The therapeutic construction of possible selves: Imagination and its constraints

Abstract

In psychotherapy, clients often are helped to elaborate, and subsequently to appropriate, possible self-theories that are made available in therapeutic conversations and activities. In this study, the ability of 6 clients (all substance abusers) to express, elaborate-explore, and synthesize feelings and experiences during role-plays in which they imagined 2 future scenarios was investigated. Clients directly expressed feelings and experiences in the more familiar, negative possible self role-play to a greater extent than in the less familiar, positive possible self role-play. However, clients' participation in the positive self role-play may have helped them to synthesize newly realized or more fully recognized feelings and experiences. These results are discussed in the light of recent conceptualizations of psychotherapeulic change from both social constructionist and personal constructivist perspectives.     

The semantics of therapeutic change

Some contemporary theorists of family therapy have recently addressed the question of how to explore the 'meaning' dimension of therapeutic change, particularly in the context of the fragmentation of 'post-modern' culture. A particularly interesting strand of work has focused on the narrative or discursive components of the family therapeutic encounter. In this article an argument is made for the importance of a 'semantic' element in theories of family therapeutic change, and the general shape of such a semantic element is outlined.     

The therapeutic nature of confessions

Since Janet and Freud, confessions have been a vital part of the psychoanalytic armamentarium. While confessions were originally cast primarily in oedipal terms, this paper examines confessions in the light of recent developments in self psychology and object relations. The central thesis presented is that confessions contribute both to the development of self-identity and to the strengthening of object relations. Clinical and literary examples are used to illustrate how individuals who choose to confess are redeemed and transformed; those who opt for conscious concealment or unconscious self-deception are destroyed. Confessions made during therapy provide valuable information on historical antecedents as well as on the vicissitudes of the self.     

The therapeutic action of psychoanalysis

Psychoanalysis does not seek to get rid of symptoms but to question them as witnesses of psychic functioning and as formations of the unconscious. Whatever their nature may be, it is a question of analysing their causes and their functions as they appear and develop during the course of the analytic process. The latter is activated by the transference relationship induced by the method within a specific setting. The aim is to bring about liberating psychic transformations. The extension of the indications and modifications in the expression of psychic suffering have led to the development of psychotherapies. Their relations with psychoanalysis proper have been evolving constantly since the first advances by Ferenczi. This long historical evolution has resulted in their redefinition. Psychoanalytic practices are currently considered to require, depending on the case, different settings and different modes of psychic involvement from the analyst. Contemporary psychoanalysis places emphasis on the internal setting of the analyst (thus his training), analysis of the countertransference, and the risk of anti-analytic aberrations.     

The therapeutic object relationship

This paper introduces the concept of the therapeutic object relationship in order to clarify our understanding of the nature of fully analytic work with the more regressive patient, which has unsystematically developed over the last 30 or 40 years. The need for such a clarifying concept seems to arise from several sources. Our analytic work with the more regressed patient appears to entail a relationship demand factor which cannot be usefully treated only as resistance to the development of the transference. These are patients with what may be described as object hunger emanating from faulted ego development and a disordered internal object world. This object hunger cannot be adequately met within the framework of the tacit, ordinary, good-enough environment of the concerned and nonjudgmental analyst. In addition, the literature on this subject still dichotomizes the relationship factor of treatment from the transference. The concept of the therapeutic object relationship appears to offer the possibility of a clinical and theoretical unification between transference and relationship. The major point of the paper may be described in terms of the manner in which we have progressed from Eissler's parameter paper of 1953 to the widened scope of analytic work made possible by object relations theory, developmental theory and observation of infant and child development. The face of analysis seems to have undergone profound modification from the early classical model to one in which developmental maturation, in addition to making unconscious conflict conscious, has become a matter for our concern. This change seems to require seeing the analyst as a special form of real object with whom the patient passes through a revised version of certain developmental pathways. The therapeutic object relationship is viewed as a potentially unifying concept which may make possible higher degrees of generalization about the variously unsystematized approaches to analyzing the more regressive, but nonpsychotic patient. Some history of definition of the analytic relationship in terms of transference or relationship is presented. In the course of the paper the therapeutic object relationship is gradually defined as one of: primal intimacy; increased permeability of boundaries between self and other; intensive empathic interaction; the evolution of self and object definition in a context of intimate relation with an object that is instrumental in this process; and the activation of transcendant forms of symbolic-creative intercommunication.(ABSTRACT TRUNCATED AT 400 WORDS)     

The impact of the therapeutic environment

This paper emphasizes the impact of the setting, space, and general physical properties of the clinic upon the difficult patient's profound neediness and absence of inner regulatory structure. Moreover, the clinic's administrative style and requirements often related to fiscal restraints, demands for accountability for both how funds are spent and treatment outcome, all impinge upon the patient. Humanizing clinics so they have the capacity for psychotherapeutic holding and provision of safety for difficult patients are discussed in detail in this contribution.     

The therapeutic effects of rational masturbation

Editor's Note: Dr. Kujoth's article inaugurates theClinician's Corner of JRECBT. Clinician's Corner will present case studies, therapeutic techniques, self-help articles and other material which has direct relevance for clinical practice. In this article, Dr. Kujoth, a licensed clinical psychologist, presents a case of his that illustrates how the philosophy of REBT towards human sexuality has a long-term liberating and self-actualizing effect on an ‘at risk’ juvenile.