The Role of Enactments

In this paper the author discusses the multiple ways in which enactments emerge in the course of an analysis. She presents several clinical examples in which enactments were used to further the analytic process as well as an example in which the work of the analysis was temporarily stalled following an enactment.     

All-women's groups: a view from inside

All-women's counseling groups are the subject of controversy among counselors. In this article the author presents a rationale for such groups, discussing several ways in which women find them more therapeutically helpful than mixed groups. She deals with the dynamics of different kinds of groups, and she urges counselors to seriously consider using all-women's groups in their work.     

Making space: Spirituality and mental health

This paper was the Mary Hemingway Rees Memorial Lecture, delivered at the XXIst World Assembly for Mental Health, Vancouver, Canada, 2001. The author had recently completed a period of appointment as the New Zealand Commissioner for Mental Health. In this lecture, the author puts in a moving plea - as a survivior of mental illness - for considering both spirituality and mental health in terms of the experience of the self. She talks about the value of communication particularly by sharing experiences via personal stories. The author goes on to contrast communication and control, and to emphasize the importance of making space in order to accept our own and others' imperfections and vulnerabilities. Attention is drawn to the work of Baruk (1978, 1998, 1999, 2000). She also discusses the way in which mental illness can lead to spiritual progress, and ultimately to mental health. The original version of the talk contained further pictorial illustrations; for technical reasons it would be difficult to reproduce all of them here in the journal. Most of the illustrative material consisted of photographs by the author, including the two photographs that are reproduced in this paper.     

Infant observation: A range of questions and challenges for contemporary psychoanalysis1

The author attempts to integrate several perspectives within the field of infant observation that reflect the analyst's personal experience as a clinician, as a professor at the analytic institute and as a researcher in the field of psychoanalysis. Can infant observation contribute to analytic technique, theory and training? If so, what would be the nature of such contribution? To answer these questions, the author reviews the literature on infant observation from Freud to the present, highlighting Latin American contributions to this subject. She makes reference to the role of technological innovations, which have allowed videotaping, repeated observations, temporal segmentation and computerized programs, thus giving rise to microanalytic research. This discussion prompts the question about the contributions made by systematic research to clinical practice. To tackle this question, the author presents both a clinical vignette taken from her personal experience, and the current debate on this subject as it appears in the work of Daniel Stern and André Green. Finally, she presents some conclusions that are part of an ongoing debate in the psychoanalytic field.     

Ripples in mental space caused by dark matters and twisted tales: Some reflections on memory,memoirs and therapeutic work

In this paper, the author reflects on the issues of memory and the writing of personal memoirs, and how this impinges on our professional work. Her title is drawn in part from the work of theoretical physicists who can hypothesise about the existence of dark matter by measuring the deformations it causes in surrounding stars and galaxies. What she suggests is that there may be limitations in keeping strictly to disciplinary boundaries, and our professional lives may defy our efforts to box them in. The opening of doors to a more extensive world of ideas is often helpful, both for psychoanalysis and for the fields which it can illuminate and by which it can also be illuminated. She uses the example of the publication and critical reception of her own memoir, Pieces of Molly to make links with our professional selves and our clinical work. She draws on the work of Freud, and other seminal thinkers in the field, as well as her own clinical work to illustrate the ways in which mental space and the memories within it can be contained and transformed over time, but also can be beset by both internal and external saboteurs.     

Response to Aron and Atlas: Cooking Up a Storm—Together

The author agrees with the approach taken by Aron and Atlas in which they utilize the idea of the prospective function to emphasize the positive aspects of enactment that can be understood to promote symbolization much as dream work does. She welcomes their appeal to the future as an important aspect of intersubjectivity. The commentary on the case of Sophie aims to show the importance of the patient’s activity in collaborating with the analyst as another way that mutuality and play expand the notion of the creative illusion first offered by Winnicott. She also shows how this approach fosters a different idea of the Third than that used by neo-Kleinians, a point first made by this author and Aron. Finally, she suggests ways this idea of the prospective function can be integrated into our understanding of the Third.     

On ethical issues at the foundation of the debate over the goals of psychoanalysis

In this paper the author points to ethical issues that underlie the debate over the nature of the goals of psychoanalysis. While it has been suggested that the lack of consensus and clarity in this debate may be partially explained in terms of opposing attitudes to the importance of therapeutic benefit and variance in core values of analysts and patients, the author shows that these explanations do not fully resolve the ambiguity. The examination of the limitations of the existing explanations points to the value of introducing an ethical dimension. She discusses two ethical issues: the complex nature of the ethical value of self-determination in psychoanalysis, and the ethical status of analytic change. The clarification of these two issues contributes to an understanding both of the inherently controversial nature of the debate over analytic goals, and of the place of ethical considerations in psychoanalytic theory and practice.     

A framework and two sketches concerning psychoanalytical training and practice

The author discusses the mode of knowledge production in psychoanalysis based on a reflection on the psychoanalytical education and its relationship to clinical practice. She points out that there is a risk in a form of clinical activity found in our education, which, under the fascination of the analyst's power of operating in the metaphorical domain of words, loses sight of the material dimension of the clinical action. In other words, this form of clinical activity loses sight of the meeting with another human being, of the repertoire of theories and experiences that informs this action and the patient's and the analyst's concrete life situation. The author highlights the role of writing as a privileged way of dealing with the material and immaterial facts that constitute the clinical action and reflects on some of the forces that structure nowadays the reception of knowledge production inside the psychoanalytical field. She uses the notion of 'minor literature', by Franz Kafka, to express the possibility that a live circuit of writings exchanged among psychoanalysts can offer to an interchange of experiences and ideas that is the live expression of the history of the psychoanalytical groups. A clinical session is presented in order to promote considerations about the psychoanalytical education, theory and practice.     

The Theory of Transformations and Autistic States Autistic Transformations: A Proposal1

This work integrates two areas of thinking: one in which the author develops considerationsregardingobservationmethodsofmentalphenomenainpsychoanalysis according to Bion's theory of transformations; the other in which she is concerned with the investigation of primitive mental states‐protomental states‐more specifi cally, the autistic states of neurotic patients, described by Tustin. Some ideas on the ‘philosophical’ position underlying transformations theory are elaborated, particularly emphasizing the idea that the same phenomenon in psychoanalysis may be considered from different perspectives, as long as it is situated within the theoretical reference frame to which it belongs. The author considers the idea that this method of phenomenon observation is part of a wider context of general human knowledge, in which uncertainty and relativity of concepts are the main components. By adopting transformations theory as a perspective of phenomena observation that pervades the analytical meeting, the author questions whether it is possible to include other groups of transformation of emotional experiences in this theory, which shows particular phenomena with specifi c qualities, distinct from those emphasized by Bion. She hypothesizes that autistic phenomena present in neurotic patients, characterizing autistic states, may be considered and detached, making up a particular group of transformation of emotional experience, which analysts often face in their daily practice. She names this group ‘autistic transformations’.     

Bodily centered protections in adolescence: An extension of the work of Frances Tustin

In this paper, the author discusses the recurrence of infantile, proto-mental functioning in adolescence mainly in the context of the work of Frances Tustin. She demonstrates, through clinical example, how the tendency to resort to bodily centered and sensation-dominated protections is reactivated on a grand scale when the internal and external physical and psychological changes, brought on in puberty, are felt to be potentially overwhelming. She also demonstrates how, when the capacity for adequate mental and emotional development is stultified, sensation and action once again come to the rescue as the adolescent's way of attenuating anxieties unconsciously experienced as resonating with those unmentalized happenings of early infancy and how the psychoanalytic relationship may be pivotal in setting previously derailed mental and emotional growth back on track.     

Fostering Spiritual Development through the Religious Dimension of Schools: The report of a pilot study in 17 independent schools

In this article the author examines ways in which spiritual development can be fostered through the religious dimension of schools. She first looks the problem of defining 'spiritual development' and discusses some empirical work in this area. She then presents some of the findings of her pilot study into the perceptions of the religious dimension of their schools by 287 Year 7 and 231 Year 10 pupils in 17 girls' independent schools. She shows the insights gained into spiritual development from pupils' responses to questions on collective worship, Religious Education lessons and school ethos.     

Working with psychotic processes in art therapy

In this paper the author describes in some detail her work in the art-therapy department of Hill End Hospital. She used not only her understanding of the work of psychoanalytical writers on schizophrenia, particularly Bion and Searles, but, more importantly, her own experience of the patients at the Hospital, to gain an insight into how these very regressed patients think of themselves and their relationship to reality. She illustrates how she used objects and images created by patients from the art materials supplied, during (usually) five two-hour sessions a week, together with conversations (and notes made in the patients' presence of these conversations) about these images at structured weekly individual-therapy sessions, to help patients to develop from a state of meaninglessness to a position in which they can choose to engage in continuing therapy.     

‘THERE IS A WAR ON! SOMEONE IS GOING TO GET KILLED’

This paper describes the first three years of work providing consultation at the interface between adult mental health and children's services. It suggests that significant numbers of children, living with parents whose mental illness may be ‘severe and enduring’, remain hidden from services. The author applies psychoanalytic theory in an attempt to understand the unconscious factors, for organizations as well as for individuals, which may contribute to making it so difficult for services to work co‐operatively to recognize these children's existence and their emotional needs. She reviews some of the related fields in which the application of psychoanalytic thinking has occurred and also describes the context in which the work takes place. A series of vignettes demonstrate some of the difficulties encountered and the ways in which the presence of a neutral third or ‘other’ can contribute to their resolution. She suggests working relationships between adult's and children's services are profoundly affected by the psychotic processes operating in the minds of these parents and that the consultant acts as a container enabling staff to manage the fragmentation and splitting which would otherwise be inevitable.     

Eating disorders as psychosomatic illness the implications for treatment

Abstract

This paper describes a body of theory which points to the possibility that eating disorders can be seen as psychosomatic illness, which is to say a symbolization of affect via the body rather than with words. The author concludes from this that eating disorders may respond better to non-verbal experiential therapies than they do to verbal therapy. She then describes four years of work with groups of eating-disordered women using non-verbal experiential therapies and suggests that the improvement in their symptoms may be the result of these methodologies and that her hypothesis merits further testing and exploration.     

Form and forming a focus: In brief dynamic therapy

This paper describes a model of training for individual work which treats as essential the consideration of group and institutional dynamics, as contrasted with the ‘prevailing model’ in which such issues are not overtly attended to. The author outlines key elements of such a ‘group-aware’ model and endeavours to show the value of it in terms of the students’ self-development, their fuller use of the training experience and in relation to their clients. She suggests that such a model has key advantages over the ‘prevailing model' for all counselling and psychotherapy students, but places emphasis on its particular relevance and value for those training to work with children, adolescents and young people.     

Words that touch2

In this paper the author examines her own use of language as a psychoanalyst and asks: what is the best way to help analysands to find the words to express not only what they are thinking but also what they are feeling and experiencing? In common with other psychoanalysts, the author has observed that each of us simultaneously utilises both advanced psychic mechanisms that are accessible to symbolism and more archaic ones, which are less so. However, she draws a distinction between people who are able to tolerate the perception of their own heterogeneity, even if it is sometimes a source of suffering, and those whom she terms ‘heterogeneous patients’. Patients in the latter category, whose lack of internal cohesion causes them anxiety, are afraid of losing their sense of identity. The author asks how we can understand their language and how we should speak to them. She uses several clinical examples to demonstrate that ‘heterogeneous patients’ need to be touched with a language that does not confine itself to imparting thoughts verbally but also conveys feelings and the sensations that accompany those feelings. It is also an ‘incarnated’ language because the words pronounced by the analyst can awaken, or reawaken, bodily fantasies in the patient. These words may enable him to find an emotional meaning in forgotten sensory or bodily experiences, which may then become a starting point for his work of thinking and of symbolisation.     

Modified group psychotherapy with chronic renal dialysis patients

Renal dialysis is a life saving, chronic medical procedure for those patients whose kidneys no longer function. However, the psychological reactions to this procedure, which necessitates a state of passivity for several hours, often overshadow the medical implications, and, in some instances, are decisive in terms of the patient's adjustment to treatment. Frequently, patients are unable to utilize individual psychotherapy to its maximum because of their need to perceive their illness as only medical. Group therapy however provides a less threatening psychological milieu and tends to give rise to peer support and mutual interaction.Barbara Halin Willinger, M.S.W., A.C.S.W., was the social work supervisor of the Renal Dialysis Unit at Metropolitan Hospital at the writing of this paper. She is a private psychotherapist and is affiliated with a mental health clinic where she also practices individual and group psychotherapy.The author wishes to thank Martin Saltzman, M.D. and Haley Glazer, M.S.W. for their suggestions.     

Between Square and Hexagon in Oresme's Livre du Ciel et du Monde

In logic, Aristotelian diagrams are almost always assumed to be closed under negation, and are thus highly symmetric in nature. In linguistics, by contrast, these diagrams are used to study lexicalization, which is notoriously not closed under negation, thus yielding more asymmetric diagrams. This paper studies the interplay between logical symmetry and linguistic asymmetry in Aristotelian diagrams. I discuss two major symmetric Aristotelian diagrams, viz. the square and the hexagon of opposition, and show how linguistic considerations yield various asymmetric versions of these diagrams. I then discuss a pentagon of opposition, which occupies an uneasy position between the square and the hexagon. Although this pentagon belongs neither to the symmetric realm of logic nor to the asymmetric realm of linguistics, it occurs several times in the literature. The oldest known occurrence can be found in the cosmological work of the 14th-century author Nicole Oresme.     

People are not cabbages: reflections on patient and analyst change

The author describes how her own internal change was a vital part of transformation between herself and two patients. She draws on Loewald's work as she discusses how change in her own internal relationship with her father was part of a lifelong emotional reorganization of Oedipal relations. She describes a process of mutual change whereby her and her patients' unconscious growth each stimulated the other. She suggests that the analyst's own emotional growth is a vital, not an incidental, part of psychoanalysis, as it brings new life to the work for patients as well as analysts themselves.     

An Evolutionary Theory of Diversity: The Contributions of Grounded Theory and Grounded Action to Reconceptualizing and Reframing Diversity as a Complex Phenomenon

The author discusses the contributions of grounded theory and grounded action to the development of a new, and evolutionary, theoretical framework for understanding diversity as a complex phenomenon. She discusses the work of Thomas and Gregory as pioneers in expanding the conceptualization of diversity, arguing that this new understanding increases the potential for creative action in systems.