On ‘the fear of death’ as the primary anxiety: How and why Klein differs from Freud

It is well known that Melanie Klein held the view that ‘fear of death’ is the primary source of anxiety and that her position is explicitly opposed to that of Sigmund Freud, who maintained that that fear cannot in any way or form be a source of anxiety. In a previous article on Freud's Inhibitions, Symptoms and Anxiety (Blass, 2013), the author argued that, counter to what is commonly portrayed in the literature, Freud's considerations for rejecting the fear of death as a source of anxiety were based on relational and experiential factors that are usually associated with Kleinian psychoanalysis. In light of this affinity of Freud with Klein a question arises as to the actual source of their differences in this context. The present paper offers an answer to this question. The author first presents some of her earlier findings on what led Freud to reject the fear of death as a source of anxiety and then turns to investigate Klein's considerations for accepting it. This takes us beyond her explicit statements on this matter and sheds new light on the relationship of her views regarding death and anxiety and those of Freud. In turn this deepens the understanding of the relationship of Freud and Klein's conceptualizations of the psyche and its internal object relations, pointing to both surprising common ground and foundational differences.     

Assessing the effectiveness of the ‘Incredible Years® parent training’ to parents of young children with ADHD symptoms – a preliminary report

This study examined the effectiveness of an evidence‐based parent training program in a real‐world Scandinavian setting. Parents of 36 young children with or at risk of Attention Deficit Hyperactive Disorder (ADHD) self‐referred to participate in the Incredible Years^® Parent Training Program (IYPT) through a Danish early intervention clinic. Using a benchmarking approach, we compared self‐report data with data from a recent efficacy study. Eight out of nine outcome measures showed comparable or higher magnitude of effect from pretest to posttest. Effects were maintained or improved across six months. The methodology of this study exemplifies a rigorous but feasible approach to assessing effectiveness when evidence‐based US protocols are transferred into the existing Scandinavian service delivery. Findings suggest that IYPT can be implemented successfully as an easy‐access early intervention to families of children with or at risk of ADHD.     

‘Clemency on the way to the gallows’: death,dreams and dissociation

The survivor of a decade of childhood sexual trauma and violence, perpetrated by a monstrous father, produced a series of dreams in the final year of a ten‐year analysis. They illuminated the ‘death drive’ beneath a lifelong preoccupation with dying and fantasies of submission to death, perpetuated by the promise of hoped‐for freedom from pain and release from a life of suffering. The initial dream involved the collapse of a team of white horses drawing him in a pillory cart to his own hanging for a crime he did not commit. It signified the collapse of a fragile psychological system based on his role as the ‘sacrificial lamb,’ protecting a (not so) innocent mother. The raw truth was now unconcealed: primal, violent, and terrifying dreams and affects emerged where he was now the murderous aggressor. His dreams would become primary agents for an instinctive, life‐giving authenticity to emerge, offering him clemency from the shattering repetitions of persecution and dissociation.     

The future of Jungian analysis: strengths,weaknesses, opportunities,threats (‘SWOT’)

Using a methodology derived from management and organizational studies, the author reviews the future of Jungian analysis. The methodology is termed SWOT – strengths, weaknesses, opportunities, threats. A selected list in each of these categories is presented. The author is transparent in allowing for the fact that the paper not only derives from a public lecture on the topic, but also retains the immediacy and the contrarian and opinionated style of such a lecture.     

When symptom is symbol: some comments on Rosemary Gordon's, ‘Masochism: the shadow side of the archetypal need to venerate and worship’

This paper is a commentary on Rosemary Gordon's paper, ‘Masochism: the shadow side of the archetypal need to venerate and worship’, with a suggestion for an alternative interpretation of masochism as a part of a sado‐masochistic couple. Gordon postulates an archetypal need to venerate and worship that can be hidden in the shadow and distorted in such practices as sexual masochism. Her paper also offers several avenues of exploration for further studies in connection with the phenomenon of masochism, including sexual perversion (‘paraphilia’), chronic psychological victimhood, PTSD and traumatology, religious extremist behaviour such as self‐flagellation, transformation in the individuation process and numinous experience. An extension of her hypothesis to include religious problems of modernity is suggested.     

The closed mind: ‘Experience’ and ‘cognition’ aspects of openness to experience and need for closure as psychological bases for right‐wing attitudes

Openness to Experience and Need for Closure (NFC) are dispositional variables related to social‐cultural right‐wing attitudes. The present study investigated their joint effects. Factor analysis revealed an ‘experiential’ dimension with high loading openness items, and a ‘cognition’ dimension with high loadings for most NFC items and about a quarter of the openness item set. The experiential openness items were weakly related to right‐wing attitudes, demonstrating little predictive value. Conversely, the cognitive openness and NFC items were powerful predictors of right‐wing attitudes, and also played an important role in integrative models, both as a predictor of authoritarianism‐based racism and as a mediator of age related increments in right‐wing attitudes. It is concluded that right‐wing attitudes should be primarily understood in terms of (motivated) cognition, and to a smaller extent in terms of experiential openness. The distinction between ‘experiential’ and ‘cognitive’ openness is critically assessed, and it is asserted that because cognition is a multifaceted construct openness contains more than one cognitive dimension. Copyright © 2010 John Wiley & Sons, Ltd.     

The relationship between ‘workaholism’, basic needs satisfaction at work and personality

The aim of this study was to examine correlates of ‘workaholism’ components (Work Involvement, Drive, Enjoyment of Work). A cross‐occupational sample of 661 Norwegian employees in six different organizations completed a web‐based survey measuring ‘workaholism’, basic needs satisfaction at work and personality. Needs satisfaction at work was positively related to Enjoyment of Work, and negatively to Drive. Conscientiousness was positively related to all ‘workaholism’ components; Extraversion and Openness to Work Involvement and Enjoyment of Work; and Neuroticism to Drive. Negative relations were found between Neuroticism and Enjoyment of Work, and Agreeableness and Drive. Although the associations were rather weak, the findings give reason to differentiate between enthusiastic and non‐enthusiastic ‘workaholic’ characteristics, which were consistent with predictions taken from central theories on ‘workaholism’. Copyright © 2009 John Wiley & Sons, Ltd.     

Reflections on the Jungian nature of psychology as the discipline of interiority: a response to Saban's ‘Misunderstandings’

Psychology as the discipline of interiority is the name of the psychology that has developed from Wolfgang Giegerich's work in the field of analytical psychology. This article offers a counterview to that of Mark Saban's claim that Giegerich's psychology is ‘irrelevant’ to Jungians today and is based on a fundamental misunderstanding of the nature of Jungian psychology. It will be shown that, in fact, it is a fundamental misunderstanding of Giegerich's work that has led Saban to form erroneous conclusions. Links between Jung's and Giegerich's conceptions of the ‘objective psyche’ will be highlighted, along with other examples of how, contrary to Saban's conclusions, psychology as the discipline of interiority has obvious connections to, and grounding in, Jungian psychology.     

Working in the borderland: early relational trauma and Fordham's analysis of ‘K’

This paper outlines a view of early relational trauma as underlying borderline states of mind, and argues that Knox's 1999 paper on internal working models and the complex provides a basis for understanding such states of mind. The author argues that in addition to internal working models, the complex also embodies and contains primitive defences of the core self. He outlines how these apply on the objective, subjective, transference and archetypal levels, and in direct and reversed forms and applies this to the account of Fordham's analysis of his patient ‘K’, which ended in impasse. The paper explores the dynamic that emerged in that analysis and suggests that it could be helpfully accounted for in terms of the co‐construction and re‐construction of early relational trauma in the analytic relationship.     

Revisioning Fordham's ‘Defences of the self’ in light of modern relational theory and contemporary neuroscience

This paper explores the evolution of Michael Fordham's ideas concerning ‘defences of the self’, including his application of this concept to a group of ‘difficult’ adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a ‘self‐care system’ in the psychological material of early trauma patients (Kalsched 1996 ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a ‘real person’ to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.     

Disintegration of the self and the regeneration of ‘psychic skin’ in the treatment of traumatized refugees

This paper presents a tentative understanding of the characteristics of the extreme traumas, elsewhere called ‘complex PTSD’, that some refugees and asylum‐seekers bring into therapy. It suggests that these kinds of traumas suffered during adulthood may involve a disintegration of the self and a loss of ‘psychic skin’. This conceptualization is derived from the treatment of a refugee who survived multiple extreme traumas and with whom efforts were made in therapy to identify a complex methodology making use of supplementary therapeutic tools in addition to individual psychotherapy. The case demonstrates how the disintegration of self implies not only a deep somato‐psychic dissociation, but also a loss of intrapsychic and interpersonal space. In the treatment this was worked through via repetition of the victim‐aggressor dynamics at multiple levels. In the end, the therapeutic context was structured like a set of concentric layers, creating a ‘bandage’ over the patient's wounds whilst his ‘psychic skin’ was able to regenerate. The conditions triggered by extreme traumas in refugees challenge some of the cornerstones of individual psychoanalytic technique, as well as the idea that individual therapy may be thought of as existing in an environmental vacuum.     

Physicians’ gender bias in the diagnostic assessment of medically unexplained symptoms and its effect on patient–physician relations

Nonspecific, functional, and somatoform (NFS) syndromes is an umbrella term for various diagnoses with medically unexplained symptoms. These syndromes are more prevalent among women than among men, and associated with negative preconceptions that can impede rehabilitation. In two studies, we quantitatively assess how patients’ gender affects the diagnostic assessment of NFS syndromes, as well as the healthcare experiences of individuals diagnosed with NFS syndromes. In the first study, our vignette‐based experiment showed that Swedish general practitioners (N = 90) were gender biased in their diagnostic assessment of NFS syndromes, such that a female patient with back pain was more likely to be assigned a NFS syndrome compared to an otherwise identical male patient. In the second study, a large community sample of Swedish individuals with medically explained (n = 432) and unexplained pain (n = 521) evaluated their treating physician's relational conduct. Even after accounting for a variety of sociodemographic variables and other pain characteristics, women with at least one NFS syndrome percieved their physician's relational conduct as significantly poorer than other women as well as men with and without NFS syndromes. When women's pain is more likely than men's to be assessed as NFS, their rehabilitation could be prolonged as pertient alternative diagnoses and treatments are omittied and their negative healthcare experiences lower their volition to partake and persevere in treatment.     

Psychopathy in a forensic sample – the factor structure of the PCL:SV in a Danish forensic sample

The research literature reveals an ongoing debate regarding the most appropriate conceptualization of psychopathic personality disorder. Specifically, it is discussed to what degree antisocial behavior is part of the conceptualization of the psychopathy construct and what constitutes the best factor model of the Psychopathy Checklist scales. The aim of the present study is to consider the underlying factor structure of the PCL:SV (Psychopathy Checklist Screening Version) in a Danish sample as well as considering the role of antisocial behavior in the psychopathy construct. Data from a Danish forensic patient sample (N = 225) was used and item response theory (IRT), aonfirmatory factor analyses (CFA) and structural equations model (SEM) analyses were carried out. Overall, the findings suggest appropriate item and model fit for the PCL:SV as well as superiority of the three‐factor model over the four‐factor model. The results are discussed in relation to the broader concept of personality disorder as well as clinical practice in regards to violence risk assessments and treatment of psychopathy.     

The ‘too muchness’ of excitement: Sexuality in light of excess,attachment and affect regulation

This paper brings together contemporary thinking about early attachment and affect regulation with our clinical and theoretical understanding of the problems of adult sexuality. In addition to recent theories of affect regulation and attachment, we incorporate Laplanche's idea of ‘excess’, which was an important transitional concept integrating real experience with fantasy in sexuality. We elaborate the idea of excess –‐ ‘too‐muchness’ –‐ to illuminate the early overwhelming of the psyche that affects the formation of sexuality. Linked to recent theoretical developments, this idea helps to grasp the relationship between sexual excitement and early affect regulation, showing how excitement becomes dangerous, thus impeding or distorting desire. The ‘too‐muchness’ of excitement recalls the experience of being a stimulated, overwhelmed, unsoothed child and influences later inability to tolerate sexual arousal and the excitement affect. A clinical case illustrates this connection between attachment trauma, anxiety about sexuality, as well as shameful experiences of gender identity as an area of trauma. We emphasize the importance of working through the terrors and desires of the mother–baby relationship as they emerge in the transference–countertransference in order to develop the ability to hold excitement and stimulation without experiencing the too‐much as the intolerable. This includes the working‐through of ruptures related to overstimulation as well as the delicate balance of attention to fantasy and intersubjective work in the transference.