The Functions of Integration and Confrontation in Internal Dialogues

While integrative and confrontational internal dialogues (IDs) are often treated as opposing and numerous positive functions are ascribed to the former, this paper assumes that integration and confrontation are not mutually exclusive but independent processes. When exploring IDs that simulate social relationships and are described by different configurations of integrative and confrontational characteristics, canonical correlation analysis revealed that in competitive dialogue, the strong confrontational attitude of the dialogue's author is accompanied by the weak integrative attitudes of both ID parties. The more the ID is based on a rivalry between the parties, the lower the levels of bond, support, and insight functions are and the higher the level of substitution is. In persuasive dialogue, the confrontational attitude of the dialogue's author is combined with the integrative attitudes of both parties. The more the ID is based on persuasion, the higher the intensity of substitution, insight, bond, support, and self-guiding is. The findings suggest a synergistic effect of co-occurring integrative and confrontational attitudes in one ID.     

Coalition and Opposition in Myself? On Integrative and Confrontational Internal Dialogues,Their Functions,and the Types of Inner Interlocutors

The typology of interlocutors in internal dialogues comprises four main emotional types: faithful friend, ambivalent parent, proud rival, and helpless child. The two studies presented in the article aimed to identify which types appear in integrative and which in confrontational internal dialogues. Additionally, Study 2 compared the functions performed by these two types of dialogues. Both Study 1 (N = 101) and Study 2 (N = 99) confirmed the hypothesis that faithful friend and ambivalent parent are interlocutors typical of integrative dialogues, whereas proud rival and helpless child are characteristic for confrontational ones. It was also found that integrative dialogues perform certain functions—namely, support, bond, insight, and self-guiding—to a greater degree than confrontational dialogues.     

Postmodern Implications for Theoretical Integration of Counseling Approaches

Theoretical integration refers to the conceptual unification of diverse counseling approaches. Past attempts at theoretical integration have not yielded a broad conceptual framework that seamlessly integrates counseling approaches with varied foundational assumptions. The author contends that the failure of these integrative attempts is a by‐product of the modernistic epistemic context in which the systems were considered and proposes an examination of common narrative features of counseling approaches in a postmodern epistemic context to achieve integration. These features are specified, elaborated, and conclusions are drawn.     

Determinants of Integration and Confrontation in Internal Dialogues

Interest in the distinction between integrative and confrontational internal dialogues has been growing, as research suggests numerous positive functions of the former compared to the latter. The article proposes a theoretical approach to integration and confrontation in internal dialogue and an empirical method of measuring these processes. Exploratory research is also presented that seeks to identify personality‐related and situational determinants of integration and confrontation in internal dialogue simulating social relationships. Canonical correlation analysis did not establish personality determinants but it did reveal situational determinants (understood as cognitive interpretation of the enacted situation) behind integration and confrontation in internal dialogue. Perceiving the internal interlocutor as similar to the dialogue's author is associated with the author's integrative attitude. An increase in the wishfulness of the dialogue is accompanied by an increase in the author's confrontational attitude and the interlocutor's integrative attitude.     

Why read Fairbairn?

The author offers a close reading of portions of Fairbairn's work in which he not only explicates and clarifies Fairbairn's thinking, but generates ideas of his own by developing concepts that he believes to be implicit in, or logical extensions of, Fairbairn's work. Among the unstated or underdeveloped aspects of Fairbairn's contribution that the author discusses are (1) the idea that the formation of the internal object world is always, in part, a response to trauma (actual failure on the part of the mother to convey to her infant a sense that she loves him and accepts his love); (2) the notion that the infant's unceasing efforts to transform the internalized relationship with the unloving mother into a loving relationship – thus reversing the effect on his mother of his (imagined) 'toxic love'– is the single most important motivation sustaining the structure of the internal object world; and (3) the idea that attacks on oneself for the way one loves, while self-destructive, contain a glimmer of insight into one's own self-hatred and shame regarding one's endless, futile attempts to change oneself (or the rejecting object) into a different person. The author, using his own clinical work, illustrates the way he makes use of his understanding of the 'emotional life' of internal objects to facilitate the patient's emotional growth.     

Insight in frontotemporal dementia: conceptual analysis and empirical evaluation of the consensus criterion "loss of insight" in frontotemporal dementia

The objective of this study was to suggest a new formulation of the core research diagnostic consensus criterion "loss of insight" in frontotemporal dementia (FTD). Eight patients with FTD (diagnoses made by interviews, medical and neuropsychological examination, CT scan, and regional cerebral glucose metabolism measured by positron emission tomography (PET) participated in the study). The results indicated that insight was present in three out of eight patients, and that insight appears to be a heterogeneous concept. Two types of insight emerged: Emotional insight associated with frontotemporal functions, and cognitive insight, related to posterior cognitive functions. These results suggest that loss of insight should not serve as a core criterion on FTD, but serves well as a supportive criterion of the disease.     

From cultural to existential diversity: The impossibility of psychotherapy integration within a traditional framework

The authors build upon Castonguay and Goldfried's analysis regarding issues and directions central to advancing psychotherapy integration. They elaborate on two issues addressed only minimally in Castonguay and Goldfried's article. The first involves moving beyond traditional psychotherapy territory to include cultural, self-in-relationship, and interdisciplinary domains. The second concerns using more holistic and synergistic processes to coconstruct integrative theories and approaches. Finally, the authors offer some insights into what they believe should be the goals of the integrative movement and into additional issues they think should be addressed to attain these goals. Psychotherapy has become so complex and changing that we need a new view—one that recognizes the impossibility of any final or superior integrative theory and the need for constant change and evolution in theory and practice.     

The psychoanalytic process: the developmental and the integrative

Psychoanalysis is a treatment that focuses on intrapsychic events and activates integrative tendencies to promote-insights. Almost from the time it originated, however, it was also promoted as a therapy informed by the interpersonal, inducing change through experiences generated within the psychoanalytic situation. In recent years the interpersonal or object relations approach has come to be categorized as "developmental," a term that fosters no end of ambiguities. The resulting confusion compromises the study of the actual developmental process on the one hand and the structure-enhancing features of transactions on the other. This encumbers research on the psychoanalytic process. The author distinguishes the intrapsychic from the interpersonal, the integrative from the developmental, and the two very different realms of psychological activities currently advanced as "developmental."     

Some notes on insight and its failures

Many patients who had been in a prior psychoanalysis or psychotherapy have a view that "insight" has not been useful to them. The previous treatment has often been condensed into a screen memory serving a variety of functions. An attempt is made in this paper to explore problems of the effectiveness of insight and its relation to a range of ego functions, transference issues, and related fantasy systems.     

Targeting Insight in First Episode Psychosis: A Case Study of Metacognitive Reflection Insight Therapy (MERIT)

One aspect of schizophrenia contributing to its complexity is the lack of insight individuals often have into their illness. While poor insight is prevalent throughout the course of the illness, more severe levels are associated with first-episode psychosis (FEP). Interventions addressing insight are necessary but current treatments have been shown to have limited effectiveness. Thus, a novel intervention, Metacognitive Reflection and Insight Therapy (MERIT), is being studied for its efficacy of improving insight in individuals with schizophrenia spectrum disorders. MERIT is an integrative metacognitive therapy consisting of eight elements to assist clients in improving their ability to form complex ideas about themselves and others and to use this knowledge to respond to psychological problems. The present study is a case illustration of the implementation of MERIT to improve insight in FEP. Clinical outcomes were assessed and results showed that the client improved in both metacognition and insight. With replication, these results suggest that integrative metacognitive psychotherapy may serve as an intervention that improves insight in FEP, which marks an important step toward improved interventions for individuals with psychosis.     

Transformations of Emotional Experience

In this paper the author approaches mental pain and the problems in a psychoanalytic treatment of patients with difficulties in the psychic transformation of their emotional experiences. The author is interested in the symbolic failure related to the obstruction of development of phantasies, dreams, dream‐thoughts, etc. She differentiates symbolization disturbances related to hypertrophic projective identification from a detention of these primitive communications and emotional isolation. She puts forward the conjecture that one factor in the arrest of this development is the detention of projective identifications and that, when this primitive means of communication is re‐established in a container–contained relationship of mutual benefit, this initiates the development of a symbolization process that can replace the pathological ‘protection’. Another hypothesis she develops is that of inaccessible caesuras that, associated with the detention of projective identification, obstruct any integrative or interactive movement. This caesura and the detention of projective identifications affect mental functions needed for dealing with mental pain. The personality is left with precarious mental equipment for transforming emotional experiences. How can a psychoanalytical process stimulate the development of creative symbolization, transforming the emotional experiences and leading towards mental growth? The author approaches the clinical problem with the metaphor of the psychic birth of emotional experience. The modulation of mental pain in a container–contained relationship is a central problem for the development of the human mind. For discovering and giving a meaning to emotional experience, the infant depends on reverie, a function necessary in order to develop an evolved consciousness capable of being aware, which is different from the rudimentary consciousness that perceives but does not understand. The development of mature mental equipment is associated with the personality's attitude towards mental pain. The differentiation between psychotic, neurotic or autistic functioning depends on what defences are erected to avoid mental pain. The primary link between infant and mother is where the building of mental equipment takes place, through communicational forms that, to begin with, are not verbal. The author suggests the need for the development of an ideo‐grammar (in gestures, paralinguistic forms, etc.) in primary relations, as the precursor forms that will become the matrix for the mental tools for dealing with emotional experiences in a mature way. The paper stresses the significance of the parental containing function for the development of symbolization of prenatal emotional experiences. This containment develops ideograms, transformations of sense impressions into proto‐symbols, instruments that attenuate the traumatic experiences of helplessness. The author takes Bion's ideas about extending the notion of dream‐work to an alpha function that goes on continually, day and night, transforming raw emotional experiences in a ‘dream’. In order to acquire a meaning, facts need to be ‘dreamed’ in this extended sense. Meaning and truth are the nurture of the mind. Mental growth, the development of adequate tools – including reverie – for dealing with mental pain, seen from a psychoanalytic perspective including reverie, implies that the object becomes a provider of meanings. Analysis begins to aim primarily at the generation or expansion of the mental container, instead of predominantly working on unconscious contents as such.     

Creating an Intersubjective Reality: Commentary on Paper by Arnold Rothstein

The author discusses Arnold Rothstein's paper “Compromise Formation Theory: An Intersubjective Dimension” and challenges his definition of intersubjectivity. She offers a perspective in which the import of intersubjectivity theory is less to dissolve the notion of objectivity than to grasp processes of mutual engagement, regulation, and recognition. While it is true that the recognition that the analyst is also a subject and therefore does not have exclusive knowledge is an important shift in the psychoanalytic paradigm, the author suggests that the intersubjective is far more encompassing than this. Intersubjective theory emphasizes the active creation of consensus or conflict about reality rather than merely the recognition that the analyst's perspective on reality is subjective. This cocreation produces a different emotional experience of connection, not merely a change in the quality of insight. Finally, Rothstein's case illustrates how he responds to the need for recognition and regulation. He shows us how focusing on the procedural allowed him to make an intersubjective shift, not simply an intrapsychic interpretation of compromise formation.     

Employee reactions to flattening organizational structures

This article examines the effectiveness of a newly introduced integrative structure and its impact on employee job perceptions in an aircraft maintenance organization. It is not common to find studies, that relate such changes to lower level employee reactions. The implementation of the change programme involved a system-wide approach incorporating both structural and cultural change. Using a retrospective methodology we assessed employee reactions to the changes introduced. We found that both intrinsic job satisfaction and job characteristics perceptions improved in the new integrative organization. The fact that positive findings have been identified when other studies found no relationship between such changes and attitudinal outcomes illustrates the efficacy of a system-wide approach to change. Extrinsic satisfaction and organizational commitment however did not improve. This can perhaps be explained by the fact that the latter areas are concerned with factors outside the direct completion of the job and may take much longer to change if indeed they can be shown to change over time at all.     

The interpretive attitude

From its start, psychoanalysis took as its primary goal the gaining of insight, and the analyst's interpretations as its primary technique for achieving that goal. Multiple factors, including the destructive impact of wild analysis and a growing appreciation of noninterpretive analytic functions, have brought those first principles into question. The author posits a conceptual division of the analyst's interpretive functions into declarative interpretations (content) and a procedural interpretive attitude (underlying process).The interpretive attitude is presented as crucial and central to psychoanalytic work, relevant and effective even when matters touching on preverbal issues are addressed.     

Reply to benjamin

Action and insight form an essential dialectic within the psychoanalytic process. Yet many recent psychoanalytic formulations, while emphasizing integration, have continued to view psychoanalytic and action‐oriented techniques dichotomously. It is reasoned that certain behavioral‐cognitive techniques that promote adaptive behavior can become an active part of an in‐depth analytic experience, providing material for an exploration that results in new ways not only of relating but also of experiencing the self and others. Such an approach, while at times helpful to certain patients, can be counterproductive for others. An integrative approach is compatible with many recent psychoanalytic frameworks emphasizing a two‐person psychology, but not with a one‐person vision of the psychoanalytic situation; in the two‐person view, it is reasoned that an integrative approach is capable of maintaining the integrity of the analytic process. The outlined technique reflects a relational psychoanalytic orientation emphasizing internalized object relations, with the use of action‐oriented techniques organized by the superordinate goal of modifying psychic structure, conceptualized principally in terms of self‐ and object‐representations. Reasoning that this approach is congruent with certain theoretical contributions from Gill, Mitchell, Sandier, and especially Wachtel, among others, I state underlying assumptions of the approach, preliminary technical guidelines, and illustrative case material.     

BODY, MOTHER, MIND: ANOREXIA, FEMININITY AND THE INTRUSIVE OBJECT

This paper takes as its starting point the preponderance of female to male patients who suffer from anorexia. The author suggests that there may be something specific about certain experiences of femaleness which predispose towards anxieties of intrusion. Two contemporary theories of the aetiology of anorexia are outlined. Both of these suggest that the problem has its origins in intrusion or invasion of different sorts. The author suggests that many women who suffer from anorexia have an intrusive object instated in their minds, which may not necessarily be the result of actual intrusions in external reality. In the final part of the paper, the author examines the intrusiveness of anorexic patients in the transference and suggests that such patients very often harbour profound phantasies of intruding between the parents, with a wish to regain their special place with mother, untroubled by the presence of father. It is further suggested that the psychopathology underlying certain cases of anorexia leads to a failure in symbolisation. This failure in turn complicates the clinical picture, making such patients particularly difficult to think with about their difficulties.     

Clinical theory at the border(s): Emerging and unintended crossings in the development of clinical theory

The author provides some scaffolding for thinking about emerging and unintended integrative developments in clinical theory. The emergent theory to which the author refers works at a different level of theoretical discourse than explicit attempts at comparative translation of psychoanalytic concepts or theories. In contrast, most of the theory that is explored in this paper involves clinical discourse aimed at solving important common clinical problems. The work of a group of authors (Jay Greenberg, John Steiner, Anton Kris, Michael Feldman and Charles Spezzano) is described as simultaneously embedded within a particular orientation while demonstrating a kind of unwitting reach to a broad swathe of analysts. Distinctions are made between this kind of linking of clinical theory versus self‐consciously syncretic and integrative approaches to theory development. The author also discusses the educational implications of this emergent theory for teaching and learning during psychoanalytic training.     

The moment and the next step

In psychoanalytical theory, the immediate future of the analysand has not been in the focus of interest. However, there is a change in the basic assumptions concerning the psychoanalytic process. Change is no longer seen as an inevitable automatic effect of insight into the unconscious. This is especially pertinent in the case of defect pathology. The author asks whether this altered view of the process will be followed by a change in technique. The question is: must change occasionally be stimulated by inspiration, suggestions and assessments from the analyst. While interpretation of the unconscious is still the major focus of analysis, some consideration of the next step of the analysand may also be part of our concern.