Thoughts on autism with special reference to a paper by melanie klein

The article begins with a brief exploration of the various aspects of adolescent's psychic qualities as these are described in Greek mythology. It is argued that myths are an integral part of the way that adolescence is perceived and myths play an important role in adolescents' psychic and external world, as well as in their mythological thinking. Connections are made with the attraction towards the creation of myths about adolescence in ancient and contemporary societies. Three clinical vignettes from adolescents' psychoanalytic psychotherapy are presented in an effort to support the idea of the value and importance of mythology in adolescence in the clinical practice. Through the clinical material, we try to explore how psychic and developmental disturbances, which might lead to psychopathology, are reflected in family and personal myths and also in the mythological thinking of adolescents.     

A DISCOURSE ON SOPHOCLES: FREUD AND DETERMINISM

A study on the subjective experience of neuroleptic treatment is used as an example of research that employs psychoanalytic theory and methodology outside the clinical situation. Psychoanalytic tenets such as psychosexuality and the unconscious are highlighted, and the systematic study of internal reality is discussed with reference to the study on neuroleptics, the results of which are presented in extenso. Metapsychology is considered as a means for systematization, and self-reflexive countertransference analysis is seen as a means for fostering trustworthiness and reliability. The validity criteria discussed are clinical relevance, coherence, and originality (as distinct from merely confirming received theory). Value conflicts between academic and psychoanalytic scientific cultures are described with reference to the data of the specimen study. The concluding discussion includes a brief comparison of the time-limited interview method with long-term, clinical psychoanalytic inquiries.

“Flechsig's Brain science is the theory and Schreber's delusions are the practice of the same traumatic collapse of…subjectivity, of the gap separating bodily cause and symbolic effect. Schreber's point would seem to be that the elimination of the gap—the attempt to fill it with neuroanatomical knowledge—is nothing short of soul murder.” Eric Santner (1996), My own private Germany: Daniel Paul Schreber's secret history of modernity (p. 75)     

Theoretical trajectories: Dreams and dreaming from Freud to Bion

This paper aims at comparing Freud's and Bion's conceptual models on dreams and dreaming. Beyond both authors’ shared disposition vis‐à‐vis problems posed by knowledge, a critical gap opens regarding their differing clinical practices. It is hypothesized that their ideas do not belong to irreconcilable paradigms, but that there are continuities besides discontinuities more frequently highlighted between Freudian statements on psychic functioning – described in his theory on dreams – and Bion's findings in his development of both the original theory and the connections between dreaming and thinking. Firstly, Freud's and Bion's epistemological sources are examined as well as their creative use and historical environment. Then certain general theoretical and clinical issues are considered concerning their theories on dreams, the evolution of their ideas and corresponding clinical contexts. In a third section, their confluences and dissimilarities are dealt with, including clinical vignettes belonging to the authors to illustrate their interpretative modes of working. This is meant to show both an implicit theoretical–clinical complementarity and the fact that, though their routes bifurcate about the function of dreams, there remain connecting paths. Lastly, the final remarks review certain issues that have frequently been controversial between these lines of thought.     

Clinical Supervision and Professional Development Using Clients from Literature,Popular Fiction,and Entertainment Media

Abstract

The use of clinical supervision is central to mental health work. In this article, the authors propose using practice cases drawn from characters found in literature, popular fiction, biographies, television, and movies as one method for clinical supervision and professional development in the mental health skill areas of client assessment, case conceptualization, diagnosis, and treatment planning. The method is illustrated with clinical formulations pertaining to four practice clients: Scarlett O'Hara; Maya Angelou's Marguerite Johnson; the fairytale character, Hansel; and the Wicked Queen of Disney's Snow White and the Seven Dwarfs. Applications and limitations of the method are discussed.     

Impact of Institutional Review Boards on cancer research

The concepts of informed consent and surveillance of human research designed to protect human subjects is commendable. The regulations of the Institutional Review Board (IRB) are having a major impact on clinical cancer research. There is greater administrative time needed of the investigator, the mechanisms of patient care have become cumbersome and some patients reject optional medical management that could be life saving. IRB regulations must be flexible to meet the needs of human subjects as well as those of the clinical investigator.     

Synchronicity,the infinite unrepressed,dissociation and the interpersonal

This paper uses the logic derived by Matte Blanco to provide an Archimedean point and a mathematics, both of which Jung complained of lacking, with which to validate the notion of synchronicity and to demonstrate that it is one of the inevitable properties of an unconscious which is unrepressed such as Jung's collective unconscious, and that such an unconscious will also be affective and interpersonal as well as intrapersonal. These have important clinical implications. After an exposition of Matte Blanco's thinking, some clinical material is presented of an episode in which patient and author both suffered the same psychosomatic symptom some time just prior to a session. Correspondences between Matte Blanco's logically derived ideas and Jung's phenomenological observations are made.     

Infant-led innovations in a mother-baby therapy group

A mother-baby therapy group for mothers and infants in their first year who are experiencing difficulties is described. In a literature review no comparable group where the infants are seen as members in their own right has been found. Themes in the mothers' material are outlined, followed by the infants' evolving interactive and internal processes. Some therapeutic factors, in particular interactions between the infants and interventions on the part of the therapists, are then illustrated with clinical material. Some infant-led innovations are described, such as the way the infants' activity is used as a basis for making ‘group as a whole’ interpretations, and in particular how the therapists' actions towards the infants have come to be viewed as a non-verbal form of interpretation. The role of attuned play in direct work with infants is discussed further.     

Shades of Mark Twain: Commentary on Paper by Steven H. Cooper

The author considers Cooper's notion of the pluralistic third from several angles as Cooper's use of the term covers a range of applications from that of an internal supervisor to the use of ideas from psychoanalytic traditions other than one's own in evaluating one's clinical work. The impression created of the American situation is contrasted with the institutionalized pluralism of the British Psychoanalytical Society since the Second World War. The author believes that the theoretical question of the analyst's accountability to a professional authority is overdetermined in the paper because the clinical material is dominated by the patient's problems in facing up to parental authority. A crucial enactment is seen as starting at the analyst's first contact with the patient, which seems to subvert the analyst's capacity to be an authority figure. The analyst finds a working relationship with his own psychoanalytic authority in the second session of the analysis but seems to lose it through an overextension of the ideas of “play,” self-questioning, and the seeking of agreement between patient and analyst. The author considers the clinical material from the point of view that his peer supervision group would take.     

Commentary on Paper by Michael Parsons

A range of clinical psychoanalytic approaches in the United States is considered as they may parallel Parsons's presentation of an “independent” orientation in Britain.

Attention is paid in particular to the analyst's sense of outsiderness and concern for otherness, along with their moral implications for clinical work. In addition, the limitations of theory and defensive misuse of theory are also addressed.     

Search Yourself: Commentary on Paper by Kenneth A. Frank

This commentary has as its point of departure essential questions about selfhood, self-knowledge, and therapeutic action. Frank's contemporary redefinition of “mutual analysis” and its impact on the clinical surround are examined, with a special emphasis placed on the willingness of the analyst to change and grow. The vital role and theme of the analyst's emotional honesty are explored with an eye toward the clinical impact of contextualism, psychoanalytic complexity, and the personal attitudes that inevitably permeate the analytic relationship and its trajectory. This commentary, in concert with Frank's paper, encourages clinicians to embrace a more collaborative, mutually analytic posture in their clinical endeavors.     

The clinical utility of Piagetian-based scales of infant development

The clinical utility of assessment scales based on Jean Piaget's theory of infant development is described. A clinical process is presented which permits one to determine (a) whether a child is showing delayed or non-delayed sensorimotor performance, (b) whether a child is showing normal or atypical patterns of sensorimotor development, (c) the extent to which deviations in a child's patterns of development are present, (d) the exact nature of such deviations, if any, and (e) what types of interventions are most appropriate for enhancing a child's acquisition of sensorimotor competencies. Four examples of the application of the clinical process are presented.     

Reply to Commentaries

Questions of historical context resonate with an Independent view of the importance of history. The historical backgrounds of North American and British psychoanalysis are relevant. Some American analysts may be seen as belonging to the Independent tradition, and the relation between Independent analysis in Britain and Relational analysis in America needs further consideration. I ask how far Relational analysis is taking on an institutional identity, and link this to Poland's discussion of “outsiderness.” Responding to Bass's and Berman's comments on my clinical examples I discuss why I sometimes do think analysts need to ascribe meaning to a patient's material. In other instances an analyst will invite the patient more into the process by which meaning evolves between them. To move freely between these positions is central to my view of clinical technique. I express doubts about analysts asking patients for their emotional reaction to an analyst's interventions. This risks being intrusive, and may tend to keep the exchange at the conscious level of a patient's mind. The analytic relationship is an interpersonal one between real people, but the analyst needs also to remain symbolically available as an object of unconscious fantasy and projection.     

Medicine as a form of practical understanding

This paper is an attempt to reframe the debate of whether medicine is an art or a science in the Aristotelian sense. The recent book of Pellegrino and Thomasma, A Philosophical Basis of Medical Practice, serves as the starting point. Taking clinical interaction as the distinctive feature of medicine, the resemblances of medicine with the characteristics of practical reasoning in the Aristotelian sense are further explored. This comparison proves especially useful in discussing the special status of medical knowledge. Clinical reasoning, resulting in clinical judgments, shows strong similarities with practical reasoning. The application of general principles, instead of deduction from them as in science is essential to both. The ancient concept of practical rationality may therefore be more appropriate while trying to ascribe rationality to medicine than the modern concept of rationality, associated solely with scientific reasoning.     

PHRONESIS,CLINICAL REASONING,AND PELLEGRINO's PHILOSOPHY OF MEDICINE

In terms of Aristotle's intellectual virtues, the process of clinical reasoning and the discipline of clinical medicine are often construed as techne (art), as episteme (science), or as an amalgam or composite of techne and episteme. Although dimensions of process and discipline are appropriately described in these terms, I argue that phronesis (practical reasoning) provides the most compelling paradigm, particularly of the rationality of the physician's knowing and doing in the clinical encounter with the patient. I anchor this argument, moreover, in Pellegrino's philosophy of medicine as a healing relationship, oriented to the end of a right and good healing action for the individual patient.     

A supposedly objective thing I'll never use again: Word association and the quest for validity and reliability in emotional adjustment research from Carl Jung to Carl Rogers (1898–1927)

As the first two decades of the 20th century unfolded, clinical psychologists, who had until then been mainly associated with intelligence testing, attempted to implement a specific psychological method—Carl Gustav Jung's (1875–1961) word-association “test”—in individual personality assessments. As one of the early clinical psychologists who attempted to use the method, Carl Ransom Rogers (1902–1987) is conspicuously absent from the historiography of clinical psychological testing. In fact, historians have recently suggested that we are lacking narratives about Rogers' early ideas and techniques in the context of both the development of clinical psychology and the emergence of psychological testing as clinicians' foremost scholarly activity. In light of the above, this paper pursues two main goals. First, it attempts to reconstruct Rogers' first original research project on emotional adjustment testing in young children in the broader context of the development of word-association tests as carried out by Jung and Whately Smith (1892–1947). Second, it aims to reconstruct Rogers' earliest theoretical ideas as well as his epistemological assumptions regarding test objectivity, validity and reliability. By drawing on unpublished documents and heretofore overlooked primary sources I show that although Rogers initially drew from Jung and Smith's complex and refined tradition, he ultimately rejected it as well as the tests themselves. At first drawn to Smith's quantitative, empiricist and experimental philosophy of psychology, Rogers was deterred when the data gathered through his own research in 1927 suggested that word association tests had no real, effective clinical value when used in children. By showcasing the complex process of test construction and validation undertaken by 1920s clinical psychologists, Rogers' case illustrates the research practices, the methodological problems and the epistemological dilemmas faced by most if not all of his contemporaries.     

Searching for the enriching sense of otherness: The psychoanalytic psychotherapist as a meaning-bearing other

Abstract

This paper is a theoretical and clinical examination of the patient's search for the otherness of the therapist as a prerequisite for change and development in relational psychoanalytic psychotherapy. A basic assumption is that being in a relationship as well as being a personal self, is to be understood, as being with a “meaning-bearing other”; that is, someone who allows for the possibility of meaningful thoughts and feelings, either through an actual communicative presence or as a consciously, prereflective, or unconsciously imagined communication partner. The term “meaning-bearing other” is used to differentiate distinct, although often synchronic, modes of relatedness. The need for intersubjective “depth”—that is, to discover the otherness of the other, and for oneself to be recognized as an experiencing subject—is regarded as a main motivational force. Winnicott's, as well as Sullivan's developmental approaches, Mitchell and Aron's views on psychoanalytic interaction, and Heidegger and Gadamer's phenomenology and hermeneutics are used as theoretical points of reference for the present discourse. The theoretical points of view are examined and discussed through excerpts from twice-a-week psychotherapy with a six-year old girl.     

Ferenczi's “Confusion of Tongues” Theory and the Analysis of the Incest Trauma

Abstract

The tender-mother transference of Ferenczi's humanistic analytic orientation was as important an advance in pioneering times as was Kohut's selfobject transference in contemporary psychoanalysis. Ferenczi's clinical theory and method began a focus on pre-oedipal experiences, which eventually became an alternate to the oedipal theory. Freud was critical of Ferenczi's formulation, leading a successful attempt to suppress his work and remove it from mainstream psychoanalysis because he believed it was “regressive.” In actuality, Ferenczi's “Confusion of Tongues” theory and “Relaxation Therapy” were prophetic and pioneering attempts to understand and treat the incest trauma (ironically the clinical data upon which Freud founded psychoanalysis 100 years ago). In the case of Miss T., Ferenczi's ideas are applied to the contemporary analysis of the incest trauma.     

Refusing the cure: Sophocles's Philoctetes and the clinical problems of self‐injurious spite,shame and forgiveness1

Sophocles's Philoctetes (409 BCE) is a dramatic masterpiece unfamiliar to most analysts. The play presents a complex portrait of self‐injurious spite of heroic dimensions as it touches on issues of intense shame, feelings of helplessness and the refusal of forgiveness. Sophocles's protagonist, Philoctetes, is a man who, like some of our patients, refuses to be healed. He intends, through his continued sickness and misery, to exact revenge against those who mistreated him. These are recognizable clinical issues, playing roles in every psychoanalytic treatment, issues that may assume a special importance in protracted, stalemated or aborted analyses. There are patients who damage the analyst by damaging the analysis they are in, a malevolent project often undertaken in revenge for wrongs suffered during childhood. This paper links Sophocles's drama to these vitally important clinical considerations through the discussion of a particular case.