Extending fields of work

The aim of this paper is to describe some acute responses to the suicide of a parent, through the account of the analytic psychotherapy of a latency child who found the body of his dead father. The acute traumatic responses of the child show that the perceptual apparatus, time and space are subverted, while the functioning of the contact barrier is deeply damaged. The importance of the environment in facilitating the first stages of the mourning process is stressed as well as the pre-traumatic personality structure. Both the Bionian model of preconception and the post-Jungian notion of archetype, revisited in terms of an unsaturated predisposition, are considered from a theoretical point of view. Preconceptions and archetypal dispositions to survive traumatic events are very important to the therapeutic outcome, along with the opportunity to start the treatment as early as possible after the traumatic event. This is particularly relevant in relation to the latency period, in terms of the capacity to contemplate the effects of the drives. The importance of allowing the child to work through all the stages of mourning is also considered, particularly rage, protest and hostile fantasies towards the lost object. The clinical material is structured as a narrative in an attempt to evoke the emotional climate experienced during the sessions as well as the state of mind of the child. The narrative is a secondary elaborated account with condensation and displacement at its core, like in dream work. Events, filtered through the analyst's state of self, are reported by lending the first person to the child in the narrative reconstruction.     

On the early history of male hysteria and psychic trauma

This paper discusses the influence of Jean-Martin Charcot's views on Sigmund Freud's early theory of hysteria and the notion of psychical trauma. We consider the early history of both psychical trauma and male hysteria, for in Charcot's view traumatic hysteria and male hysteria are identical. Freud's two 1886 lectures on male hysteria, delivered after his return from Paris, are crucial to the subject because they present Freud's first impressions of Charcot and his teaching. Some of the ideas presented in the two lectures foreshadow Freud's later generalization of the etiological role of trauma and his theory of the role of psychical trauma in the genesis of hysteria; that is, each hysterical symptom is due to a psychical trauma reviving an earlier traumatic event—the so-called principle of deferred action (Nachtraglichkeit). Several arguments substantiate the thesis that Freud's notion of psychical (sexual) trauma was developed in reference to Charcot's notion of traumatic hysteria, and that the early psychoanalytic theory of psychical trauma is clearly indebted to Freud's encounter with Charcot's male traumatic hysterical patients. The discussed Freudian development points out the major role of (physical) traumata in eliciting psychopathological pictures and in this way is of definite historical relevance for the present-day discussion on the traumatic nature of the so-called multiple personality syndrome and other dissociative disorders, and post-traumatic stress disorders.     

Fresh old news from Ferenczi about the function of dreams: The dream as a Kur,as a treatment and as a Gyógyászat

This article discusses a text on the function of dreams and their relation to trauma. Ferenczi intended to present this material as a talk at the 12th International Congress of Psychoanalysis, which was to take place in Interlaken, Switzerland the same year that he wrote it (1931). The entire conference, however, was postponed, and parts of this communication’s content appeared in other texts in which Ferenczi rethinks the concept of trauma and its clinical significance. In the present article the author makes use of the Freud/Ferenczi correspondence to contextualize Freud’s Hungarian follower’s originality regarding his theorizations about different aspects of the function of dreams. In the 1931 speech, as well as in this article, Ferenczi used a patient’s dream work as a clinical example of a process in which traumatic experiences and unmastered sensory impressions can be repeated to achieve a better working‐through for the dreamer. The process Ferenczi describes resembles an effort of self‐treatment, of self‐Kur.     

Developmental aspects of trauma and traumatic aspects of development

In this paper I try to show that inherent in healthy development are emotional experiences that are the stuff of trauma. Failure to reintegrate these experiences means that they can serve as a resonating board for difficulties in later life, adding to their traumatic impact. Focusing on global changes that occur at the end of the first year, I exemplify these developments with an infant observation and show how a six-year-old boy's failure to integrate them contributed to his experiencing a normal life event as a trauma. I then offer clinical material from the analysis of a man to demonstrate how later life events resonated with early experience associated with this period. All are linked to a complex pattern of object relations I have come across clinically, whereby feelings of grief associated with an idealized object are split off from feelings of grievance against an object experienced as persecutory because of its perceived superior status.     

The use of observation in the psychoanalytic treatment of a 12-year-old boy with Asperger's syndrome

The author describes some aspects of a once-weekly psychoanalytic psychotherapy of a 12-year-old boy diagnosed with Asperger's syndrome. The patient's emotional and cognitive development had been impaired since early life, possibly due to an internal deficit and to the likelihood of inadequate environmental holding. He was unaware of having difficulties but was underachieving academically, was socially isolated and often visibly unhappy in his life. The patient's denial, splitting, and projection of emotion and insight presented the therapist with the difficult task of how to reach him. In order to communicate with him emotionally, the therapist created a modified technique which reflected the patient's development from part-object to whole-object relationships. This development became apparent in the sessions and was interpreted in the transference relationship. An account of the patient's early years was pieced together from a detailed commentary of what was being observed and intuited by the therapist during the sessions, as well as by an understanding of the countertransference. By the end of two years' treatment, the patient's sensitivity and creativity, which had been buried beneath a self-sufficient, autistic-like encapsulation, finally began to emerge in his communications with his therapist.     

Frank in mind: a journey to self

Abstract

This paper describes two years’ intensive psychotherapy with an 11 year old boy I shall call Lou, who as a result of traumatic experiences in his early life, struggled to integrate a robust sense of self and in particular to find accord with a sense of himself as male. The impact of maternal depression, paternal gender dysphoria and domestic violence are discussed in relation to this young boy’s capacity to resolve the ordinary Oedipal challenge and find narcissistic value in a male body image to consolidate his gender identity. Concomitant difficulties with separation from his mother and aggression towards himself and others significantly impacted his ability to manage in a mainstream school environment and he was excluded at the time the therapy began. A clinical narrative is presented which illustrates Lou’s journey in psychotherapy, where he began to engage and allow links to be made. He sought to understand his position in a world that did not make sense to him, to face a hitherto ‘unthinkable’ past and to integrate disparate aspects of himself including a male gender identity. Notably Lou’s creation of ‘Frank’ constructed from dead, lost and reanimated objects is described and the actual and symbolic functions of this therapy object are discussed in relation to his internal development and the progress of the work. Parallels are drawn with Mary Shelley’s novel Frankenstein, where the creature strives for psychological birth and understanding. Lou and I struggled in the paradox of the themes of his narrative; a male/female father; potency and castration; corruption and repair and how to be a boy, held and helped in part through the paternal function of a female therapist.     

Intersubjectivity and the creation of meaning in the analytic process

By means of a clinical illustration, the author describes how the intersubjective exchanges involved in an analytic process facilitate the representation of affects and memories which have been buried in the unconscious or indeed have never been available to consciousness. As a result of projective identificatory processes in the analytic relationship, in this example the analyst falls into a situation of helplessness which connects with his own traumatic experiences. Then he gets into a formal regression of the ego and responds with a so‐to‐speak hallucinatory reaction—an internal image which enables him to keep the analytic process on track and, later on, to construct an early traumatic experience of the analysand.     

Orgasmic reconditioning without deviant imagery: a case report with a pedophile

A male pedophile was treated with a modified form of orgasmic reconditioning that, contrary to previous approaches, did not utilize deviant imagery during treatment. Pretreatment assessment of sexual arousal indicated high responsiveness to the stimuli of young girls, while responsiveness to adult females was almost absent. Treatment consisted of having the subject masturbate to ejaculation while speaking fantasies concerning adult females aloud. Four hours after the masturbation sessions, the subject underwent a measurement session in which his response to three deviant and three non-deviant slides were evaluated and attitude measures administered. Results showed a considerable increase in response to slides of female adults and a decline in response to slides of female children. Follow-up measurement sessions indicated that treatment gains were maintained 2 months following the end of treatment. These results suggested that in some cases the use of deviant imagery during orgasmic reconditioning is not necessary to facilitate treatment. It was also suggested that a comprehensive change in sexual orientation is more than a conditioning process and requires a modification of an individual's self-perception of his/her sexual identity.     

The body, adolescence, and psychosis

This article explores aspects of the clinical development of a male 17 year-old patient who had four weekly sessions of psychoanalysis during an acute psychotic crisis. In the context of arrested adolescent development, a psychotic crisis can present an opportunity to set the process of maturation in motion again. Adolescent psychosis is examined in the light of Bion's theories of catastrophic change - in which the container/contained relationship becomes explosive and overwhelming - as well as of Ferrari's and Matte Blanco's hypotheses on the mind-body relationship. The authors emphasize the role of denial of the body and its changes in the genesis of adolescent psychotic conflict, and show how the analytic relationship can offer crucial reverie conditions for promoting recognition of the body, bodily sensations and affects, as a prerequisite for the activation of an autonomous mental system. This clinical approach entails recognizing the urgent need to make room for the elaboration of intrasubjective relationships and for mind-body dialogue, transference interpretations being postponed. Clinical material and fragments of analytic dialogue illustrate the authors' hypotheses and demonstrate the patient's development towards recognition of his body and an incipient capacity to think associated with the perception of the limits set by time and reality.     

Early consequences of pre-Oedipal maternal deprivation

Abstract

The goal of this paper is to emphasize the early consequences of pre-Oedipal maternal deprivation, addressing the theories and techniques of the pioneers of child psychoanalysis. Even when these theories differ in their understanding and conceptualization of child psychopathology, their common denominator is that they believe in the importance of the infant’s early experiences of life and the necessary physical and emotional constancy of the mother–infant dyad. This paper approaches the different theories using three clinical vignettes. Through the synthesis of the psychoanalytic therapeutic process of a four-year-old boy, we can see how the conflicts and symptoms evolved and resolved in the course of five years of treatment, during which the boy’s behavior and productivity changed, allowing the treatment to come to an end. This boy was able to work through his traumatic separation experience in analysis, and to develop more mature defense mechanisms that led him toward a better adjustment to his environment. We can conclude that the early interruption of maternal care led to serious symptoms in this child’s behavior and mental organization. If these difficulties had not been addressed in time, the symptoms would have gone on to become severe.     

The real person of the analyst and his role in the process of psychoanalytic cure

This paper focuses on the real relationship with the analyst in the psychoanalytic situation as an aspect of the therapeutic process that leads to change. The role of free association, clarification, and interpretation of the transference are taken for granted as major activities of the analyst, and the real relationship with him is seen as a complementary but important ingredient for change. In particular, his emotional availability determines the climate of analysis. The concepts of neutrality, anonymity, and abstinence, though of importance as guideposts in the conduct of an analysis, have conceptual limitations that not infrequently bind the analyst in a stance that is not useful for the progress of the analysis. On occasion, confirmation by the analyst of the verity of an experience in the patient's early life facilitates the analytic process. This occurs particularly in situations of early trauma, but at times may include chronically traumatic early life experiences. An important motivating force in analysis is the patient's unconscious wish to find the ideal parent absent in early life experience, a wish that is experienced and ultimately analyzed. This is to be distinguished from a defensive idealized transference. Psychoanalytic developmental psychology contributes to our understanding of how the real person of the analyst, his emotional availability, his responsiveness at particular times, his attitude toward action and progressive change in the patient, affect the therapeutic process that leads to change.     

From interactions to mental representations: Psychodynamic parent – infant therapy in a case of severe eating and sleep disorders

This paper describes the process of psychodynamic psychotherapy with an infant and his family, during a developmental phase in which the infant's mental organization was in transition from the level of interactions to representations. The treatment of a 23-month-old boy suffering from a severe sleeping and eating disorder was initiated in a parent?–?child psychotherapeutic setting. The sleep disorder was a consequence of separation anxiety. Additionally, phobic avoidance of new oral experiences led to an eating disorder. These symptoms had developed in the context of dysregulation of the triadic family relationships (mother?–?father?–?children), which tended to split into two-plus-one relationships. After one year, the setting was changed to alternating individual and family sessions. Due to his developing symbolic capacities, the boy was able to express his inner concerns and his internalised affect-laden experiences through play and actions. His internal world could now be addressed by interpretations. New psychodynamic theories and research results on early triadic development were taken as the theoretical background for the psychotherapeutic work. We understood the course of the treatment and the development of the transference/countertransference relationships in terms of processes of triadification (at the level of interpersonal relationships) and triangulation (at the level of intrapsychic representations).     

Experience of traumatic events and personal myths of birth

ABSTRACT

Focusing on the analysis of a clinical case, this article studies the manner in which certain traumatic events can induce some individuals to produce auto-traumatic processes. In parallel, it demonstrates how the foundations of a subject’s origins can, at an early stage, find themselves undermined by an environment that does not recognise the subject, and that sends out messages that seem to exclude him or her from their filiation. What can follow is a partial breakdown in the ideation of origins that leads some individuals to create a personal myth of birth. This myth, that borrows some elements from collective myths, can to some extent substitute itself for the representation of filiation. This process will be differentiated here from delusional phenomena, or the ‘sexual theories of children’. This article also demonstrates the important role of the analysis of ‘anxiety dreams’ in these traumatic configurations: this analysis has the power to bring to light the different conflicting elements with which the ego identifies, so as to put an end to the auto-traumatic process, as well as giving clues for lifting the amnesia regarding a childhood personal myth of birth. Under these conditions ‘acts of birth’ can become inscribed into the analysis.     

An Investigation of the Efficacy of Online Expressive Writing for Trauma-Related Psychological Distress in Hispanic Individuals

This study compared the efficacy of 2 online expressive writing protocols for a traumatic/stressful life event in a Hispanic student sample. Participants who had reported a traumatic event were randomly assigned to either the emotion-focused group or the fact-focused group. The emotion-focused group focused their written accounts on emotions and feelings as well as facts about a stressful/traumatic experience, whereas the fact-focused group focused on facts of a stressful/traumatic event. Both groups completed 3 online writing sessions scheduled for 3 consecutive days, a 1-week online follow-up assessment, and a 5-week online follow-up assessment. Both groups statistically significantly reduced trauma symptoms over time with the emotion-focused group demonstrating statistically significantly greater trauma symptom reductions than the fact-focused group at the 5-week follow-up assessment.     

Exploring Expressive Sandwork as a Form of Psychosocial Care: A Case Study of a Vulnerable Adolescent

This paper explores the use of expressive sandwork as a form of psychological support for a youth with psychosocial vulnerability. A case study, which emanated from a community outreach project, is briefly described of a male black participant, from a low socioeconomic background, who is currently in correctional services care. The participant engaged with sandplay over five weekly sessions, lasting approximately an hour each. The data obtained during these sessions were thematically analyzed and the findings suggest that expressive sandwork enabled this individual to become more aware of his emotional wellbeing and foster a sense of hope. Expressive sandwork offers a form of short-term psychological support in circumstances where limited or no help is available.     

Unrecognized Posttraumatic Stress Disorder as a Treatment Barrier for a Gang-Involved Juvenile Offender

This study examines the case of GH, an 18-year-old Latino male participating in an employment-based delinquency intervention for gang-affiliated youth. Although postintervention measures revealed that GH showed gains on key outcomes (i.e., delinquency, employment), he experienced sporadic treatment setbacks (e.g., work absenteeism, fighting) that disrupted his progress. A comprehensive psychological assessment suggested that his aggressive, illegal behavior and difficulty maintaining employment could have been influenced by previously undiagnosed posttraumatic stress disorder (PTSD). Excerpts from counseling sessions illustrated how reactive aggression, hypervigilance, sleep disruptions, and emotional numbing could have interfered with treatment gains and ultimately contributed to GH's re-arrest. Implications for early, accurate identification of PTSD in delinquency interventions for gang youth are discussed.     

Diagnosing a male hysteric: Don Juan-type

The aim of this paper is to provide a clinical account of a male hysteric, Don Juan-type, taken from the early stages of treatment. The patient presented with a relationship problem but there soon emerged a form of compulsive sexuality or hypersexuality in his love relations that became a central feature of the clinical picture. This hypersexuality expressed itself in a compulsive need to stage, or to stage-manage, interpersonal scenaria of a sexual or sexualised nature. These scenaria, which were repeated in different variations and with different personnel, are seen by the author as a dramatisation of the primal scene with the patient taking up the position of the oedipal father. Explanations for the disappearance of male hysteria are given, including a new theory which claims that an imbalance in psychoanalytic theory itself led to the feminisation of hysteria. This critique allows certain forms of hypersexuality in men to be promoted as a form of hysteria, the most common example being Don Juanism-a form of compulsive sexuality that encompasses normative, conversion and character features. The paper also examines the male hysteric's developmental agenda. What the patient's compulsive sexual tableaux exposed was that he had never faced a separation that was not a triangular experience. This meant that his separations were experienced as two developmental agonies telescoped into one-separation (pre-oedipal) and exclusion (early oedipal). This combination, the author suggests, is so frightening in a particular group of men as to explain the choice of hysteria as opposed to some other choice of neurosis.     

Attempted clinical application of a technique for promoting robust free recall to a case of alcoholic Korsakoff's syndrome

A case study is reported which attempted to teach personal orienting information (i.e., recent history) to an amnesic male patient. The structured cuing methods reported by Kovner, Mattis, and Pass (1985, Journal of Clinical and Experimental Neuropsychology, 7, 395-411) were adopted. This involves structured presentation and cuing of target words embedded in a narrative. Some patients eventually are able to freely recall large amounts of material presented in this way. In the present case, the patient received 30 training sessions over 8 weeks. The material to be remembered was 10 target words pertaining to recent personal history. These words were embedded in accompanying storyline. The patient's immediate recall at the end of each session improved to some extent over the training period. However, delayed recall for the material remained nil throughout. Twelve months after the last training session the patient showed some "implicit" retention of the material. The findings are contrasted with Kovner et al.'s dramatic results and discussed.