Die analytische Monade als Wiege der Realitätsprüfung

The relocation of my practice caused a lot of irritation and trouble, but triggered also psychic improvements in the analytic process with my patients, which is interpreted by referring to the theories of M. Balint and B. Grunberger. It is helpful to focus here on a narcissism concept which is not under instinctual control and to distinguish it from the transference rooted in drive theory. Especially useful proves to be the statement of both M. Balint and B. Grunberger that it is necessary to acknowledge and to affirm the wish of the analysand to establish and experience a pre-objectal “primary love” resp. an analytic monad. In case studies I try to show that the acceptance and affirmation of the projection of not drive-controlled narcissistic omnipotence feelings to the analyst are apt to secure and to preserve the narcissism of the analysand. Only this way can idealization and a stabilizing ego ideal initiate the integration of narcissistic exigencies and instinctual drives and organize the establishment of the reality principle.     

Previous reward decreases errors of commission on later ‘No‐Go’ trials in children 4 to 12 years of age: evidence for a context monitoring account

Inhibitory control is widely hypothesized to be the cornerstone of executive function in childhood and the central deficit in a number of developmental disorders, including attention‐deficit/hyperactivity disorder (ADHD). However, recent evidence from adults indicates that performance on response inhibition tasks may primarily reflect non‐inhibitory attentional control (context monitoring) processes. Yet it may be that inhibition plays a more central role in childhood – a time when the architecture of cognitive processes might be more transparent due to wide variability in skill level. Here we directly test inhibitory and context monitoring explanations of task performance on a Go/No‐Go task in a large group of children 4–12 years of age. We conclude that traditional inhibitory conceptualizations of task performance on the Go/No‐Go task cannot account for our findings, calling into question evidence supporting a central role for inhibitory control in cognitive development or developmental psychopathology.     

Holding in mind: Theory and practice of seeing children in groups

ABSTRACT The authors will describe their therapy group for children in a Child and Family Consultation Centre. They will discuss the rationale for this treatment. An account will be given of the group processes with special reference to different feelings as they emerge in the transference relationships. Issues concerning the dynamics of co-therapy will be addressed. The work on the ‘reflective function’ by Fonagy and Target, which the authors think is an important contribution to understanding the therapeutic process in the group, will be discussed.

What literature there is on group therapy for children suggests that it is an effective form of treatment. This article describes the way in which the children's issues come alive in group therapy and in this way can be addressed quickly, in comparison with individual therapy where the process is sometimes slower. It will be emphasized that structure and boundaries are essential for containment of children so that psychoanalytic reflectiveness can take place. This reflectiveness includes understanding of the group process as well as the inner world of the child.     

A response to Maggie Turp's paper from a body psychotherapy perspective

Whilst appreciating the quality of containment in Turp's work as a learning point for the Body Psychotherapy tradition, the author argues that Turp does not represent a psychotherapeutic way of ‘working with the body’. This would require a deconstruction of the body/mind dualism inherent in much psychotherapeutic (and psychodynamic) theory, so that the complexity of the spontaneous and reflective body/mind processes, especially in their polar extremes (body/mind dissociation – body/mind integration / ‘psyche/soma unity’), can be contained. An holistic body/mind formulation of countertransference is approached by which – rather than being used as a gratifying or cathartic therapeutic shortcut which avoids the intensity of the transference – the body can be seen to constitute an avenue into the full experience of the transference/countertransference process and its relational sources in early development.     

From the Balint method toward profession-related supervision

This paper focuses on Michael Balint's special application of psychoanalysis, originally conceived as a training of doctors. Then the attempt is made to discover indirectly, since Balint never described his method in context, what he thought mattered in terms of method. Besides Balint's own contributions, those of his own staff are also consulted as well as the cultural background of the Tavistock Clinic and the Tavistock Institute. Then the further developments of the Balint method in the German-speaking world are presented. At the center are the special features of the method: (a) the atmosphere, (b) the narrator's contribution, (c) listening and reactions of the members of the group, (d) the unconscious enactments in transference and countertransference and the mirror-phenomena, respectively. Furthermore, the respective central points of reference are discussed from the viewpoint of communication science: (a) case, (b) group, and (c) institution. In conclusion and based on these foundations, the characteristics of the application of the Balint method in the form of a particular profession-related supervision are presented.     

Treatment of Male Homosexuals in Groups

Abstract

The healing power of psychodynamically oriented therapy and training groups rests, to a large degree, upon the quality of the here and now interactions. For the work to be effective, the basic principles of analytic group work need to be followed, including the observance of no extra–group contact. Simply said, nothing leaves the room. This principle has both ethical and clinical implications. It is my premise that while some forms of outside contact between members are relatively benign, other types are not. Outside contact that is built into the fabric and context of the group may pose a risk, as may be the case where dual relationships exist between members. The impact of dual relationships between group members in the particular instance of analytic training institutes is the focus of this article. What happens to the transference in this context when members reveal too much of their personal lives to each other through dual relationships is explored. It is suggested that extra–group contact can disrupt the balance between reality and transference distortion in group interactions in at least three ways: (a) “The Emperor’s New Clothes” effect, (b) looping, and (c) gaslighting. Vignettes are presented to illustrate these phenomena and suggestions for reform are offered.     

Creating Harmony Out of Dissonance

Abstract

The thesis of this paper is that the intimate relation ship offers an opportunity for transforming self-experience and re suming individual development. By applying theories of intersubjec tivity, three levels of contextual relatedness are discussed. The first is; that of the infant and caregiver, in which the self is developed and characterological styles of relating become entrenched, and from which stem the unconscious organizing principles that become activated in significant adult relationships. The second is the context of intimate partners and suggests that mate selection is based in a mutual dovetailing of narcissistic transference. This explains how the romantic illusion is shattered when internal conflicts between main taining the selfobject tie and attempts to self-demarcate occur in the intersubjective context. The third is that of conjoint treatment, in which problems and solutions are viewed as two-person events. The therapist'S task is to facilitate the de-construction of archaically derived interpretations through mutual self-validating interactions.     

Finding unconscious phantasy in the session: Recognizing form

The concept of unconscious phantasy has played – and still does play – a central role in psychoanalytic thinking. The author discusses the various forms by which unconscious phantasies manifest themselves in the analytic session as they are lived out and enacted in the transference relationship. This paper also aims at expanding the kleinian theory of symbol formation by exploring the impact that emotional aspects connected to early “raw’, “pre‐symbolic’ phantasies have in the analysis and how their corporeal elements interlock with the signifying process. The author follows the expressive forms of primitive unconscious phantasies as they appear in a psychoanalytic session and proposes that the emotional effect that can be experienced in the communication between patient and analyst depends in great measure on “semiotic’ aspects linked to primitive phantasies that are felt and lived out in embodied ways. Rather than a move from unconscious phantasies that typify symbolic equations to those showing proper symbolization, these can coexist and simultaneously find their way to what is communicated to the analyst. As early phantasies bear an intimate connection to the body and to unprocessed emotions when they are projected into the analyst they can produce a powerful resonance, sometimes also experienced in a physical way and forming an integral part of the analyst's counter‐transference.     

The psychodynamics of forensic mental health nursing

Abstract

The aim of this paper is to clarify some important interpersonal dynamics that underpin forensic patients’ presentations within the clinical environment, in a way that is accessible to nurses. The world of forensic mental health nursing is often difficult to describe to those who have not experienced first hand prolonged clinical contact with patients at the therapeutic interface of secure services. Even then, the characteristic, intense emotional phenomena that tend to arise out of interpersonal relationships with patients and colleagues is not easy to articulate. Yet, for those of us who consider our professional identity to be one of “forensic mental health nurse,” it seems important to find a way to put words to what appears to occupy a large component of our working lives. More importantly, if we can develop a way to make sense of the way our work makes us feel and the way we can find ourselves relating to others within our professional roles, we will be in a better position to harness our energy and enthusiasm in the service of supporting forensic patients towards effective care and treatment pathways. Of course, forensic patients are supported through services with or without a framework for articulating emotional and interpersonal experiences. However, this frequently occurs in the context of significant struggle. For patients, this struggle is often characterized by difficulty communicating what their needs are, and for nurses this struggle is often characterized by feeling emotionally overwhelmed by their task of providing containing, therapeutic relationships for patients whose interpersonal needs are not clear to them. This article will use case examples to describe some of the complex interpersonal and emotional challenges faced by forensic nurses, and explain how a psychodynamic framework could support nursing practice in each of the case examples.     

The history of large group phenomena in relation to group analytic psychotherapy: The story of the median group

This paper presents a history of the large group approach in relation to Foulkesian group analytic psychotherapy, including the nature of this approach in relation to Foulkesian principles. Much of the theory reflects Foulkes's attitude, but there are also clear distinctions made, notably a new stance in our thinking about groups as a result of the increase in size (i.e., a membership of about 20), the introduction of the cultural dimension which this increase entails, and the question of what happens after the resolution of Kleinian, oedipal and familial conflicts has been achieved in psychoanalysis and small groups, no-tably what happens once “exile” has been achieved. The approach presented proposes to handle the frustration and hate that these conflicts engender in the form of negative or antilibidinal energies, and their transformation into psychic energy, through dialogue leading from hate to the establishment of koinonia, or impersonal fellowship, and of microcultural influences which promote rather than inhibit communication. Being neither small nor large, a group of about 20 members has become known as a “median” group.     

The good,the bad and the uncertainty: Trainees' perceptions of the personal development group

Background: Views about the purpose and role of personal development groups (PD group) in the counsellor training process are varied. Some argue they enhance self‐awareness, self‐exploration, the ability to be congruent and, ultimately, that they make for better practitioners. Others argue there is no clear evidence for such benefits and that they can actually be damaging to trainees. Aims: This study aimed to explore the beliefs of 25 trainees enrolled on counselling diploma or counselling psychology doctoral courses. It looked in particular at their perceptions of the purpose of PD groups and their expectations regarding support, difficulties and the scope of their participation. Method: Data was collected using open‐ended questions in an anonymous survey and was subjected to a thematic analysis. Results: Trainees appeared to hold mixed – and sometimes conflicting – views about the PD group. For some it was a positive endeavour that facilitated learning about self and clients, and helped in the processes of developing counselling skills and keeping the training group healthy. For others it was a feared space, which could elicit negative emotional experiences, and impact negatively on both learning outside of the PD group and the health of the group itself. Still others were unclear about its purpose. Hope/idealisation (of the process, the facilitator and course tutors) were also evident in the trainees' responses. Implications: Implications of these findings for counselling training are discussed.     

Trauma and the transference‐countertransference: working with the bad object and the wounded self

This paper focuses on the transference‐countertransference dynamics that manifest in work with those individuals who experienced severe early relational trauma and, in particular, childhood sexual abuse. The literature is surveyed from Davies and Frawley's (1992a) seminal paper through to more current trauma‐related and sensorimotor approaches, which deepen our understanding greatly. The rapidly shifting, powerful, conflicting and kaleidoscopic transference‐countertransference dynamics are explored in the light of these views and in relation to a lengthy clinical example. The author elucidates the dual‐aspect of the traumatic complex, whereby the abuser figure, which is disavowed by the patient, becomes manifest in prosecuting the analyst for the ‘wounds’ that the analysis evokes. The paper also explores the particular nature of the splitting processes, whereby pressure is put on the analyst to adopt an idealized role, in particular to act as a self‐object, in order to enable the patient to safely express and ‘be’ themselves in an attempt to make up for what was not possible in childhood; the analyst will necessarily fail in this task. In the context of powerful masochisto‐sadistic dynamics, the analyst's masochism is likely to be called up in the spirit of caring ‘humanity’ (another inevitable enactment), which can impede the progress of the analysis if not addressed. The extreme woundedness, intense affect and moral outrage associated with these dynamics are characteristic and compelling. Issues relating to disclosure, enactment and analytic attitude are also discussed.     

A secondary task is not always costly: Context‐based guidance of visual search survives interference from a demanding working memory task

Repeatedly encountering a visual search display with the target located at a fixed position relative to the distractors facilitates target detection, relative to novel displays – which is attributed to search guidance by (acquired) long‐term memory (LTM) of the distractor ‘context’ of the target. Previous research has shown that this ‘contextual cueing’ effect is severely impeded during learning when participants have to perform a demanding spatial working memory (WM) task concurrently with the search task, though it does become manifest when the WM task is removed. This has led to the proposal that search guidance by LT context memories critically depends on spatial WM to become ‘expressed’ in behaviour. On this background, this study, of two experiments, asked: (1) Would contextual cueing eventually emerge under dual‐task learning conditions if the practice on the task(s) is extended beyond the short training implemented in previous studies? and given sufficient practice, (2) Would performing the search under dual‐task conditions actually lead to an increased cueing effect compared to performing the visual search task alone? The answer is affirmative to both questions. In particular, Experiment 1 showed that a robust contextual cueing effect emerges within 360–720 dual‐task trials as compared to some 240 single‐task trials. Further, Experiment 2 showed that when dual‐ and single‐task conditions are performed in alternating trials blocks, the cueing effect for the very same set of repeated displays is significantly larger in dual‐task blocks than in single‐task blocks. This pattern of effects suggests that dual‐task practice eventually leads to direct, or ‘automatic’, guidance of visual search by learnt spatial LTM representations, bypassing WM processes. These processes are normally engaged in single‐task performance might actually interfere with direct LTM‐based search guidance.     

“Transferring” and transference

This paper is part of my research into psychotic transference and is also related to the psychotic aspect of any adult or infantile patient in analysis. In my research, I studied the origin of the concept of transference in Charcot's time before Freud, and the transformation of this concept in psychoanalysis. Freud thought that psychotic patients were not able to establish a transference relationship, but some of his early papers show the opposite. In fact, Freud himself and then several other analysts were able to develop a personal experience regarding the possibility of contact and transferring feelings and delusional experiences in a therapeutic context – individual, group, or institution. I provide some clinical examples in this paper, as well as some theoretical, personal views regarding intrapersonal and interpersonal transference. Like Freud and Melanie Klein, I believe that transference starts with life, but that in psychoanalysis it has a particular meaning.     

Group Psychotherapy in the Psychiatric Training of Medical Students

Group-as-a-whole theory is a relational paradigm of some complexity. Despite the growing popularity of this perspective, there is abiding confusion about the essence of group-as-a-whole practice and whether the approach attends sufficiently to members and part processes. The threefold aims of this article are to (a) show how group-centered thinking differs essentially from traditional psychodynamic theory that relies heavily on familial dynamics, interpretation, and transference analysis; (b) present the mind-set and working principles for a generic treatment that specifically utilizes collective forces generated in the context of the group matrix; and (c) compare and contrast the thrust of recent dyadic relational therapies with group therapy generally and the group-as-a-whole approach more particularly. The relationship between the whole (group) and its parts (members and what they bring) is detailed and demonstrated as it appears in the context of fused, affiliated, fragmented, and differentiated groups.     

Studies in social influence IV: Minority influence in a context of original judgments

This research was devoted to the studv of minoritv influence in a context of originality of judgments. It was stimulated by a consideration of the role pla-ved by the normative context in influence processes. In most research, this implicitlv underlies the phenomena studied. Thus, studies of social control have naturally appealed to the objectivity context. Innovation, in the social milieu in which it is involved, frequentlv implies an originality context. We hoped to study experimentally its effects on the process of social change. To this end, five experimental conditions were created, in which the originality norm was introduced in different ways – by experimental instructions, by influencing the perception of his own creativity by each individual and by using the time factor to encourage the fuller acceptance of this norm. In each condition, a consistent minority defended a deviant response in a colour perception task (the experimental paradigm used in our previous research using an objectivity context). The originality context affected the development of minority influence. Judgment based on perceptual evidence was abandoned to a significant degree, and new influence behaviours appeared. Individuals followed the minority or avoided the conflict by apparently original compromise responses. They were able to adopt several modes of response in the destructured way during the experiment, as they could oppose the minority by adopting a counter-norm. Although these reactions depended on the way in which the originality norm was introduced, theprimary role in this process was nevertheless played by the minority, which provided the pole of attraction and persuasion in the group.     

Mein Konzept der Supervision

The reflections on supervision presented in this paper were written against the background of a psychoanalytic training. The paper describes what – in the author's view – characterizes a patient in psychoanalytic psychotherapy, a psychoanalytic therapist, and a supervisor. In addition, the author reports on his personal experiences which he has made with supervision in the course of his activity as a psychoanalyst in the roles of supervised and supervisor. In this context, he presents some actual memories from supervisory experiences with M. Balint, H. Argelander and F. Morgenthaler.     

From identified patient to identifiable group: the alchemy of the group as a whole

Group-as-a-whole theory is a relational paradigm of some complexity. Despite the growing popularity of this perspective, there is abiding confusion about the essence of group-as-a-whole practice and whether the approach attends sufficiently to members and part processes. The threefold aims of this article are to (a) show how group-centered thinking differs essentially from traditional psychodynamic theory that relies heavily on familial dynamics, interpretation, and transference analysis; (b) present the mind-set and working principles for a generic treatment that specifically utilizes collective forces generated in the context of the group matrix; and (c) compare and contrast the thrust of recent dyadic relational therapies with group therapy generally and the group-as-a-whole approach more particularly. The relationship between the whole (group) and its parts (members and what they bring) is detailed and demonstrated as it appears in the context of fused, affiliated, fragmented, and differentiated groups.     

Die Handhabung der Übertragung

Zusammenfassung. Freud hat die Handhabung der übertragung als das schwierigste wie das wichtigste Stück der analytischen Technik bezeichnet. Mit Handhabung meinte er nicht den Umgang mit der übertragung im allgemeinen einschlie?lich der übertragungsdeutungen, sondern etwas Spezifischeres und Zupackendes, das sp?ter den Ruch des Nicht-Analytischen bekam. Der Autor zeigt den wichtigen Stellenwert des Terminus bei Freud und untersucht seine Entwicklung von der Ichpsychologie über Ferenczi und A. Balint bis hin zu Gill und Thom?. Er konstatiert eine erhebliche Bedeutungsverschiebung und -erweiterung. W?hrend Freud damit das energische Eingreifen des Analytikers an dramatischen Wendepunkten der Analyse gemeint hatte, schl?gt der Autor vor, die Handhabung der übertragung heute als eine ubiquit?re Dimension des analytischen Arbeitens zu betrachten. Sie bezieht sich auf den Handlungsaspekt des analytischen Tuns und nicht auf das Deuten im engeren Sinn. Damit wird der Beitrag des Analytikers zur Interaktion thematisiert. Wenn wir diesen Beitrag, d.h. alle Aspekte des Analytikerverhaltens, als Handhabung der übertragung qualifizieren, so erschlie?en wir sie als Elemente des intersubjektiven Geschehens und der übertragungsbeziehung und machen sie der Deutungsarbeit zug?nglich. Die Handhabung der übertragung ist der genuin Freud’sche Ausdruck für das, was Balint und Loch die psychoanalytische Beziehungskunst genannt haben – komplement?r zur Deutungskunst.

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The handling of transference

Summary. In Freuds opinion the handling of transference is the most difficult and important part of psychoanalytic technique. By handling he did not mean dealing with transference and transference-interpretations in general but something more specific and grasping, that has been regarded as non-analytic later on. The author shows, how important the term was to Freud, and explores its development from ego psychology, Ferenczi and A. Balint to Gill and Thom?. He finds a lot of changes and conceptual clarification. Whereas Freud used the term for the vigorous interventions of the analyst at dramatic turning points of analysis, the author suggests to consider the handling of transference as a ubiquitous dimension of analytic work. It refers to the aspect of action in analysis, not to interpretation, and therefore means the contribution of the analyst to interaction. In qualifying this contribution, that is all aspects of the analysts be- haviour as a handling of transference, we make them accessible as elements of the intersubjective process and the transference relationship, and with that we become able to analyse them. The handling of transference is the genuine Freudian term for what Balint and Loch called the art of relating (Beziehungskunst) – complementary to the art of interpretation (Deutungskunst).

     

Semiotic aspects of the countertransference: Some observations on the concepts of the ‘immediate object’ and the ‘interpretant’ in the work of Charles S. Peirce1

The fi eld of semiotics, established by Charles S. Peirce, is characterised by its recognition of non‐linguistic signs and embedment in a communicative interaction; for this reason, it is especially well suited for a semiotic investigation of intersubjective processes. In this paper, the authors show how these intersubjective processes can be understood in semiotic terms within the transference‐countertransference setting. Based on a case vignette, the relationship between the ‘real object’ (e.g. an unconscious fantasy) and the sign (e.g. a particular facial expression) is fi rst demonstrated. In this mediation between sign and referent, an important role is played by the ‘immediate object’, by which Peirce understood the mental concept of a sign. However, a further component of the Peircian sign is responsible for the emergence of the countertransference, namely, the ‘interpretant’. The core of Peircian semiotics, namely the concept of an (infi nite) process of signifi cation, sheds light in semiotic terms on the dialectical movement between transference‐signs and countertransference‐signs, the interpretation and encounter between two subjects. The paper concludes with a discussion of both the interdisciplinary applicability of Peircian semiotics, for example in the context of the neurosciences, and the differences between the Peircian epistemological position and psychoanalytical conceptions of the objective cognition of mental processes.