How Can I Help You? Dimensional versus Categorical Distinctions in the Assessment for Child Analysis and Child Psychotherapy

ABSTRACT

This paper describes the process of a psychoanalytically-informed or a psychodynamic diagnostic assessment with children, contrasting it with a DSM-like diagnostic process. The importance of understanding and sensitively addressing the experience of parents when they bring their child to a professional for help is highlighted. The promotion of a psychoanalytic atmosphere, the unique contribution of a child analyst or psychodynamic clinician to the general mental health field, is an approach which promotes the development of a therapeutic alliance. This allows both parents and children to express their underlying issues as openly as possible. In addition to the basic assumptions of psychoanalysis (the ubiquity of unconscious mental activity and the impact of the past on the present/the developmental perspective), several factors are crucial to bear in mind: the importance of understanding the nature of the child’s (and the parent’s) emotions, emotion regulation, development of mental representations of self and other, and their conflicts and defense mechanisms. Potential therapeutic approaches are highlighted, including stressing the need to empirically study how decisions are made by a mental health provider when moving from assessment to treatment recommendation.     

Understanding violence: Does psychoanalytic thinking matter?

A coherent psychoanalytic theory of violence has been hindered by the very few psychoanalysts who have actually worked with violent patients, by political allegiance to certain psychoanalytic schools of thought, a naïve belief that all violence is typically not intentional, but rather a problem of impulse control, and the lack of understanding of recent neurobiological findings concerning aggression. Although intensive psychoanalytic treatment is usually not appropriate for violent individuals, the authors assert that a comprehensive understanding of violent behavior from a psychoanalytic perspective is of relevance for all mental health practitioners interested in the nature of human aggression. Actual violence is informed by bodily enactments and regressions to primitive subjective states; the effects of trauma on representation and symbolic functioning; the demarcation between affective and predatory violence; and understanding how all of our mental processes, including cognitions, wishes, memories, unconscious phantasies, ego-defenses, and object relations, are originally rooted in the body. The authors review the historical psychoanalytic literature on violence and critique contemporary psychoanalytic theorizing regarding the etiology of violent behavior in the light of some neurobiological research findings. They conclude with treatment recommendations for those clinicians whose patients have been violent toward others.     

Light and color in a void: The analysis of a special needs child

This clinical report comes from the five year, four day a week analysis of a male child. What is special is that this treatment is of a child with marked mental retardation. I have retained this nomenclature because that is how Ricardo's parents described his mental capacity. What they meant was that he was greatly impaired in his cognition and this could be seen in Ricardo's severe cognitive, social, behavioral, and relational improprieties. I have privileged the function of psychoanalytic understanding and the role of transference to bring about modifications in this child's internal world. And I have considered the patient's psychotic mental state to be in need of psychoanalytic treatment not withstanding his psychosis's connection to his cognitive handicap. I have also added information I have received after the analysis, information that demonstrates continued integration coming from the analytic process. Owing to Ricardo's limited mental capacities, this article advances clinical information that is not often found in analyses of children. There are possibly many other children like him who nonetheless would benefit from dynamic psychoanalytic understanding. On the other hand, I shall not discuss this matter theoretically, even though some theoretic considerations are necessary. Clinical practice and the transferential relation are this report's principal material.     

Thalamic fear

This paper suggests that some neuroscience concepts particularly concerned with brain pathways in trauma and fear, as well as the neurobiology of emotion, provide an additional vertex to the psychoanalytic understanding of patients' material. The role of the body has been neglected in psychoanalytic thought and formulations in favour of purely ‘mental’ experience. The paper attempts to show how neuro-psychoanalytic understanding, which is conveyed to patients through interpretation, can increase their depth of understanding. Different types of memory are delineated and the paper describes a simplified schema of emotional processing, drawing on Damasio's distinction between emotion as an instinctual body based experience and its mental representation as feeling. Clinical examples are used to illustrate the usefulness of the distinction. The concept of emotional regulation is discussed as well as showing how its failure is associated with the appearance of persecutory superego structures.     

Challenges of patient‐led mental health services to psychoanalytic clinicians

This paper considers implications to psychoanalytic psychotherapy of the British Government's decision to implement a patient choice agenda for state‐funded mental health services in England and Wales. It places the patient choice agenda in the context of consumerist society and argues that the complex nature of psychoanalytic psychotherapy leaves it more vulnerable than other psychological therapy modalities to compete in the current reality of ‘consumer’‐led public mental health, which, in turn reflects a profoundly changed social context from that to which psychoanalysis traces its roots. Unless psychoanalytic clinicians recognize and find ways to adjust to this context they will jeopardize the survival of psychoanalytic psychotherapy in an increasingly market‐orientated model of mental healthcare provision in the public sector, eager to promote more ‘consumer friendly’ psychological therapy models.     

The mind beyond our immediate awareness: Freudian, Jungian, and cognitive models of the unconscious

Abstract: Several branches of cognitive science now focus on the nature of the unconscious. This paper explores some of the findings and models from this research. By introducing formulations based on non‐clinical data, the cognitive scientists—in neural linguistics, computational modelling, and neuroscience—may depart from the older psychoanalytic formulations. An understanding of unconscious neural processes is nevertheless emerging showing how synapses are modified by experience and how learning, conscious and unconscious, is due to this important aspect of brain plasticity. Freud and Jung's formulations about the unconscious psyche, representing the main tenets of depth psychology, are also based on a conception of the mind as extending beyond immediate awareness. However, their models are more hypothetical in that their data, almost exclusively, come from treatments of psychotherapy patients and their verbal accounts. So how do these two conceptions of the unconscious match, where do they differ? And how does the neural understanding in the present research support theories and practices of analytic treatments?     

Evolution,Altruism, and the Collective Superego

ABSTRACT

Our psychoanalytic understanding of human nature is that humans are self-interested. However, this view differs with those of evolution, ethology, and neuroscience, which show evidence of a natural altruistic capacity. A theoretical foundation for this capacity can be found in psychoanalytic works, particularly those of Melanie Klein. An emerging understanding is that of an altruistic capacity that is induced and shaped by early experience and either fortified or corrupted by social pressures and mental processes. In individuals and in collective society, superego dictates can conflict with natural altruistic impulses. Recognition within psychoanalytic theory of a primary altruistic capacity is important, because we as psychoanalysts have an impact on individual and cultural self-perceptions through our treatment of patients and through our writings and therefore contribute to the shaping of values in our society.     

The Latin American contribution to the psychoanalytic concept of phantasy

The author argues that the ubiquity of phantasies at various levels of mental functioning is undisputed in the current schools of psychoanalytic thought; however, she demonstrates some variations in their understanding of how the psychotherapeutic access to different configurations occurs. In the process of examining and acknowledging the central role played by unconscious phantasies in his patients’ symptoms, Freud gradually broadened the vernacular meaning of the German word ‘Phantasie’ that refers to imagination and the world of imagination, conferring on it the specific features that came to characterize its use in the psychoanalytic vocabulary. Later, the expansion of the concept derived from Melanie Klein’s clinical material obtained from child analyses gave rise to important debates. The author discusses the main points of disagreement that led to these debates, as well as their various theoretical and technical implications. Psychoanalytic associations in Latin America were strongly influenced by Klein and her followers. Thus, most of their scientific writings use the concept of unconscious phantasy put forward by the Kleinian school. Taking Kleinian principles as their starting point, Baranger and Baranger made the most original Latin American contribution to the concept of unconscious phantasy with their works on the unconscious phantasies generated by the analytic pair.     

Mental health and mediumship: an interpretative phenomenological analysis

There is a lack of research examining the mental health of practicing mediums, yet the nature of mediumship work inherently presents a number of challenges to the mental health of practitioners. In this study, we aimed to gain an understanding of how mediums experience their mental health in relation to their mediumistic practice and how they recognise and respond to psychological difficulties experienced by their clients. Fourteen mediums from the North West of England took part in one-to-one interviews, which were transcribed and subject to interpretative phenomenological analysis. Four themes were identified: from past traumas to mediumistic identity; spirit makes sense, mental illness is chaos; being resilient but vulnerable; and ethical mediumistic practice. The research highlights the value of not dismissing or attempting to change appraisals of valued aspects of mediums’ anomalous experiences. However, the findings do indicate that support for exposure to clients’ difficulties might be helpful.     

MAKING ROOM FOR MADNESS IN MENTAL HEALTH: THE IMPORTANCE OF ANALYTICALLY‐INFORMED SUPERVISION OF NURSES AND OTHER MENTAL HEALTH PROFESSIONALS

In this paper, I discuss the importance of psychoanalytically informed supervision and training of nurses and other professionals in mental health settings. Using examples from supervision groups I will illustrate how a psychoanalytic approach to mental health can complement other ways of thinking about practice and management. Psychoanalysis provides a framework for understanding the relationship between the internal world of the patients, the therapeutic relationship and the social system. I will also argue that this understanding helps to develop and maintain therapeutic factors while reducing the risk of damaging behaviour and beliefs.     

Resonance and Ambiguity—about Metaphorical Thinking

This presentation is based on the theory, presented by the author, of the development of the mind and its psychoanalytic treatment as a stage-specific continuum, applicable in principle to all levels of disturbed and arrested mental development. This paper focuses on the nature of attainment and mediation of understanding with psychotic, borderline and neurotic patients, and the significance of successful conveyance of understanding as related to the general goal of psychoanalysis, to achievement of a structural change in the analysand's representational world and, finally, to the question of the main curative factor in psychoanalytic treatment. After discussing all these questions, the author ends up giving the conveyance of stage-specific and individual understanding a central place in all of them. The goals of understanding and psychoanalysis in general seem to be more-or-less identical. Starting and continuing new structuring internalizations in the patient's world of experience is primarily motivated by conveyance of the analyst's stage-specific and individual understanding, and thereby leading to alleviation or elimination of consequences of the developmental arrest. It seems thus warranted to conclude that conveyance of the stage-specific and individual understanding seems to be the central curative element in the psychoanalytic interaction.     

Psychoanalysis as a creative shaping process2

The author first explains the concepts of creativity, play and aesthetic experience. He then outlines the psychoanalytic process as a creative one that shapes reality. Making a link between psychoanalysis and the humanities, he demonstrates that creative play is a fundamental aspect of the human experience of reality. Aesthetic experiences during the psychoanalytic process are comparable to the play by which children structure their world and artists' activity in following their urge to shape. Furthermore it is shown that creative actualisation testifies to a quasi‐biological need for coherence and structure. Through modern hermeneutics, the truth claims of aesthetic shaping can be established in epistemological terms. The basic principles of hermeneutics‐historicity, linguisticity and communicative experience‐find their psychoanalytic counterparts in memory, representational shaping and transference‐countertransference. Psychoanalysis is demonstrated to be simultaneously a science and an art. On the basis of a case history, aesthetic experience is shown to constitute a specific and unique form of access to psychic reality. Aesthetic experience and creativity do not only aid recovery from ‘bad psychological states’, they are also indispensable for the entire understanding of internal and external reality. It is possible to develop this understanding through a creative psychoanalytic attitude.     

On the construction of thinking

In this study the author attempts to widen our understanding of language and thought construction by using Chinese ideograms as a model. This allows us to understand how concrete internal objects can coalesce to form abstract internal objects, e.g. concepts, ideas, symbols, and metaphors. One can establish a pictorial language that antedates verbal language. This is the case in the dream work that we routinely study. Thus, this study delves into the physiology of the alpha function. To this end the author not only relies on psychoanalytic concepts but also on concepts from philosophy and from language itself. The author presents the ideograms not only for discussion but also for their visual impact. If we really want to understand pictorial images, they must be seen and not just discussed from a theoretical point of view. Based on this understanding the author advances a proposal for the technique used in treating patients who cannot establish mental representations for their affect. And the technical proposal is illustrated in two clinical cases.     

Parental styles in prospective fathers: A research carried out using a semistructured interview during pregnancy

Recent reviews on research into fathers consistently have drawn attention to the increased knowledge and thinking of the multifaceted, complex, and changing nature of fathers' role. Paternal involvement has been studied with reference to a number of variables, including personality, attitudes, and family structure. The concept of “understanding mental states” and of mentalization and the notion and working definition of Reflective Self Function, as devised by Fonagy and colleagues, seem to have important implications for paternal and parental involvement, and for normal development of the infant–caretaker relationship. The aim of our research was to broaden current knowledge and thinking about fathering during pregnancy by investigating how 112 prospective fathers are involved in the transition to fatherhood and how they are able to reflect on their experience. Our aim was to identify parental styles according to May's concepts and to rate Reflective Self Function in The Clinical Interview for Parents During Pregnancy [Colloquio per Genitori in Gravidanza (CGG)]. The CGG is a semistructured clinical interview devised with the most recent psychoanalytic views on mental representations taken into account and is aimed at investigating feelings and attitudes toward the baby, the couple's inner and subjective world. Our results highlighted the complexity of paternal involvement in pregnancy and its relation with Reflective Self Function. Specific relations also were found between Reflective Self Function and the three styles of detachment/involvement identified by May. ©2004 Michigan Association for Infant Mental Health.     

A Buddhist contribution to the psychoanalytic psychology of self

The author attempts to integrate the concepts of self used in psychoanalytic theory with the understanding of the nature of self as explained within the Buddhist meditative tradition. He divides different concepts of self in psychoanalytic theory into three major levels of consciousness and abstraction: self as experience, representational self and self as system. The representational level is defined as consisting of unconscious organizing structures of interaction: the system level is a hierarchically higher organization of representations, while the experiential level consists of the moment-to-moment flow of consciousness. He argues that for the sake of theoretical clarity these levels should be differentiated in discussions of self. He then describes the Buddhist psychology of self and tries to show how this perspective can enrich psychoanalytic understanding of the experiential self and of narcissism, which in Buddhist language would be described as clinging to (seeking or avoiding) images of self that arise in the mind. Last, he describes a model of therapeutic development using different levels of self and the interrelationship between them, showing how psychoanalytic psychotherapy and Buddhist insight meditation emphasize different levels of self using complementary rather than mutually exclusive methods.     

The educational boundary1

In this contribution, the authors defi ne and discuss the educational boundary in analytic training, which they believe is an often neglected and useful concept in psychoanalytic education. The framework on which their discussion rests includes the recent attention of psychoanalysts to issues of boundaries and ethics. Their understanding of how clinical work affects the mind of the analyst educator, as well as the ways the personalities of various analysts affect their dealings with faculty peers and students, are the other cornerstones of their discussion. The authors contend that many of the institutional problems encountered in the training of analysts can be better understood when viewed through the prism of the educational boundary. They present examples which illustrate several of the ways psychoanalytic educators complicate the training experience of candidates, offer specifi c explanations as to why analysts struggle as they try to manage their educational interventions, and indicate in a discussion of potential remedies that those behaviors might be avoided if the educational boundary is in focus. They also provide an example of how the educational boundary can be more effectively managed.     

Observations on some aspects of current psychoanalytic theories

The competing theories in the psychoanalytic marketplace today should be judged on their merits, not on the basis of the authority of whoever first proposed them. What is valid in each theory should be included in any formulation of a psychoanalytic theory of mental development and functioning. Since psychoanalysis, as part of psychology, is a branch of natural science, pluralism in theory is to be avoided in psychoanalysis as in every branch of science. The psychoanalytic method is a valid one of studying a particular aspect of brain functioning. The method and the theories based upon it are as "organic" as is the case with any of the other neurosciences. Any valid psychoanalytic theory of mental functioning and development should include the following conclusions: (1) Unconscious mental processes are omnipresent and of great importance in mental functioning; (2) Thoughts are as causally related to one another as are other events in the universe; (3) Mental functioning is a developmental phenomenon with describable, sequential features; and (4) A major role in mental functioning and development is played by conflicts over the sexual and aggressive wishes that characterize mental life during the period from three to six years of age, and by the compromise formations that result from those conflicts. The last of these conclusions, though disputed by many, is abundantly supported by evidence that is not dependent on the use of the psychoanalytic method, as well as by evidence furnished by the use of the psychoanalytic method. There is also much evidence to support the assertion that any psychoanalytic theory that attributes language-dependent thoughts to a child whose brain is not yet mature enough to be capable of language is to be considered invalid, as are any observations made by the psychoanalytic method (= clinical observations) that are influenced by such an invalid theory. In psychoanalysis, as in every other branch of science, an observer--no matter how astute and how experienced--who subscribes to an invalid theory will be led astray by that theory, sooner or later, in one way or another.