Children with Autistic Spectrum Disorders: Individual Differences,Affect, Interaction,and Outcomes

In this article, we have drawn upon the attachment motivational system (Bowlby, 1988; Lichtenberg, 1989; Shane, Shane, and Gales, 1997) as a guide to providing “positive new experience” as the cornerstone of therapeutic progress. We see positive new experience as paramount, over and above insight and/or interpretation because insight and interpretation are so varied among different theories. The common denominator that is effective in therapy, then, must be something beyond insight and interpretation. We call that therapeutic factor the positive new experience and will draw from attachment theory to understand its components. In addition, using the attachment motivation system and trauma research, we elaborate on why certain types of negative experiences in psychotherapy and psychoanalysis should be avoided. We address, in particular, harmful repetitions of traumatic relational patterns or traumatic events in the transference, overemphasis on “the empathic stance,” and the search for motivation in patients' behaviors where such a search may be based on the false assumption that all behavior is motivated. This latter category addresses aspects of behaving that may not be motivated; that is, they just “are,” and as such, the search for and attribution of meaning in such instances may lead to failed understanding and insight and to faulty correctives. We have illustrated with clinical examples both positive new experience and three types of negative experiences to be avoided in treatment.     

Relational Psychoanalysis Potential Usefulness with Black South African Clients

The aim of this article is to suggest that relational psychoanalysis may be a useful approach for working with clients from indigenous African cultures. In particular, the article considers the utility of relational psychoanalysis to understanding and enacting the therapeutic relationship with clients from an indigenous African cultural background. The notion of “we” self from the perspective of African cultures is a case in point for possible compatibility between relational psychoanalysis and black clients who come from background that place a high value on communal or “we” selves. An integrative therapy that combines African worldviews and relational psychoanalysis is possible.     

“Crunches,” “(K)nots,” and Double Binds—When What Isn't Happening Is the Most Important Thing: Commentary on Paper by Barbara Pizer

This discussion compares Pizer's concept of “relational (k)nots” with “crunches” and double bind impasses. It argues that all of these constructs capture what happens when conventional analytic method—the exploration, elucidation, and interpretation of transference—fails to work. In this context a “last-ditch effort” emerges, a necessary crisis of treatment. The situation is a plea that something must occur “now or never” or the “charade of therapy is over.” This plea is extraordinarily challenging since it embodies contradictory elements wherein the patient's very call for involvement with the analyst is embedded in a process that obfuscates their connection. Notably this sets the stage for the “damned if one ‘gets it’ and damned if one doesn't” experience that is a part of the paradox of recognition/mis-recognition that befuddles many analyses.

Extrication from such impasses requires the analyst's recognition that she is colluding in a kind of avoidance or distraction from recognizing their disconnection. Her second act involves meta-communication about their process. That is how their “relational knot” both binds them together while negating their connection. While this observation may be necessary it is recognized as insufficient on its own. Thus her third move out of the impasse requires her to enter into a state of improvisation. That is, to use some part of herself that must surrender from the one-up one-down impasse position of “either your version of reality or mine.” Instead, she must cultivate through her action a third way in which both she and her patient can think about their impasse and do something about it, including something different from what either one might have imagined before.     

The Sceptical Paradox and the Nature of the Self

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Defeating Dr. Evil with Self-Locating Belief

Dr. Evil learns that a duplicate of Dr. Evil has been created. Upon learning this, how seriously should he take the hypothesis that he himself is that duplicate? I answer: very seriously. I defend a principle of indifference for self‐locating belief which entails that after Dr. Evil learns that a duplicate has been created, he ought to have exactly the same degree of belief that he is Dr. Evil as that he is the duplicate. More generally, the principle shows that there is a sharp distinction between ordinary skeptical hypotheses, and self‐locating skeptical hypotheses.     

The minimal self hypothesis

For millennia self has been conjectured to be necessary for consciousness. But scant empirical evidence has been adduced to support this hypothesis. Inconsistent explications of “self” and failure to design apt experiments have impeded progress. Advocates of phenomenological psychiatry, however, have helped explicate “self,” and employed it to explain some psychopathological symptoms. In those studies, “self” is understood in a minimalist sense, sheer “for-me-ness.” Unfortunately, explication of the “minimal self” (MS) has relied on conceptual analysis, and applications to psychopathology have been hermeneutic, allowing for many degrees of interpretive latitude. The result is that MS’s current scientific status is analogous to that of the “atom,” at the time when “atom” was just beginning to undergo transformation from a philosophical to a scientific concept. Fortunately, there is now an opportunity to promote a similar transformation for “MS.” Discovery of the brain’s Default Mode Network (DMN) opened the door to neuroimaging investigations of self. Taking the DMN and other forms of intrinsic activity as a starting point, an empirical foothold can be established, one that spurs experimental research and that enables extension of research into multiple phenomena. New experimental protocols that posit “MS” can help explain phenomena hitherto not thought to be related to self, thereby hastening development of a mature science of self. In particular, targeting phenomena wherein consciousness is lost and recovered, as in some cases of Unresponsive Wakefulness Syndrome (UWS), allow for design of neuroimaging probes that enable detection of MS during non-conscious states. These probes, as well as other experimental protocols applied to NREM Sleep, General Anesthesia (GA), and the waking state, provide some evidence to suggest that not only can self and consciousness dissociate, MS might be a necessary precondition for conscious experience. Finally, these findings have implications for the science of consciousness: it has been suggested that “levels of consciousness” (LoC) is not a legitimate concept for the science of consciousness. But because we have the conceptual and methodological tools with which to refine investigations of MS, we have the means to identify a possible foundation—a bifurcation point—for consciousness, as well as the means by which to measure degrees of distance from that foundation. These neuroimaging investigations of MS position us to better assess whether LoC has a role to play in a mature science of consciousness.     

Physical,verbal, and relational forms of bullying among German students: age trends,gender differences,and correlates

A revised version of the Bully/Victim Questionnaire [Olweus, 1991] was given to 2,086 fifth–tenth grader students from schools in two German federal states. The results were analysed in terms of frequencies of self‐reports of different forms of bullying (physical, verbal, relational/indirect; for bullies and for victims), gender and grade differences. Overall, 12.1% of the students reported bullying others and 11.1% reported being bullied (victimisation). We classified 2.3% of the students as bully/victims due to their self‐report. Significantly more boys reported bullying others, regardless of bullying form, and significantly more boys than girls were classified as bully/victims. Although there was no gender difference for victimisation at all, boys reported significantly more often than girls being bullied physically. Besides, self‐reports of pure and overlapping forms of bullying behaviour (relational, verbal, physical) were analysed. With regard to age trends, students from middle grades reported the highest rates of bullying. Self‐reported rates of victimisation were higher for younger students, regardless of form of victimisation. Furthermore, class size was not linked to reports of bullying and victimisation. Results from logistic regression analyses emphasised that the variables “gender” and “grade” add significantly to the prediction of self‐reported bullying; “grade” and variables measuring impaired psychosocial “well‐being” of students at school (e.g., feeling of not being popular, negative attitude towards breaks) add significantly to the prediction of self‐reported victimisation. The results are discussed against the background of other study findings, accentuating the significance of gender‐ and age‐specific forms of bullying/victimisation. Aggr. Behav. 32:1–15, 2006. © 2006 Wiley‐Liss, Inc.     

Applications,Implications, Complications: Reply to Reviews by Elkind,Gerson, and Levine

The author appreciates the careful reading and thoughtful reviews by Sue Elkind, Sam Gerson, and Howard Levine. Elkind's review particularly captures and articulates many of the key ideas in the book Building Bridges: The Negotiation of Paradox in Psychoanalysis and creatively applies concepts of negotiation, paradox, an inherently multiple “distributed self,” and metaphor in her own work consulting on treatment impasses. Gerson incisively focuses on the core idea of recognizing, accepting, and bridging differences and contradictions in personal, and national, perspectives; he also articulates an understanding of the attempt of relational analytic writers to bridge the intrapsychic and the interpersonal with due recognition of each. The author replies extensively to Levine's comparison of Pizer's work with that of Semrad and other “classical” analysts and challenges Levine's premise that a relational perspective, grounded as it is in a two-person contextual psychology, ignores or devalues interpretation, insight, free association, and autonomous mental functioning. Quoting from clinical material in his book, Pizer presents the outcome of a “relational” analysis in terms of the patient's increased access to internal “potential space,” unconscious experience, curiosity, and reflectiveness about the mental life of self and other, and an increased ability to value personal experience in relationship and in solitude.     

Moments of Therapeutic Impasse: Commentary on Jody Messler Davies's “Whose Bad Objects Are We Anyway? Repetition and Our Elusive Love Affair with Evil”

Davies contributes to the development of relational theory by formulating and illustrating what occurs during especially difficult moments in an analytic exchange. In understanding enactments, Davies importantly underscores the contribution of both the analyst's and patient's “bad objects.” This author attempts to build bridges between Davies' language and concepts anchored in object relations theory and this author's language and concepts based in contemporary or relational self psychology, including the integration of cognitive psychology. In addition, this author delineates the use of the “empathic,” “othercentered,” and “analyst's self” listening/experiencing perspectives to explicate the case material and to provide alternative understandings and pathways for psychoanalytic work. The thesis set forth is that the use of different listening/experiencing perspectives expands choice for the analyst when working in difficult moments of the clinical exchange.     

Enthusiastic Improvement: Mary Astell and Damaris Masham on Sociability

Many commentators have contrasted the way that sociability is theorized in the writings of Mary Astell and Damaris Masham, emphasizing the extent to which Masham is more interested in embodied, worldly existence. I argue, by contrast, that Astell's own interest in imagining a constitutively relational individual emerges once we pay attention to her use of religious texts and tropes. To explore the relevance of Astell's Christianity, I emphasize both how Astell's Christianity shapes her view of the individual's relation to society and how Masham's contrasting views can be analyzed through the lens of her charge that Astell is an “enthusiast.” In late seventeenth‐century England, “enthusiasm” was a term of abuse that, commentators have recently argued, could function polemically to dismiss those deemed either excessively social or antisocial. By accusing Astell of enthusiasm, I claim, Masham seeks to marginalize the relational self that Astell imagines and to promote a more instrumental view of social ties. I suggest some aspects of Astell's thought that may have struck contemporaries as “enthusiastic” and contrast her vision of the self with Masham's more hedonistic subject. I conclude that, although each woman differently configures the relation between self and society, they share a desire to imagine autonomy within a relational framework.     

THE CHILD AS A TRAUMATIC SELF-COMPONENT IN FERENCZI’S LATER PSYCHOANALYSIS

In the Ferenczi renaissance of the last few decades it has become more and more important to elaborate and reconstruct the general shape, the “Weltanschauung”, of his psychoanalysis. The construct of his “psychoanalytic anthropology” is based on the relational nature of individual existence. Relationality pervades the life narrative through the concept and role of the trauma and is crucial to the understanding of Ferenczi’s self-concept. He understood the human individual as essentially fragmented in a “preprimal” way, in which the split self contains the child, as an active, always present infantile component. Through powerful allegories like the “Orpha” or the “wise baby,” Ferenczi suggested an essentially post-modern idea of self that can be connected and differentiated from Winnicott’s True and False Self.     

Reply to Reviews of Awakening the Dreamer: Clinical Journeys by Philip M. Bromberg

I reply here to reviews by three inspiring thinkers, Ethel Person, Susan Sands, and Allan Schore who, though uniquely different from one another in their conceptual frames of reference, share a sensibility as clinicians and creative scholars that has led them to engage and appreciate my work in depth while enriching it with their individual perspectives. Ethel Person's review is meaningful to me for many reasons, not the least of which is the fact that we think very much alike about “how we are” with patients despite the diversity in our families of origin. Her thinking, which extends the boundaries established by any one school of thought, transcends doctrine, especially that of “technique.” I am equally grateful to Susan Sands, whose review stimulated a dialogue between us about the similarities and differences in our views of the analyst's personal role in enactments with severe trauma survivors and whether there is reason to distinguish between life-threatening and developmental trauma. My reply to Allan Schore's review satisfies a long-standing wish to engage with him in dialogue about what he refers to in his review as “a remarkable overlap between Bromberg's work in clinical psychoanalysis and my work in developmental neuropsychoanalysis, a deep resonance between his treatment model and my regulation theory” (this issue, p. 755). In my reply I comment from my own vantage point on how our shared commitment to an interpersonal and intersubjective perspective—my interpersonal/relational treatment model and his “Interpersonal Neurobiology” led us to arrive at overlapping views on developmental trauma, attachment, the dyadic regulation of states of consciousness, and dissociation.     

The Psychoanalytic Other: Commentary on Paper by Helen K. Gediman

Dr. Gediman locates the intersection of modern Freudian and relational theory in the arena of what she calls the “disclosures of everyday analysis” (p. 242). She suggests that because Freudian analysts, like their relational colleagues, work intersubjectively, relational theory does not itself embody a paradigm shift away from the Freudian model. I disagree. Relational theories assume that the analyst's work is inevitably informed by the relational context in a way that precludes clinical certainty. Gediman, however, believes that the analyst is capable of separating her countertransference response from her subjectivity and thus can interpret from a position of clinical certainty. Each set of theoretical assumptions is associated with a somewhat different analytic stance and analytic ideal. Freudian analysts aim for a position of “methodological neutrality” that relies on considerable certainty in the countertransference while giving the analyst plenty of room within which to use her subjectivity. The relational ideal concerns the analyst's capacity to enter into an asymmetrical treatment relationship and to tolerate the uncertainty generated therein.     

Back to the “States” Victim and Abuser States in Borderline Personality Disorder

Chronic and complex posttraumatic stress involving terrorization and betrayal by a caretaker can result in a particular kind of psychic organization that is structured largely by underlying, alternating victim/masochistic and abuser/rageful states. When we move our view of experience “back” to its underpinning in states, we can see how the oscillation between these states is a continual reenactment of the traumatic violation of the relational boundary. While “borderline” persons are capable of conscious awareness of their dramatically differing behaviors, the meaning of the behavior is disavowed. These unlinked, but switching states are decontextualized. Inasmuch as context provides meaning, the acted-out parts remain encapsulated as unowned experience.

Diagnostic formulation in terms of these dissociated states supplies a needed cohesiveness for the criteria given in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM—IV) and adds specificity to the “borderline” defenses as spelled out by Kernberg. These shifting victim/masochistic and abuser/rageful self-states can be observed and talked about and are accessible to experience. Themes of behaviors that are typically enacted have to do with boundary violations, destructive entitlement, betrayal, and mirroring the earlier experience, particularly of traumatic betrayals of attachment, of these survivors.     

Affective Experiences and Honesty in the Interaction: Discussion of Holly Levenkron's Paper

Anchoring her views in the work of Benjamin and other American relational authors, Levenkron asserts that intersubjective relatedness in which there is recognition of separate realities is essentially the only form of relatedness. Framing growth as coming about through the recognition of another's subjectivity provides a basis for “confrontation” and for a more direct injection of the analyst's subjectivity into the analytic encounter. More specifically, it fosters the expression of the analyst's subjectivity from what this author calls the “other-centered” and “self” perspectives.

In contrast, the recognition of selfobject and caretaking relatedness positions the analyst to express directly aspects of the analyst's subjectivity pertaining to mirroring, idealizing, and twinship selfobject needs. Kohut and classical self psychologists have delineated selfobject needs and the selfobject dimension of relatedness and transference and have emphasized the consistent use of the empathic listening/experiencing perspective. American relational theorists have delineated intersubjective relatedness and the usefulness of the other-centered listening/experiencing perspective. This author focuses on an integrative theory including three forms of relatedness and different listening/experiencing perspectives. Different listening/experiencing perspectives and forms of relatedness fundamentally influence analysts' affective experiences within the analytic encounter as exemplified in Levenkron's case.     

At the verge of unthinkable anxiety: On the relevance of a neurophysiologically informed relational perspective on meaning-making in psychosis

Abstract

This article examines the relevance of relationally oriented psychoanalytic phenomenology as a frame of reference for understanding psychotic states in schizophrenia. The etiology and structural characteristics of such states are examined from both a neurophysiological, and a relational and interpersonal point of view. Many findings indicate organic abnormalities in schizophrenia, acquired through an exposure to physical risk factors and genetic predisposition, but relational traumas also seem to have an impact on the form and content of psychotic states. This may happen through interruptions in the “use-dependent” maturation of the brain in a relational milieu. In addition, at the level of meaning-making, we find that the emotional and relational contexts—both past and present—give the substance or “raw material” for hallucinations and delusions. In a psychotic state, the person also tries to handle basic affects and relational needs, and to make meaning in states of overwhelming chaos and anxiety. Donald W. Winnicott's theory of “a holding environment”, Stephen Mitchell's theory of the relational matrix, and Stolorow, Atwood, and Orange's concepts of a “shattered world” and annihilation anxiety are used as a framework in the analysis of the phenomenology of psychosis. Two case illustrations, one from child psychotherapy and one from therapy with an adult patient, are used to illuminate the theoretical points of view.     

Familientherapie

In the field of family therapy besides the emphasis on the autonomy of the different schools (behavioral, psychodynamic, systemic), partly motivated by professional politics, a growing openness for concepts developed in other approaches can be observed. Approaches and results of attachment and affect theory and research find their way into the conceptualization of family processes and family therapy. Processes in the “self” of the therapist are taken into the discussion of therapeutic processes in systemic therapies. Furthermore, new fields of application of family therapy approaches have developed: parents-infant therapy and counseling, therapy of the elder, family medicine and coping with the consequences of the “human genome project”. New research on the empirical validation of relational dynamic concepts and on the evaluation of family therapies show a trend to see the claim for making treatments as short as possible in very relative terms. It is assumed that the family therapeutic approach will become more important in the future.     

Who cares about organizational justice? How personality moderates the effects of perceived fairness on organizational attachment

The present article tests whether two theoretically relevant individual differences moderate the impact of perceived fairness on organizational attachment among young professionals in a large Dutch multinational firm. Drawing on the relational and control perspectives on organizational justice, we predict that any relationship between perceived fairness and organizational attachment will differ between individuals with varying beliefs in personal control and will be stronger for individuals with high interdependent self-construal (ISC). The findings revealed that almost all positive main effects of perceived fairness on organizational attachment were indeed moderated by either type of personality. As a result, we found support for both the relational as well as the control perspective, depending on the type of attachment considered. “Hard” reciprocation through extrarole behaviour seems to be inspired by the empowering impact of control through fairness. “Soft” reciprocation by affection and staying intentions (cognitions) on the other hand, results from the relational bond that is strengthened by fair treatment.     

Voices,Boxes, and Sources of Messages

Can adults be induced to use social rules distinguishing “self” and “other” to respond to the behaviors of technologies? In a 2×2×2 between-subjects laboratory experiment involving the use of multiple computers with voice output, 88 computer-literate college students used a computer for tutoring and a different computer for testing. The performance of the tutoring session was either praised or criticized (Manipulation 1) in the same voice as the tutoring session or a distinct voice (Manipulation 2) via the computer (box) that performed the tutoring or a distinct computer (box; Manipulation 3). Respondents were shown to use voices but not boxes to distinguish “self” from “other” behavior in applying the social rules “Performance evaluations from others are more accurate than are performance evaluations of self,”“Praise from others is friendlier than praise from self,” and “Criticism from self is friendlier than is criticism from others,” to evaluate the tutoring and evaluation session.