Falling off the couch

The patient's therapeutic regression intensifies certain unconscious meanings of the analytic couch. In addition to representing the analysis or the analyst in general, the couch can represent the unconscious, or it may take on the symbolic significance of the analyst's or mother's arms, lap, breasts, or womb. When the genetic roots of the patient's transference include substantial experiences of disappointment, narcissistic injury, and mistrust, the theme of falling from the couch may emerge as a dream, an association, or even an enactment. This theme usually implies the presence of a deepening but mistrustful transference, based on earlier disappointments by the patient's primary objects. Falling off the couch may be associated with being dropped as an infant, rolling out of bed as a child, birth, miscarriage, castration, death, termination, defending against passive wishes, punishment for sexual or aggressive transgressions, escaping an attack, descending into the unconscious, or wanting to be picked up and comforted.     

Perversion on the other side of the couch

Abstract

Taking as his starting point the fact that, according to Freudian theory, perversion is inherent to the human being, the author focuses upon an aspect of perversion that has been little discussed: perversion on the other side of the couch, and thereby questions of how, in psychoanalytic theoretical and clinical practice, perverted drive motions may be presented. Such a phenomenon takes various forms: actually being enacted with patients; using psychoanalytic theory as a normative rule; the individual choice of profession and so forth. To exemplify his point of view, the author presents four different expressions of sexuality in Freudian theory: genital sexuality, perverted sexuality, the sexuality of the Ideals and narcissistic sexuality. After differentiating these four sexual expressions, the author shows how each of them may generate perversion in both clinical and theoretical psychoanalysis.

Ceccarelli P Perversion auf der anderen Seite der Couch

Indem er als Ausgangspunkt die Tatsache nimmt, daß entsprechend der Freudianischen Theorie Perversion dem menschlichen Sein inhärent ist, fokussiert der Autor auf einen Aspekt der Perversion, der wenig diskutiert wurde: Perversion auf der anderen Seite der Couch und damit Fragen, wie in der psychoanalytischen und klinischen Praxis pervertierte Triebbewegungen dargestellt werden können. Ein solches Phänomen zeigt sich in verschiedenartigen Formen: tatsächlich mit Patienten in Szene gesetzt; im Gebrauch psychoanalytischer Theorie als einer normativen Regel; die individuelle Wahl des Berufs und so weiter. Um seinen Standpunkt zu exempifizieren, stellt der Autor vier verschiedene Ausdrücke von Sexualität in der Freudianischen Theorie dar: genitale Sexualität; perverse Sexiualität; die Sexualität der Ideale; und narzißtische Sexualität. Nach einer Differenzierung dieser vier Ausdrücke für Sexualität zeigt der Autor, wie jeder von ihnen Perversion in klinischer und theoretischer Psychoanalyse generieren kann.

Ceccarelli P. Perversión del otro lado del diván.

Tomando como punto de partida el hecho de que de acuerdo a la teoría Freudiana la perversión es inherente al ser humano, el autor se enfoca en un aspecto de la perversión que ha sido muy poco discutido: la perversión del otro lado del diván, se pregunta cómo en la práctica psicoanalítica clínica y teórica, algunos impulsos pervertidos pueden estar presentes. Un fenómeno así puede tomar diversas formas: pasos al acto con pacientes, usar la teoría psicoanalítica como regla normativa, la elección individual de profesión y así. Para ejemplificar su punto de vista, el autor presenta cuatro diferentes expresiones de la sexualidad en la teoría freudiana: la sexualidad genital, sexualidad pervertida, la sexualidad de los Ideales, y la sexualidad narcisista. Además de diferenciar estas cuatro expresiones sexuales, el autor demuestra como cada una de estas formas puede generar perversión en el psicoanálisis clínico y teórico.     

The patient's own pillow on the couch

Material is presented from two hypochondriacal patients who insisted on using their own pillows on top of the bolster-pillow on the analyst's couch. A number of important transference fantasies are seen as underlying this unusual resistance to the progress of the analysis. In addition, the analyst's countertransference feelings are described.     

The week the couch arrived

Changes in the therapeutic environment can elicit intense and unpredictable responses from patients, who then react to the new elements with their own unique thoughts, fantasies, emotions and behaviours. When the change is very specific, and when it entails implications for the treatment itself, these patient responses can coalesce around more profound experiences of the transference as well as of the countertransference. The author, as a candidate or analyst-in-training, purchased an analytic couch for his office and observed the unfolding of what this new couch meant for existing treatments. Using clinical examples, he describes the three most common patient responses that occurred: rejecting, ambivalent, and embracing. The richly variant ideas and fantasies related to the analytic couch are described, and the couch's history within Freudian and Jungian contexts is reviewed. Personal determinants that could lead to the decision of whether to use a couch as part of analysis are considered from the standpoint of the analyst's preferences and own experience with the couch. The couch is discussed as a signifier of the analytic process with cultural meanings alluding not only to familiar stereotypes, but also to psychological healing and self-development.     

The couch and the chador

The authors present a clinical discussion of the psychic functions of the chador, a veil‐like outer garment worn in public by some Iranian women. Drawing on Anzieu’s theoretical concept of the skin ego, the authors suggest that the chador does not just cover the body; it may also envelop the psyche and function as a second skin for the ego. The maternal function of a holding environment is symbolically displaced on any clothing that ‘hides,’‘covers,’‘veils,’ or ‘dresses’ the body. The skin’s containing functions are extended through sensory and metonymic mediations to clothes, thus providing an imaginary maternal sack for the person. The clinical vignettes presented here suggest that for some Iranian women the chador may work, on one hand, as a second skin ego and a shield against a perceived intrusive world. On the other hand, it may work as a punitive maternal superego, a ‘holding cell’ in a jail that paralyses the separation/individuation process. Operating in the service of the patient’s resistance and defense, the chador may also function as a psychic refuge and a place to hide on the couch.     

REM sleep and the analytic process: a psychophysiologic bridge.

Recent research on the physiology of REM sleep has supported the hypothesis that it serves processes of psychologic adaptation. This study examines the relationship between physiologic parameters of REM sleep and evidence in analytic material of the need for adaptation. Significant correlations were found between defensive strain before sleep and REM latency, and between change in defensive strain from evening to morning and total REM time.     

The couch as icon

The couch has always been an integral part of psychoanalytic practice. It has even become a cultural icon representing psychoanalysis itself. However, minimal evidence exists in the psychoanalytic literature that using the couch is necessary or even necessarily helpful to establish a psychoanalytic process and conduct an analysis. Furthermore, it can potentially be harmful to patients such as those who have experienced early loss and trauma or who have significant ego organizational problems. Therefore, the use of the couch per se does not seem well suited as a defining criterion of psychoanalysis. To the extent that it may be clinically valuable, the use of the couch should be more carefully considered and critically examined.     

Patient's Promise

No abstract available for this article.     

Movies on the couch: The MOVIE model of film therapy

Film therapy, the therapeutic use of movies in psychological therapies, is a growing area of interest to therapists and researchers. This paper discusses the benefits of film therapy and presents a method, the MOVIE model of film therapy, a widely applicable, trauma-informed framework for individual or group therapy, counsellor education and self-help. Film or cinema therapy is a highly accessible and relatable method for many diverse groups. The benefits identified include emotional processing, greater ease of dialogue, increased empathy, interpersonal learning, new perspectives and learning skills. Following the model's reflective steps, clients mindfully observe and voice their emotional and psychological responses to movie-watching; identify how the imagery, characters, themes and story symbolise personal experience; and consider any new possibilities that emerged for their own lives. The model is informed by a practice-focussed review of literature and draws on methods from mindfulness and experiential and narrative therapies. The steps are widely applicable in a range of settings and can be adapted across counselling modalities. Further research to consider the outcomes of using the model, alongside qualitative research on clients' experiences of working this way with film, is recommended.     

Research off the couch: Re-visiting the transsexual conundrum

This paper outlines the findings of a qualitative study involving interviews with eight transsexual individuals who had volunteered to take part in a television (TV) documentary about transsexuality. The participants were interviewed before taking part in the documentary and after its screening on national TV. The author proposes that for either biological and/or psychological reasons, some transsexual individuals experience early on a profound and disturbing incongruence at the level of the bodily self. In turn, this experience of incongruity is not contingently mirrored by primary attachment figures and remains unmentalized, thus disrupting self-coherence. In an attempt to restore self-coherence, the individual searches for the ‘right’ body that is anticipated to relieve the felt incongruity. The way this modified body relieves the incongruity is through the certainty it imparts that the image in the ‘mirror’ will match the subjective experience of the body. In this study, the experience of being mirrored through the group process during filming and the audience's response to the TV series, which was very positive, appeared to be associated with an attenuation in the urgency with which planned body modifications were being discussed post-TV screenings.     

病人角色的社会心理学思考

病人角色是一个角色丛,患者在诊断治疗过程中,可能扮演医疗自助者、医疗求助合作者、医疗拒助者、医疗失助者、医疗反助者或医疗受试者等不同角色.医疗卫生工作者对病人角色内涵的理解,直接影响着医学认知、医学教育改革、医患关系及以病人为中心的落实.