The illumination of history

Formulations regarding the patient's history have not only played an important part in understanding the patient, but interpretations explicitly linking the present with the past have been seen as central to the therapeutic process. In this paper the author considers the role of historical reconstruction in bringing about psychic change. He emphasizes the therapeutic value that lies in the exploration of the way the patient's history is embodied in his internal object relationships, becoming manifested in the transference-countertransference relationship. The author presents clinical material which he suggests allowed the analyst to follow the way the patient's internal object relations, coloured by her history, became expressed and played out in the sessions. He suggests that, when these processes can be followed and addressed in the present, this may lead to a diminution in the underlying anxieties. This can thus promote psychic change by freeing the patient's capacity to achieve a sense of connection with her history, and to tolerate the meaning of what emerges, which illuminates both the present and the past.     

Mindless Bodies–Bodyless Minds

Possibilities opened up by scientific–technical developments of the last century have led to the breaking up of our basic concepts regarding elementary aspects of human life. Boundaries are more easily crossed (also among genders); the reality of functions and the functions of reality are becoming interchangeable. The audio-visual galaxy, which has evolved over the course of the 20th century, with its two dimensionality has resulted in generations growing up in the past decades who have learnt that the “other” can be a virtual body: the sensual is no longer an essential part of human relations. The somato-affective aspects of the experience get split off—relationships emerge between bodyless minds. This fragmentation also means that the body is seen increasingly as mindless: the linkages between body and mind are profoundly undermined. Reality and fantasy melt into one another. Reality control and thinking becomes insecure effected by a view of the world that has lost its keystones of orientation. When body boundaries get confused in such a manner how do ego boundaries develop? How will primary relationships alter among such conditions? What will the internal images of the objects be like? The deconstruction of our basic concepts about space, time, dimensions, body- and ego boundaries made differentiation and the processes of symbolization extremely difficult. Postmodern ideas, questioning the validity of facts have contributed greatly to transforming our image of reality also on a theoretical level. How do these massive changes effect our daily clinical work and our theory of the mind? My paper tries to explore some experiences and ideas related to these questions through clinical cases and narratives of our present times.     

MODELING RELATIONS

In the ordinary way of representing relations, the order of the relata plays a structural role, but in the states themselves such an order often does not seem to be intrinsically present. An alternative way to represent relations makes use of positions for the arguments. This is no problem for the love relation, but for relations like the adjacency relation and cyclic relations, different assignments of objects to the positions can give exactly the same states. This is a puzzling situation. The question is what is the internal structure of relations? Is the use of positions still justified, and if so, what is their ontological status? In this paper mathematical models for relations are developed that provide more insight into the structure of relations “out there” in the real world.     

Living Politically: An Irigarayan Notion of Agency as a Way of Life

This paper formulates Luce Irigaray's notion of agency as a political way of life. I argue that agency, within an Irigarayan framework, is both the outcome and the condition of a political life, aimed at creating political transformations. As Irigaray hardly addresses the topic of agency per se, I suggest understanding Irigaray's textual style as implying specific “technologies of self” in the Foucauldian sense, that is, as self‐applied social practices that reshape social reality, one's relations to oneself, and enhance one's freedom and pleasures in these relations. This interpretation aims to extract concrete transformative practices, which, by shaping one's sense of self in relation to others, create oneself as a free and active subject.     

Living on Shifting Sands: Grounding and Borderline Personality Organization

Grounding is a concept in Bioenergetic Analysis which refers to a person's relationship to reality. This relationship is thought to encompass all aspects of reality, external physical reality as well as internal psychological reality. Using this conceptual framework, an effort is made to link the somatic structures and processes to the psychic structures and processes which go into the perception and understanding of reality. In this paper that framework is applied to the concept of grounding in people with borderline personality organization. Experiential, clinical and theoretical data are blended to elucidate both the experience of reality and the structural underpinnings of that experience in people organized in this way. Clinical interventions drawn from this theoretical standpoint are described, particularly as they relate to development of the ability to apprehend reality more fully.     

Inside and outside the window: some fundamental elements in the theory of psychoanalytic technique

The underlying concern of this paper is that psychoanalysis as practised today is in danger of losing its specificity and so losing its way. The author suggests this is possible for three reasons: the problem analysts face in responding to the strong emotional demands the great majority of patients necessarily place on them, the unintended consequences of the apparent success of 'here and now technique' and the absence of good clinical theory. The paper mainly discusses the author's ideas about some core elements of the clinical theory that all psychoanalysts must use when they are working and proposes (at the risk of being facile) some relatively simple heuristics related to them which are meant to be helpful. Recalling Kurt Lewin's maxim that 'there is nothing so practical as a good theory', he will suggest that continuous reflection on how one is using theory in daily practice is highly practical, if the theory is good enough. Theory in fact is a necessary 'third' in psychoanalytic practice which, if kept in sufficient working order close enough to clinical experience, provides an ongoing and very necessary check on our sense of reality. But, of course, as a third it can, like reality itself, be the focus of both love and hate with equally problematic consequences. The paper starts with a clinical example of a difficult but apparently successful analysis reaching its end, which will be used throughout the paper to illustrate and elaborate the theoretical ideas set out.     

The dynamic self in psychoanalytic psychology a formulation

Following Hartmann's theoretical formulations, the self has been explored primarily as a body of self‐representations coordinate to object representations; the dynamic organizations of the mind (the id‐egosuperego systems) have been seen as impersonal (nonself) functions.

This paper attempts a conception of the id‐ego‐superego structures as self‐functions in intimate relation to self‐representations. Building on an integration of Piagetian and psychoanalytic object relations frameworks (event theory), it proposes that the earliest self‐experience occurs in dynamic schemes of personally motivated interaction between self and nonself. These I‐schemes lay the groundwork for both the dynamic and the representational aspects of the self: Their structure results in experience characteristic of the dynamic id and in their character as undifferentiated interactions provides the base for the development of self‐ and object representations. Development occurs by integration and differentiation in processes of conflict resolution. The paper traces these developments in outline as they lead to the transition in the dynamic self from id to ego organizations, and in the self‐representations from part‐selves and part‐objects to a whole and individuated self in relation to whole objects.     

The not-so-silent couple in the individual

This paper aims to examine two often separate areas of analytical enquiry, the nature of the self, with its foundation in the concept of a primary self which may achieve a sense of coherence over time, and the nature of internal objects, a concept that forms the basis of theories concerning part selves and sub-personalities. It is argued that these concepts might be integrated to provide a unified model of the self, thereby integrating theoretically disparate aspects of mental structure and functioning. Through an examination of clinical material, the archetype of the coniunctio is evoked to offer an understanding of how, in the absence of a stable conjunction of (maternal) reverie and (paternal) thinking functions, a series of linked but oppositional internal couples may be created which lends to the self the experience of a combined and sustaining inner couple. The internal couple creates a source of psychological survival for the self, with the function of providing a reliable structure in which the processes of the self may unfold, but equally requiring strict adherence to a pernicious system of internal defences that allows for very little interaction with others outside the self. At the same time, these defences inevitably become blocks to further development, and the work of transformation is thwarted. For transformation to occur, it is necessary for the self to find another, often the analyst, who may be allowed to partake in the internal conjunction, thereby promoting a better grounding for the self.     

The testing of reality from the standpoint of the body self

Traditionally, the body self has been regarded as involved in reality testing principally in the determination of the distinction between the source of a stimulus being internal or external. The body has been closely related to instinctual drives, to urgency, and thus to conflicts that are crucial to normal and pathological development. However, the concept of the body self comprising all the psychic experiencing of body sensation, body functioning, and body image is broader than the body's connection to inner-outer reality testing and id pressures. The findings from childhood observations and from clinical research indicate that at each stage of the child's life, from earliest infancy on, the maturation and development of the body self becomes integrated with the whole group of psychic regulatory activities that contribute to the individual's sense of reality. The development of the body self at each period involves criteria by which some aspect of reality is tested. The subject of this paper has been the developmental pattern of experiences that contribute to the individual's sense of his body in particular and to the sense of reality of the self in general.     

The self, the psyche and the world: a phenomenological interpretation

Abstract :  This paper takes as its starting point Jung's definition of the self as the totality of the psyche. However, because the term psyche remains conceptually unclear the concept of the self as totality, origin and goal, even centre, remains vague. With reference to Heidegger's analysis of human being as  Dasein , as well as Jung's writings, it is argued that Jung's concept of psyche is not a synonym for mind but is the world in which we live psychologically. An understanding of the psyche as existentially situated requires us to rethink some features of the self. For instance, the self as origin is thus not a pre-existential integrate of pure potentiality but the original gathering of existence in which, and out of which, personal identity is constituted. The ego emerges out of the self as the development and ownership of aspects of an existence that is already situated and gathered. Relations between the ego and the self are about what is known, or admitted, and its relation with what is already being lived within the gathering that is existence. The self as psyche, origin, and centre are discussed, as well as the meaning of interiority. Epistemological assumptions of object relations theory are critically discussed. The paper also includes critical discussions of recent papers on the self.     

Making Music Together: Discussion of Gianni Nebbiosi’s “The Smell of Paper”

Finding life in our patients is a common goal for analysts. Historically this project had been defined as one of freeing unacceptable impulses from their imprisoning defenses with the analyst, via interpretation, then contrasting the patient’s internal fantasied reality with “actual” reality. Untangling fantasy from reality could free the impulses to provide energy for more realistic projects. This imagery stands in stark contrast to the fluidity of a contemporary relational conceptualization of human experience where our inner experience is now understood to be the lens through which we construct our vision of external reality, always a subjective perception. Clinical change—finding life—now depends more on the activation of a generative intersubjective process between patient and analyst, which contributes to the expansion of the patient’s subjective experience. Gianni Nebbiosi’s use of music and of mime to help him feel his way into his patient’s and ultimately into his own similarly defended experience demonstrates the creativity and idiosyncratic clinical approaches that emerge from a contemporary relational orientation. This orientation recognizes the analyst’s subjectivity as a fundamental tool of clinical change—a vehicle through which any theoretical approach will necessarily be shaped. Differing approaches to a clinical situation do not always simply reflect theoretical disagreements; they may also reflect the expression of the particular subjectivity of the analyst.     

The layers of presence: a bio-cultural approach to understanding presence in natural and mediated environments.

This paper proposes a bio-cultural theory of presence based on four different positions related to the role and structure of presence, as follows. First, presence is a defining feature of self and it is related to the evolution of a key feature of any central nervous system: the embedding of sensory-referred properties into an internal functional space. Without the emergence of the sense of presence it is impossible for the nervous system to experience distal attribution: the referencing of our perception to an external space beyond the limits of the sensory organs themselves. Second, even if the experience of the sense of presence is a unitary feeling, conceptually it can be divided in three different layers, phylogenetically different and strictly related to the three levels of self identified by Damasio. In particular we can make conceptual distinctions between proto presence (self vs. non self), core presence (self vs. present external world), and extended presence (self relative to present external world). Third, given that each layer of presence solves a particular facet of the internal/external world separation, it is characterized by specific properties. Finally, in humans the sense of presence is a direct function of these three layers: the more they are integrated, the more we are present. In the experience of optimal presence, biologically and culturally determined cognitive processes are working in harmony--to focus all levels of the self on a significant situation in the external world, whether this is real or virtual.     

Applying Psychoanalysis to Couple Therapy: The Treatment of a Couple with Sexualized Persecutory Internal Objects Resulting from Trauma

The application of psychoanalytic theory and technique to the treatment of couples has been relatively overlooked despite the long history of concern by psychoanalysts with the role of marriage in individual development and suffering. This paper uses an example of marital and sex therapy to illustrate the application of psychoanalytic object relations theory to couple therapy, and describes the way that in-depth treatment of the couple's persecutory object relations that follow severe trauma can be effectively conducted. The paper concludes with a brief discussion of issues of shame and guilt in psychoanalytic theory and their relevance to this couple.     

费尔贝恩人格客体关系理论的心理治疗观

英国精神分析学家费尔贝恩在修正与发展弗洛伊德和克莱因思想的基础之上,提出了一种纯粹的人格客体关系理论,他发展了一套修正的心理病理学思想。他认为,精神分裂是所有心理病理现象的基础;心理治疗的目标是要让病人从无意识中释放坏的客体和减少自我的分裂、达到人格的整合,而分析师与病人的关系则是心理治疗的中心。     

On Attachment to Internal Objects

This paper considers some clinical implications of attachment theory from the perspective of the theory of internal object relationships and the unconscious phantasies that derive from such relationships. The paper focuses on the contributions of Bowlby and his followers, particularly Mary Main, who has developed a language-based methodology to study representational processes in adults and children, bridging the gap between the systematic study of human behavior and clinical psychoanalysis. The theory of inherent role responsiveness in the internal object world—mental representations of self and other in interaction and externalized in complementary role relationships through exchanges of unconscious and conscious messages—is presented as the psychoanalytic complement of Bowlby's theory of internal working models of attachment. Role responsiveness occurs internally as well as externally, so that one can speak of attachment to phantasy objects as well as external objects. Clinical examples illustrate how the therapist, through maintaining a free-floating responsiveness to the patient's enactments, may reconstruct the internal working models of attachment and their origins in the transference. The paperthus illustrates the way in which the origins of phantasy derive from the wished for and feared states related to early experiences of felt security, or lack of it, in relation to the attachment objects, thereby integrating the psychoanalytic theory of phantasy with attachment theory.     

The Case Study of Jacob: Childhood Sexual Abuse and the Limitations of the Holding Environment

Childhood sexual abuse and trauma influence relational development in significant ways. Notable among them are the development of a patient's internal object world, fantasies, and sense of self. Dynamic formulations and holding techniques are used to identify, process, and alter fractured relational dynamics. However, the use of such techniques may also influence a patient's narrative process, pulling them away from the realities of their life as lived. Using the case study method, focusing specifically on the patient's narrative development, this article examines the impact of analytic framing on a patient's experience of child sexual abuse and trauma.     

I,Me, You & Us: can a psychodynamic model provide a relational perspective on psychosis?

The concept of psychosis existed long before the current diagnostic definitions we have today. However, current opinion and treatment of psychosis is often dominated by a narrow psychiatric discourse. As a result of this conceptualisation, a diagnosis of psychosis can often feel limiting and disempowering for the individual, especially if he or she holds an alternative perspective. A psychodynamic model may therefore provide a method to examine psychosis from a relational perspective; this may, in turn, broaden one’s understanding and experience of a psychotic episode. In this article, two case examples from different cultural perspectives are used to highlight and explore the potential benefit of psychodynamic theory in the formulation and treatment of psychosis. A psychodynamic model using object relations theory is used for the exploration of both internal and external relational experiences. Both psychodynamic and psychiatric rationales are thus challenged to reflect on the impact of rigid perspectives and how they may limit treatment efficacy. Current research and literature around the use of psychodynamic theory in the treatment of psychosis is reviewed in light of this perspective.     

The use of the analyst as an autistic shape

In this paper I describe through detailed clinical material the challenges posed by patients who employ entangled autistic defenses. I discuss the complicated nature of treating a patient who employed entangled autistic defenses and utilized my voice in an effort to preserve an undifferentiated state of dual unity. My patient's pursuit of dual unity took a very concrete form in her attempt to mitigate the terror of separateness. This concreteness was expressed via the patient's urgent request that I read letters she wrote to me between sessions. This type of autistic defense placed great strain on my ability to think analytically and I also became increasingly concrete in my response to the patient. Crucial to the analyst's regaining a space in which to think and a sense of separateness is the ability to contact the ground floor of her separate bodily experience. This is just the beginning step in the analyst separating herself from the powerful press to join the patient in a state of dual unity. Interpretation in action (Ogden, 1994) was an effective way to convey the importance of creating and tolerating internal space in myself and begin to create internal space in the patient. Previously such space had been closed down in order to manage primitive fears of annihilation. When a patient is absorbed in an entangling autistic retreat words do not reach the patient on a symbolic level but rather are experienced primarily as an assault on the need for dual unity with the analyst. The patient's need to be wrapped in a sensation based world of dual unity is preferable to a world of spoken words that carry the danger of delineating psychic separateness. In essence there is no self to speak words, only a whirl of an amorphous sensation self lacking definition. I believe with certain kinds of patients it may be necessary to first lose and then work to regain one's analytic mind, as I have powerfully described in the case of Linda. Linda's profound loss of connection to the ground floor of her experience could only begin to be addressed when I worked to extricate myself from ‘our magic carpet ride’ of dual unity, contacting the reality of my bodily experience, and begin to tolerate the terror I felt regarding my separateness from Linda. I also describe the confusing vacillation between entangled and encapsulated defenses in patients like Linda as previously identified by Cohen and Jay (1996). Ultimately, this kind of slow difficult analytic work began to help Linda develop a capacity to think and provided an alternative to the deadened world of her autistic protections.