement between these two groups concerning the critical importance of a receptive other for the successful buildup of virtually every aspect of mental life (not to be confused with the concept of co-creation), they also have quite substantial differences; differences that are rooted in contrasting basic assumptions about the ways in which fantasies, unconscious transference displacements, and self-regulating repetitive processes are set up in the mind. The discussion also illustrates how the clinical management of hysteria differs considerably depending on whether what is taking place in the consulting room is conceived of as an autonomous, repetitive process that the patient brings to the treatment and repeats (one way or another) over and over again, or whether it is conceived of as co-created, belonging to the minds of both persons in the room, even if not in equal measure or equal ways.     

A qualitative study of the decision to engage in tanning behaviors among female college students

IntroductionIndoor tanning is associated with increased risk of melanoma and is particularly prevalent among female college students in the U.S.ObjectivesThe present study aimed to explore why female students decide to engage, and keep engaging in indoor tanning.MethodsWe included eighteen female undergraduates who participated in group discussions. The group discussions were recorded and transcribed, then they were organized into themes.ResultsThree main themes appeared: appearance reasons for tanning, tanning-related health risks, and tanning salon-marketing strategies. Students were overall informed regarding tanning-related health risks, and suggested that they justified their tanning behaviors by rationalizations. They also revealed that the marketing strategies employed by tanning salons made them more likely to tan frequently. Finally, students spoke about how the health risks, the affects on appearance, and leaving the college setting might lead them to stop tanning.ConclusionsThese findings suggest that tanning among students could be reduced both by engaging students in programs addressing rationalizations about the risks associated with tanning, and policies targeting marketing techniques and tanning salon locations.