Regression,Dissociation, Self-States,and the Developmental Dimension in Therapeutic Action

The concept of regression is at the core of psychoanalytic accounts of what goes on in analysis. It is, however, so “in our bones” that we are tempted to overlook it. In its justifiable enthusiasm of theories of self-states and dissociation, Relational psychoanalysis may be underemphasizing how much regression—both to earlier developmental stages and less organized modes of experiencing—is central in our approach to therapeutic activity and mutative action. In responding to Rina Lazar’s analysis with Sheli, I call for enhanced attention to the most powerful Freudian ideas from the new intersubjective perspectives.     

The Therapist,the Patient,and the Therapeutic Setting: Mutual Construction of the Setting as a Therapeutic Factor

The author examines several types of therapeutic action intrinsic to Davies's clinical work. Among these actions was Davies's eventual and careful willingness to ask her patient to hold affective states that the patient had previously been unable to hold; to discover a way to speak to her patient about her own struggles with the patient while risking, and actually knowing, that, inevitably, some of the patient's discovery of what the analyst feels will resonate with painful past experience; to create another countertransference space in which Davies found a way to become a different kind of bad or disappointing object to the patient than the patient's earlier disappointment with parental figures, though one that proved much more helpful and bearable than her previous experience; and eventually, though implicitly, to accept the aggressive and harsh ways in which the patient was already experiencing newness in the context of repetitive disappointment. In each of these types of action, the opportunity for mourning figures prominently.     

Clinical Mutual Attunement and the Development of Therapeutic Process: A Preliminary Study

Despite the identification of many factors that play a central role in the development of the psychotherapy process, there is still a lack of evidence about the basic relational mechanisms that pave the way to its working. In this pilot study, we focus on nonverbal microprocessual attunement as the basic mechanism grounding the displacing of discrete factors in shaping the clinical process. Two single sessions of two short-term psychodynamic treatments, selected respectively from a good- and a poor-outcome treatment, have been coded in terms of patient and therapist speech rate, coordination in ruptures, resolution of the therapeutic alliance, and patient's displayed thinking processes. Two dynamic structural equation models focusing on clinical attunement as a factor able to activate the interplay of the assessed clinical dimensions have been theoretically designed and tested in both cases. The driven theoretical structural equation models fit the data, suggesting a different role of nonverbal attunement as a moderating factor. The obtained results are consistent with the hypothesis claiming that a good-outcome psychotherapy session is characterized by a mechanism of clinical attunement that enforces the therapist–patient relationship and promotes the integration of formal thinking processes that affect emotional and cognitive domains.     

Therapeutic Action in the Work of a Playful Clinician: A Reflection on Dr. Silber’s Reimagining of Humpty Dumpty

ABSTRACT

In my discussion of Dr. Silber’s paper, Reimagining Humpty Dumpty: The Therapeutic Action of Play, I mirror Dr. Silber’s playful posture in her use of the Humpty Dumpty fable to talk about children and their care by society. My reflections on Dr. Silber’s therapeutic work with her two young patients focus on her co-creating meaning with each child’s parents as well as with the child. I discuss that by holding in her mind both the subjectivities of the child and his parents, Dr. Silber is able to practice a fundamentally relational therapy. I would have liked to have heard more about her emotional reactions in her work with both cases as another important dimension of her work. Finally, I emphasize through my play with Humpty Dumpty several ways that society can support children and families that are essential for their development: parental leave, developmentally approptiate expectations for children in school, and the facilitation and protection children’s open ended time and ability to play.     

A Career Developmental Perspective on the Therapeutic Alliance: Implications for Counseling

This review explores the role played by childhood emotional maltreatment (CEM) in selecting a career in the field of mental health and the potential positive and deleterious effects of these career‐choice motives on the therapeutic alliance. The reviewed findings support the assumption that CEM may serve as a precursor for career choice of professions in the mental health field. Implications are suggested for the counselor/therapist–client relationship, also known as the therapeutic alliance, as well as for career counseling.     

统一·行动·未来——马丁·布伯对犹太教现代性的思考

在当代的犹太教思想家中,许多学者提出重新理解犹太教的现代性任务。马丁·布伯是其中比较出色的一位。他洞察到现代性危机中的犹太教处境,在此基础上,批评了先前几种犹太教复兴观念:政治犹太复国主义、宗教共同体理论和民族共同体理论。他努力挖掘犹太教精神传统,分析犹太教中的现代性观念:包括统一、行动、未来三种精神。他的阐释工作的启示在于:一方面,必须以批评的和反思的眼光来面对西方的现代性,为现代性困境寻找出路;另一方面,也为犹太教展示出现代性的资源,拓展了犹太教在现代的生存空间。     

Heinz Werner: His Life,Ideas, and Contributions to Developmental Psychology in the First Half of the 20th Century

ABSTRACT

The author provides an overview of Heinz Werner's life and contributions to the field of developmental psychology during the first half of the 20th century. She focuses on his early work in Vienna and Munich as well as his tenure at the Psychological Institute in Hamburg, up through the time when he became a named Professor in Psychology at Clark University. Recognized as one of the founders of developmental psychology, Heinz Werner worked in the areas of perceptual development, comparative psychology, and symbol formation. Versatile in rigorous experimental methodologies, and in observational and phenomenological methodologies, Werner's approach to development stood in contrast to other approaches of development, both past and current. For Werner, development was a heuristic, a way of looking at processes in a variety of domains, including ontogeny, phylogeny, microgenesis, biology, developmental psychopathology, neuropsychology, and comparative psychology. Werner viewed development as proceeding from a state of relative globality and lack of differentiation to a state of increasing differentiation, articulation, and hierarchical integration, but he also stressed that individuals can function at different developmental levels under different times and conditions. Werner's holistic, organismic, comparative, and contextual approach to development transcended interdisciplinary boundaries, allowing him to study the interrelatedness between thought, language, feeling, perception, and culture.     

Thinking,Drinking, and Driving: Application of the Theory of Reasoned Action to DWI Prevention1

This study drew upon the theory of reasoned action (TRA) to predict the intention to drive while intoxicated (DWI). Four hypotheses were tested using telephone survey data from a random sample of 1,259 adult residents of Bemalillo County, New Mexico. Results showed the TRA to be predictive across a diversity of social groups. Contrary to hypotheses, subjective norms were a more powerful predictor than attitudes, and the perceived severity of DWI penalties was positively correlated with DWI intention, a paradoxical result that was explained with reference to the social environment of likely DWI offenders. The results suggest that anti‐DWI public‐information campaigns should stress the importance of informal social influence against drunk driving, rather than merely the legal penalties for drinking and driving.     

Getting Personal: Thoughts on Therapeutic Action Through the Interplay of Intimacy,Affect, and Consciousness

How do patients internalize new good object experience and how do these previously closed systems open up? What happens within and between analyst and patient that leads to the opening up of affective channels between them and allows consciousness to become transpersonal? The ways in which self-state experience becomes more fluid and cohesive, or less dissociated, is an affective process. This process occurs intersubjectively, as well as between self-states within each individual. When particular self-states come together between analyst and patient, especially those associated with pain and shame, disruption and instability may result within the mind-system (intrapsychic organization) of either or both partners. Managing the affective strain and psychic destabilization are vital tasks for the analyst and patient, in order for relationships between parts of the self (within one individual) to move from pain and hiddenness to compassionate recognition, thereby allowing and facilitating for parts of the self within the other individual to, in turn, move from pain and hiddenness to compassionate recognition. This is a core process of internal life, leading to the development of intimacy between self-states as well as between individuals.     

Contributions of Cognitions,Psychological Flexibility,and Therapeutic Alliance to Suicidal Ideation in Psychiatric Inpatients

Although suicide treatment is an expanding area of research, there is relatively less in the literature with respect to how specific vulnerabilities to suicide are addressed by treatment. Utilizing measures of suicide cognitions, therapeutic alliance, and psychological flexibility, we compared their relative contributions to suicidal ideation during and posttreatment among a group of adult psychiatric inpatients (N  = 434). Results revealed that cognitions contributed considerably more unique variance to suicidal ideation than alliance and flexibility at discharge and at 2 weeks postdischarge, and to change in suicidal ideation over the course of treatment. Psychological flexibility explained a small amount of variance at the 6‐month time point. Factor level analyses also were conducted, with the unsolvability factor within suicide cognitions accounting for the largest portion of variance at both discharge and 2 weeks postdischarge. Study limitations, implications, and future directions are discussed.     

Thinking with the Weight of the Earth: Feminist Contributions to an Epistemology of Concreteness

This essay proposes a possible direction for feminist epistemology—an embodied rationality that defines the process of knowing as a dialogue with particulars or the “things themselves.” On the grounds that modem reality is marked by abstract projects of homo mensura, I argue that the task of postmodernism is to ground cognition in the world by breaking the habit of looking at the world, as if from a distance, and by ceasing to think about the world as if it were composed of a collection of objects-in-general.     

Mentalization and Metaphor,Acknowledgment and Grief: Forms of Transformation in the Reflective Space

This paper illustrates the clinical application of current theorizing about mentalization and reflective functioning and shows how it can synergize with established analytic concepts. The paper presents a single case, that of a middle-aged woman patient with a moderate but significant history of trauma and presenting with narcissistic/borderline and masochistic dynamics. Unlike some applications of the new concepts, however, this paper does not focus the case presentation around them but instead shows how a number of processes contribute to the development of mentalization. These include corrective engagement in enacted repetitions of the patient's past mistreatment, the development of a central metaphor that allows for proto-reflection and playing with painful affects, and a mourning process precipitated by the death of a family member to whom she is ambivalently attached. In the course of the presentation, then, a variety of psychoanalytic concepts are applied, such that the paper works as a synthesis of mentalization theory with them. Specifically, transference-countertransference dynamics are tracked, projective identifications and containment processes are described, interactions and interpretations lead to progressive change, and fantasies, conflicts, and internal object relations are observed and analyzed. Such direct and detailed clinical application of the concept also makes it more vivid, lucid, and experience near.     

小学儿童互选友谊的发展趋势及攻击行为的影响：3年追踪研究

对小学3、4年级的285名儿童进行了3年追踪调查,分析了儿童分别与男、女生互选友谊数的变化趋势及其在个体间的差异,探讨了外部攻击和关系攻击分别对两类互选友谊数的影响。结果表明：（1）儿童的男、女生互选友谊数在3年时间内都有显著的增加趋势,并表现出显著的性别差异,儿童与同性互选友谊数显著多于他们与异性的互选友谊数,男生与女生互选友谊数的增加速度比女生与女生互选友谊数增加速度慢,儿童与男生的互选友谊数越多,他/她与女生的互选友谊数就越少,表明了性别隔离现象的存在。（2）在控制了关系攻击的影响后,儿童的外部攻击对他们在各时间点测得的与女生的互选友谊数有显著的消极影响,而对他们与男生的互选友谊数影响不显著;在控制了外部攻击的影响后,儿童的关系攻击对他们在各时间点测得的与女生的互选友谊数有显著的积极影响,而对他们与男生的互选友谊数影响不显著。这说明外部攻击和关系攻击对儿童互选友谊数的影响存在性别差异     

Sociopolitical Enactments as Arenas of Mutual Vulnerability: Psychotherapeutic Experiences During the War Between Israel and Gaza in the Summer of 2014

The understanding that sociopolitical, cultural, and socioeconomic spheres always play a part in psychotherapeutic endeavors forms a central aspect of the relational premise. Nevertheless, the literature rarely relates to psychotherapeutic interactions in which patient–therapist exchanges involve sociopolitical disputes or discussions. The main thesis of this paper suggests that the sociopolitical context in which the psychotherapeutic process takes place tend to serve as an arena of mutual vulnerability (Aron & Starr, 2013) between patient and therapist out of which Sociopolitical Enactments characterized by a curative potential tend to emerge, especially during times of war and horror. Two very different Sociopolitical Enactments that took place with patients in Tel Aviv during the war between Israel and Gaza in August 2014 are presented, followed by a literature review and conceptualization of Sociopolitical Enactments as arenas of mutual vulnerability that explicitly or implicitly facilitate working through processes of traumatic self-states, challenge binaries, and open up ways for inquiring power relations in the therapeutic alliance and beyond.     

Supervision in the Psychotherapy of Schizophrenia: Awareness of and Mutual Reflection upon Fragmentation

Historical and newly emerging models of schizophrenia suggest it is a disorder characterized by the fragmentation of the experience of the self and the world, leading to the interruption of how a unique life is unfolding in the world. It has been proposed that psychotherapy might therefore promote recovery by facilitating the development of a greater ability to integrate information about the self and others. In this paper we explore how the supervision of a metacognitively-oriented psychotherapy can assist therapists to experience and conceptualize fragmentation within sessions, join patients in the gradual process of making sense of their psychiatric problems and life challenges, and ultimately envision and achieve recovery. Common challenges and responses within supervision are described and discussed.

     

Forging Components Anew,Modes of Therapeutic Action: Reply to Discussions by Drs. Hirsch and Newirth

I elaborate my view of the analyst’s role as catalyst, and use of an enlivening presence, to foment the growth of mentalized thought in some patients. The need to forge certain components anew in such patients’ rendering of experience mentally is highlighted, in contrast to an emphasis on patients’ capability, expressed by Dr. Hirsch. I argue for a place for deficit in relational thought, and for a relational reframing of the concept. Compatibility is seen with Dr. Newirth’s focus on the transformation of mental processes as integral to therapeutic action and the value of Bion’s models of containment and thinking in striving toward such ends.