The Psychotherapeutic Encounter: Sexual Acting Out As the Focus of Intervention

Clinical observation indicates that sexual acting out takes place during periods in which the integrity of the self is threatened by some disappointment, some frustration, or what is perceived as an unavoidable but unfair demand. Rather than confront the problem within the object relationship, the conflict is acted out. The sexual encounter reduces anxiety and facilitates the containment of depressive and aggressive feelings. Self-integration is attempted even at the risk of losing something, be it a wife, a husband, a girlfriend or the presidency. At the time it seems the only possible way to cope with painful or threatening stimuli.     

Playing with Dreams: The Introduction of a Third Party into the Transference Dynamic of the Couple

Dreams in couple therapy are expressions of the multiple discontinuous selves of partners and of interpersonal defenses. Two dreams offered during analytic couple therapy illustrate the use of transference and countertransference to observe disturbances in self-cohesion, communication of self-states, and attempts to affectively influence the partner. Dreams transferentially communicate the state of the realtionship, activate a third formation expressing shared pathology, and facilitate the growth of new aspects of the self seeking a more loving bond.     

Tattoo and taboo: on the meaning of tattoos in the analytic process

Tattooing projects a visual image in transference to form a backdrop for the most salient unconscious inner conflicts arising during an ongoing analytic process. Like a snapshot, the tattoo is a dialectic record of the mother-father relationship, of desires for closeness and distance, commonality and difference, identification and individuation. As Walter Benjamin famously stated about the nature of visual images in his Arcades Project, the tattoo represents "dialectics at a standstill." What seems paramount to the patient who participates in the act of tattooing is the need for stasis and immutability, as if bringing unconscious conflicts to "standstill" were to deliver a sense of stability. Unconsciously, the need is triggered by a threat to the inner stability resulting from fear of violating a taboo escalating to the point that fears of abandonment and fusion become unbearable. On the one hand, the tattoo is a visual symbolization of a taboo transgression; on the other hand, it activates the same through an act of self-injury that resembles the magical ritual acts of indigenous peoples' use of tattoos. The taboo thus serves as an ersatz for the actual violation of the taboo in real life, so that the tattoo may be ascribed a magical significance or totemic function. And yet the tattoo's success as a vehicle for constructing a transitional object is always contingent on the tangible manipulation of the skin conjoined with the creation of a symbolizing visual image. The image then acts like a "patch" to repair holes blown into Winnicott's "potential space" and to reconstruct it.     

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.     

The scenic function of the ego and its role in symptom and character formation1

The author argues that the scenic function of the ego permits the situationally appropriate representation of an unconscious, infantile configuration – that is, of a relatively stable, personality‐based drive scene having the same status as latent dream thoughts. The products of conflict elaboration (symptoms, etc.) are manifested in different ways in accordance with the conditions of the relevant situation. The contents of the drive scene are created by the psychical apparatus on the basis of infantile perceptions and are revealed in screen memories. The capacity for situationally appropriate representation is apparently bound up with the mobile drive, including its narcissistic transformations. Desexualization (in the sense of neutralization) renders scenic elaboration impossible. The drive derivatives withdrawn from the scenic configuration contribute to ego organization and the formation of character traits, which no longer vary according to the situation, but can only be modified by a change in personality structure itself. It is as yet unclear whether a process of resexualization can make them amenable once more to analytic work. The form of narcissistic libido that can assume a scenic configuration is closely related to primary narcissism. Its manifestations, which may likewise emerge in situation‐dependent symptom formations, appear accessible to analysis.     

The act of interpretation1

The author understands the interpreting act as an attempt to perceive what happens in the transference/countertransference fi eld and not just what happens in the patient's mind. Interpretation transcends mere intellectual communication. It is also an experience in which analysts’ emotions work as an important instrument in understanding their patients. Interpretation is seen to possess manifest as well as latent content; the latter would contain the analysts’ feelings, emotions and personality. The unconscious content of an interpretation does not inconvenience or preclude the development of the analytic process, but, on the contrary, it allows new associative material to emerge, and it transforms the analytic session into a human relationship. Analysts’ awareness of this content derived from patients’ apperceptions is a signifi cant instrument for understanding what is happening in the analytic relationship, and what transpires in these sessions provides fundamental elements for analysts’ self‐analysis. Some clinical examples demonstrate these occurrences in analytic sessions, and how they can be apprehended and used for a better understanding of the patient. The author also mentions the occurrence of diffi culties during the analytic process. These diffi culties are often the result of lapses in an analyst's perception related to unconscious elements of the relationship.     

The Effectiveness of Couple Therapy

Abstract

Most theories and methods about couple dierapy are developed and tested in Anglo-Saxon countries. In this clinical study, we tested these theories and methods within a Swedish public health context. We assessed the outcomes of 131 couples (262 individuals) using the Dyadic Adjustment Scale (DAS) and the Family Climate (FC) survey. Initially, the couples displayed severe marital distress and a dysfunctional family climate. Both marital satisfaction and family climate improved considerably, which confirmed the effectiveness of these methods in a Swedish context.     

Psychosomatic Health: The Body and the Word

Abstract

Why do men get firsts and women gets seconds? This question is currently being debated by some in Oxford University, but not elsewhere, where men's educational under-achievement - in secondary-school league tables, for instance (see, e.g., Phillips 1993) - is more often a matter of concern. Stephen Frosh (1998) has considered both issues in terms of the way young men are constructed and construct themselves through performing and acting on prevailing stereotypes about men and masculinity. These stereotypes include recklessness, not caution, which Maryanne Martin (1998) says contributes to men getting firsts at Oxford by virtue of this trait being rewarded by Oxford University's tutorial and examination system.

In the following pages I too will talk about the equation of men with recklessness. Or, more accurately, I will talk about the way in which men and women act on nightmares and dreams that often glorify men, not least as reckless heroes, in large part because, despite the gains of feminism, glory is still more often men's than women's prerogative in male-dominated society, of which Oxford University is a prime example. I too will consider how this might contribute to men more often getting firsts, and to women more often getting seconds in finals in Oxford. I will end with some implications of my findings for therapy - at least, for the kind of therapy I do as a Freudian therapist. I will therefore begin with Freud.     

The analyst's excitement in the analysis of perversion

The author believes that unconscious sexual excitement in the transference and countertransference is an especially problematic aspect of the analysis of perverse character pathology and that perverse sexual gratifi cation deserves a more prominent position in the clinical theory of analyzing perversion than that which has been assigned tacitly through analysts' routine focus on the defensive and destructive dynamics of perversion. He presents clinical material from the analysis of a perverse patient that illustrates the role of excitement in the transference perversion established in this analysis; and he asserts that gratifying perverse enactments occurring in the transference perversion can appear not only as conscious or unconscious excitement in the transference but also, at times most clearly, as the analyst's excitement. The author suggests that using a clinical theory that supports the analyst in understanding his excited responses as perverse countertransferences-i.e. evoked excitement complementary to the sexual component of a perverse transference-will assist him in locating and thinking about gratifying, perverse excitement in the transference where it is most usefully analyzed. Finally, he discusses some of the reasons why analysts might deny, suppress or otherwise avoid perverse countertransferences and in so doing contribute to sustaining perverse resistances.     

The Dutch Identity: A new tool for the study of item response models

The Dutch Identity is a useful way to reexpress the basic equations of item response models that relate the manifest probabilities to the item response functions (IRFs) and the latent trait distribution. The identity may be exploited in several ways. For example: (a) to suggest how item response models behave for large numbers of items—they are approximate submodels of second-order loglinear models for 2 ^J tables; (b) to suggest new ways to assess the dimensionality of the latent trait—principle components analysis of matrices composed of second-order interactions from loglinear models; (c) to give insight into the structure of latent class models; and (d) to illuminate the problem of identifying the IRFs and the latent trait distribution from sample data.This research was supported in part by contract number N00014-87-K-0730 from the Cognitive Science Program of the Office of Naval Research. I realized the usefulness of the identity in Theorem 1 while lecturing in the Netherlands during October, 1986. Because this was in no small part due to the stimulating psychometric atmosphere there, I call the result the Dutch Identity.     

The Reverse Double Standard in Perceptions of Student-Teacher Sexual Relationships: The Role of Gender,Initiation, and Power

ABSTRACT

The present study tested the prediction that male teachers are judged more harshly than female teachers for engaging in heterosexual intercourse with a student. One-hundred and eighty-seven adults (116 women, 71 men) evaluated a hypothetical newspaper article describing an alleged student-teacher relationship as part of a 2 (Gender Dyad: Male Teacher/Female Student or Female Teacher/Male Student) × 2 (Initiator: Student or Teacher) between-subjects design. As expected, a reverse sexual double standard was revealed, in which participants judged situations involving male teachers more harshly than they judged situations involving female teachers, but only when the sexual contact was teacher-initiated. Participants also believed that male students received more social benefits from the sexual contact than did female students.     

The Influence of Television on Adolescent Girls' Sexual Attitudes and Behaviour in a South African Setting

This study explored how television influences the sexual attitudes and behaviour of adolescent girls in a South African urban setting. A total of 4 adolescent girls participated (average age = 16 years old, range = 15–17 years old). Data was collected using in-depth interviews. Thematic content analysis (Neuman, 2006) was used for the data summarization. The results of the study suggest that television viewing influences the adolescent girls' sexual attitudes and behaviour towards permissiveness. Participants also indicated being influenced by parents and peers in their sexual attitudes.     

The Use of Metaphors with African-American Couples

SUMMARY

There is a dearth of data in the literature on African-American couples. This omission probably reflects the assumption that interventions that are effective with one race are effective with others. This paper explores the use of metaphor as a tool for working with an underserved and neglected population. Since the African-American culture is extensive in its use of metaphor, this medium provides a fertile channel for therapeutic communication.     

The Effectiveness of Therapy with Couples Reporting a History of Childhood Sexual Abuse: An Exploratory Study

The purpose of this pilot study was to explore the impact of childhood sexual abuse (CSA) on couples therapy. Participants were couples seeking therapy who were screened for CSA prior to therapy. Groups were compared using self-report and therapist-rated measures of individual and relational distress. Results indicate that although therapists report significant differences between CSA couples and couples not reporting abuse at the onset of therapy, those differences do not translate into significant differences in the perceived effectiveness of therapy as measured by change scores on therapist rated levels of distress, questions regarding the effectiveness of therapy, dropout, and length of treatment.     

The Satir Model with Female Adult Survivors of Childhood Sexual Abuse

Child sexual abuse is a recognized problem in the United States and Canada. There are several approaches to therapy with adult survivors of childhood sexual abuse. This article discusses Virginia Satir's model of therapy as it applies to sexual abuse. The emphasis of the Satir model is on transforming the impact of the abuse, no matter how the client chooses to process her relationship with the abuse, and is illustrated through a case study.     

Postponing trauma: The dangers of telling

Surviving a major historical trauma has consequences that are difficult to live with. Survivors who remain silent are often condemned to a desiccated existence, a dried‐out life, a death in life. Survivors who speak out run an even greater risk. Telling their ghastly tale may trigger somatic consequences, psychotic episodes, or even suicide. As to the psychoanalytic cure, the free association it requires carries its own danger: negative therapeutic reaction in sometimes extreme forms. Avoidance of horror may turn into avoidance of life itself. Awful as it may seem, this avoidance of life may represent a victory over a menacing chaos. Should we as analysts accept the risk of endangering such a victory, no matter how unsatisfactory? The psychoanalytical injunction to speak out may trigger an upsurge of shame and terror. Is subjectivation always possible? This paper is about what happens when denial and splitting strategies are suspended, when ‘crypts’ are opened. Is there an analytic ‘poros’ allowing for a controlled return of affects? Is there a therapeutic solution to the problem of telling a wreckage without being caught in it? The dangers of ‘telling’ will be discussed in regard to new analytic strategies and new interpretive registers. When the ‘silent psychic sharing’ proves insufficient, some analysts go so far as to take part in the shame, share the grief, ‘lend their own psyche’, become a ‘double’ of the analysand, accept the existence of ‘sanctuaries’. To what effect?     

False Memories,Negative Affects,and Psychic Reality: The Role of Extra‐Clinical Data in Psychoanalysis1

Psychoanalysis as a treatment originated in the idea that neurosis is related to the ways in which individual psychic reality departs from actuality. Psychic reality includes memories, beliefs and their associated affects and fantasies connected with an individual's experience of the inner and outer world. The psychoanalytic determination of what meaningful memories or beliefs are inaccurate, distorted or false ordinarily relies upon principles of intra‐clinical validation. By itself, however, intra‐clinical validation is subject to limitations and pitfalls that conviction alone about what is actual cannot circumvent. Despite this fact, there are remarkably few analytic case reports demonstrating false or signifi cantly distorted memories through the use of data obtained from outside the consulting room. This paucity of reports may be related, at least in part, to the belief that the use of extra‐clinical data is essentially unanalytic or supports resistance. Based on the views that (a) psychic reality cannot be regarded as exclusively subjective or objective but is inherently both; and that (b) a goal of analysis is to achieve a different, acceptable and more accurate view of reality, the authors report a clinical case involving a confi rmably false pivotal memory and its associated negative affects. They discuss theoretical and technical considerations in utilizing extra‐clinical data during the treatment process.