Some thoughts on moving West

Abstract

This paper outlines an application of psychoanalysis in the tradition of Donald Winnicott in the clinical practice of paediatric diagnostic radiography. A practical way in which psychoanalytic theory may be employed in the care of essentially ‘normal’ children and their parents in the ‘abnormal’ setting of a district general hospital is demonstrated. The themes of holding and the effect of impingements, transitional phenomena and creative apperception and experiencing are addressed. A brief case study of one 15-month-old child is presented.     

Selecting a patient or initiating a psychoanalytic process?

The defences provoked in the analyst by the anxieties associated with the difficult tasks of ‘assessment’ and ‘selection’ for psychoanalysis can result in a tendency to think in terms of ‘hurdles to be cleared’ by potential psychoanalytic patients, rather than ‘opening the gates’. This can result in a diminution of the analyst's capacity to enlist and sustain a psychoanalytic stance. Only within a psychoanalytic frame can a meaningful psychoanalytic process unfold, at all stages of a potential patient's movement from their first contact through to, possibly, entering into an analysis. The author illustrates the value of this thinking by describing the work of the London Clinic of Psychoanalysis where there has been a shift of emphasis in psychoanalytic consultation towards working with individuals on their potential to initiate a psychoanalytic process, and away from the sole aim of ‘selection of a suitable patient’. In this paper, the author notes that when institutional culture and practice supports psychoanalytic identity, this makes it more possible to recognize and articulate the anxieties provoked by the ‘emotional storm’ inevitable in psychoanalytic consultation, and the draw towards unhelpful enactment that may otherwise obscure the initiation of a psychoanalytic process that may or may not result in analytic treatment. Illustrative case material from the Clinic is presented.     

Amalia X: dialogical sequence analysis as a method in theory-based single case research in psychoanalysis

In this article, Dialogical sequence analysis (DSA) is introduced as a method in theory-based single case research. The structure of article is as follows: first, we will describe briefly the historical background of single case studies and their position as the foundation of psychoanalytic knowledge formation. Secondly, we will describe through Amalia X’s case how one psychoanalytic ‘specimen case’ has been used as a cornerstone for a comprehensive psychoanalytic process research model, the so called ‘Ulm model’. Amalia X is one of the most studied single cases internationally also outside psychoanalytic process study field. Thirdly, we will introduce the central theory and practice of DSA. Fourthly, in the last section of our article, we will show in practice how DSA can be used in the analysis of Amalia’s dream in the session 152.     

BOOK REVIEWS

Crisis resolution and home treatment teams (CRHT) are integral to acute psychiatric services. This survey quantifies staff burnout using the MBI-HSS (Maslach Burnout Inventory) and notes sources of stress and satisfaction before (2012) and after (2013) service transformation of a CRHT in Leeds into a single point of access, with home treatment devolved to community teams. Moderate to high Burnout scores were observed over the study period, with a rise in the mean depersonalisation score from 5.8 to 7.2 over the study period. Contact with colleagues; work with patients and variety of work emerged as rewarding while themes of suicide and violence were most linked with stress, with clinicians reporting self-doubt in the face of difficult clinical decisions. Clinicians positively rated a weekly psychoanalytic reflective practice group. A pictorial representation of qualitative results uses psychoanalytic theory inconceptualising ‘skins’ around various aspects of the clinical setting, which then become semipermeable in response to a patient in crisis when clinicians feel poorly supported by the changing organisation.     

Going backstage: a psychoanalytically informed study with amateur musicians in adult mental health services

Many mental health service users engage in potentially therapeutic amateur music practice, though the role of this in the maintenance of mental health is largely unexplored. The application of psychoanalytic ideas to music-playing gives suggestions for how this activity could helpfully sublimate distress. For this study, six men who attend adult mental health services and play a musical instrument took part in three unstructured hour-long interviews. The material was analysed with a psychoanalytically informed method. Four inter-related themes emerged: ‘Left on the outside’; ‘Playing and linking’; ‘A beautiful gift to myself’; and ‘Frustrating play’. In the lives of these amateur musicians, music’s role as a transitional object and means of containing distress is explored. There is discussion of the narcissistic function of music and the dynamics around music as an exhibitionistic act. The value of paying attention to music in the life of a patient is considered.     

Telling a traumatic story through Art: Arshile Gorky’s ‘The Artist and his Mother’

For more than a decade, through re-working a composition based on a sepia photograph, Arshile Gorky (ca. 1904–1948) tried to give form and represent that which by definition defies forms and shatters one’s capacity for representation. Having witnessed the systematic ethnic cleansing of his people as a child, Gorky began a ‘journey’ in his attempt to comprehend his traumatic ordeal through Art. In 1926, with the safety of a constructed name and life, the artist started working on ‘The Artist and his Mother’ series. Focusing on the two versions of Gorky’s early painting and using relevant aspects of psychoanalytic theory, the paper explores his work through a psychoanalytic lens. Psychoanalytic theories on extreme traumatisation along with psychoanalytic notions of temporality will be utilised in an attempt to follow the artist’s struggle to re-create and rework aspects of his traumatic history.     

Mourning’s dissonance; who am I who mourns and whom do I mourn?

In this article I explore how a relational psychoanalytic and phenomenological perspective can open out new possibilities for interpretations of experiences of bereavement. I critically discuss Freud’s acclaimed paper, ‘Mourning and melancholia’ in the light of work by philosophers Merleau-Ponty (a phenomenologist) and Judith Butler (a contemporary post-modern feminist philosopher). I reflect on how questions of identity, language, and embodiment, crucial themes in Merleau-Ponty’s and Butler’s theorising of human subjectivities, emerge in two literary/autobiographical accounts of mourning: Nora Webster, by the contemporary Irish writer, Colm Tóibín, and Mourning Diary by the French philosopher, Roland Barthes. Through my discussion of these philosophical and literary texts I argue for a psychoanalytic perspective which is attuned to the conscious and unconscious subtleties and complexities of mourning and engages with the ways in which the identities of the mourner and the mourned and the relations between them are, for the mourner, constantly in flux. I emphasize the importance of attending in the psychoanalytic relationship to the specificity and uniqueness of individuals’ languages of mourning and to the effects on experiences of bereavement of gender, race, class, sexuality, age, and physical ability within particular socio-historical and cultural contexts.     

THE REBIRTH OF THE IDOLS: THE FREUDIAN UNCONSCIOUS AND THE NIETZSCHEAN UNCONSCIOUS3

The author explores how psychoanalysis mutates in its passing from the privacies of the session to the public spaces of academia, shifting away from enquiry into unfolding unconscious psychic processes guided by its method, and from the clinically based notions Freud and his diverse followers constructed, here called the ‘Freudian unconscious’. In postmodern intellectual contexts Freud's work fuels a ‘Nietzschean unconscious’, issuing from public lecterns in the protagonistic, self‐creating feats of a ‘psychoanalytic discourse’. The ideology of such mutation ishere traced from Nietzsche on to Heidegger and Kojave, and then to Lacan and Laplanche. It reflects the might of the ‘death of evidences’ and the Romantic penchant for the limit‐experience and the primacy accorded to the creative imagination. Discourse as revelation rests on a ‘paradox of the enunciation’ whereby the subject (author) of the statement is taken to be identical to the subject (matter) of the statement. Banishing the boundaries of illusion and evidence, and of self‐overcoming and insight, academic ‘psychoanalytic discourse’creates a ‘return of the idols’ in ‘theoretical’ narcissistic identification.     

Process‐orientated psychoanalytic work in initial interviews and the importance of the opening scene

From the very first moment of the initial interview to the end of a long course of psychoanalysis, the unconscious exchange between analysand and analyst, and the analysis of the relationship between transference and countertransference, are at the heart of psychoanalytic work. Drawing on initial interviews with a psychosomatically and depressively ill student, a psychoanalytic understanding of initial encounters is worked out. The opening scene of the first interview already condenses the central psychopathology – a clinging to the primary object because it was never securely experienced as present by the patient. The author outlines the development of some psychoanalytic theories concerning the initial interview and demonstrates their specific importance as background knowledge for the clinical situation in the following domains: the ‘diagnostic position’, the ‘therapeutic position’, the ‘opening scene’, the ‘countertransference’ and the ‘analyst's free‐floating introspectiveness’. More recent investigations refer to ‘process qualities’ of the analytic relationship, such as ‘synchronization’ and ‘self‐efficacy’. The latter seeks to describe after how much time between the interview sessions constructive or destructive inner processes gain ground in the patient and what significance this may have for the decision about the treatment that follows. All these factors combined can lead to establishing a differential process‐orientated indication that also takes account of the fact that being confronted with the fear of unconscious processes of exchange is specific to the psychoanalytic profession.     

The Analytic Principle and Attitude: Mobilizing Psychoanalytic Knowledge to Maximize Social Work Students' Practice Competence

Although psychoanalytic approaches have been marginalized in the foundations of contemporary clinical social work practice, there are core themes in various psychoanalytic theories that can be made accessible to maximize students’ practice competence. We elucidate the psychoanalytic principle of unconsciousness as well as the analytic attitude of inquisitive listening and its components. Using vignettes, we demonstrate how we teach this attitude in bachelor's in social work (BSW) and master's in social work (MSW) classrooms. This approach can help students begin to think and listen psychoanalytically. It offers them a way to better understand the person beyond the symptoms.     

'Little Hans': From his phobic episode to becoming an opera director

‘Little Hans’ is one of the most highly commented cases in the psychoanalytic literature. His work as an opera director from 1925 in Europe and then in the United States of America is much less well known. This may seem especially surprising given that Freud very soon detects Hans’s emerging interest in this subject. Yet Freud does not mention it either in 1909 when he reports the case, or when Hans visits him in 1922, even though Hans had already decided to become an opera director at this point. The author of this article endeavours to show how this artistic choice could be understood as a way of accommodating, in a double transference relationship with Freud and with his father, the unanalysed residue of the ‘Krawall’ (a term invented by Hans) and ‘the black thing’, both of which appeared during the phobic period.     

‘It’s Not Just about Faith’: Narratives of Transformation When Moving Out of Islam in the Netherlands and Britain

ABSTRACT

This article investigates the narratives of people with Islamic backgrounds in the Netherlands and Britain who have moved out of Islam. Rather than focusing primarily on ‘leaving faith’ (i.e. a predominantly negative and religiously centred approach), it will present four types of thematic trajectories that consider the broader life-worlds and experiences of the interlocutors. These themes will illustrate the relative weight of the religious voice in trajectories, rather than presupposing the centrality of religion in one’s (former) identity or trajectory. It will thereby display a broader understanding of the interlocutors’ experiences as being in a negative relation to religion alone: not only religious, but also political, social, ethnic and gender boundaries provided the contexts in which people moved out of Islam. The themes (‘religious break’, ‘social break-away’, ‘the entrance’ and ‘unconscious secularization’) will be illustrated by four case studies. A fifth case will be presented to illustrate the potency of the intertwinement of the themes.     

Psychoanalytische Kompetenzen

The author presents a project trying to gain as transparent as possible criteria for a competent psychoanalytic practice. The project is oriented at David Tuckett’s (2005) proposal of tracing the implicit knowledge of psychoanalytic experts on quality and of making it explicit. Thirty written comments by experienced training analysts on candidate‘s case reports are utilized. A qualitative content analysis leads to the formulation and explanation of ten psychoanalytic competences. They are framed by a model that conceptualizes psychoanalytic practice by three steps: (1) perceiving unconscious material in a participant–observational frame, (2) reflecting it in a conceptual frame and (3) interpreting it in an interventional frame. The competences of the first frame involve the abilities of evenly suspended attention and abstinence, of working with the countertransference and with psychoanalytic interaction and intersubjectivity, the ability to establish an as helpful experienced relationship, the ability to tolerate and to handle anxiety, tensions and conflicts, and the ability to give psychic space and developmental freedom to the patient. The conceptual frame comprehends the ability to establish, form and end a psychoanalytic process, the ability to utilize theoretical concepts and that of selfreflection. The last but not least ability is related to interpretation in the interventional frame. It is not possible in this survey to characterise the competences in a more detailed way nor to add the indispensable vignettes in order to anchor the competences in practice. Some most interesting questions on plurality and competence in psychoanalytic work are raised.     

The so‐called death drive,an indispensable force for any subjective life

The psychoanalytic movement has difficulty in overcoming the malaise bequeathed by what Freud wanted to call the ‘death drive’. This term remains doubly problematic: first because the indispensable antagonist of Eros‐binding cannot be reduced to a particular drive; and secondly because this Anteros plays a vital role in subjectivization. The Freudian idea of the ‘death drive’ has in addition the drawback of confusing dissociative thrust (unbinding) with the aggressive component of libidinal cathexis. Now it is precisely the lack of articulation between them that leads to deconstructing it. For it is constantly observed that in the psychic register aggression is much more fixing than unbinding. The essential role of Anteros/unbinding in the process of subjectivization can be illustrated through several key operations in subjective development: sublimatory activity and its renunciation of pleasure‐discharge, the work of mourning opposed to melancholic fixation, the intricating‐unbinding parental function, and finally the psychoanalytic treatment and its work of analysis. This means we should cease to anathematize the dynamic component of unbinding as ‘of death’ and seek to explain the concept of subjectivization better.     

‘Bound in a nutshell’: Thoughts on complexity,reductionism, and ‘infinite space’1

Pluralism is the hallmark of 21st century psychoanalytic discourse. Nevertheless, an unpleasant byproduct of pluralism is a tendency in some quarters to retreat into orthodoxy, stemming from a perceived need to shore up theoretical boundaries in the service of differentiating one theory from another. The delineation of borders places us at a risk of losing sight of the fact that genuine psychoanalytic thinking is fundamentally non‐reductionistic. Moreover, the core psychoanalytic notion of overdetermination, which Freud never abandoned throughout his career, has recently been neglected as authors argue in their communications that one point of view is better than another. Both analysts and their patients secretly are drawn to simple formulations that eschew complexity. The need to remain open to the ‘infinite space’ of meaning, motive, and causation should be a hallmark of clinical psychoanalytic practice. The author considers the implications for technique, and provides case material to illustrate some of the challenges inherent in approaching psychoanalytic work as a complex phenomenon.     

Catalysts for psychic change: Perspectives from contemporary psychoanalysis

This paper was given as the inaugural ‘Ellen Noonan Counselling Lecture’ on 3 July 2007, at Birkbeck College, University of London, and I have retained some of the spoken style of the original lecture. Since the 1960s, psychoanalytic models of change and growth have in themselves undergone radical changes. The aims of psychoanalytic and psychodynamic work are now less tied to a model of ‘health’ or ‘normality’ and more linked into processes that enable people to keep developing throughout life. The lecture examines some of the new theories of psychic change and growth from the contemporary Independent, Lacanian and post-Kleinian schools of psychoanalysis and, using clinical illustrations, explores the implications of these new theories for psychodynamic practice.     

September 11th,an attack at the limits of thought

The paper deals with imagination and its failures from a psychoanalytic perspective. We offer a definition of imagination failures and suggest how they can be interpreted as an opportunity to learn from experience. In order to show that the topic has a concrete and not only speculative significance we consider the public report on September 11 as a case study. The report was published by the National Commission on Terrorist Attacks Upon the United States after a long investigation of the facts and circumstances relating to the September 11 attacks. The document has been the object of strong criticisms, as we argue in the paper. Both the document and some of the critiques that it received focus, however, on significant aspects of the debate about imagination, such us the fragility of imaginative thought, its dependence on unconscious desires and its plurality of outcomes: a plethora of imaginaries can in fact be developed at any time, from the same set of information about reality. We comment on these aspects and reinterpret them from a Bionian perspective. The concepts of ‘unthinkability’, ‘imagination failure’ and ‘depressive position’ are used to inform the necessity of dealing with an evolving and conflictual geopolitical scenario. Particular attention is paid to the proposal of ‘routinizing, even bureaucratizing, the exercise of imagination’ within the institutions that deal with National Defense. This possibility is discussed in depth in order to suggest how it may be concretely implemented. In conclusion, a strong case is made for the usefulness of psychoanalytic reflection in the arena of relationships among countries, with particular emphasis on the new terrorist challenges.     

PSYCHOANALYSIS AND COGNITIVE BEHAVIOUR THERAPY ‐ RIVAL PARADIGMS OR COMMON GROUND?3

The author suggests that contemporary enthusiasm for cognitive‐behavioural therapy reflects our longing for swift, rational help for psychological suffering. Competition for funding threatens the psychoanalytic presence in the public sector. The psychoanalytic and cognitive‐behavioural models are contrasted, and the relative richness of the psychoanalytic paradigm outlined. The author suggests that a cognitive model is commonsensical, but less complex, with less potential explanatory and therapeutic power. She discusses how the analytic stance is always under pressure to ‘collapse’ into simpler modes, one of which resembles a cognitive one. This also occurs inevitably, she argues, when attempts are made to ‘integrate’ the two models. Cognitive and ‘integrated’ treatments nevertheless have the advantage that they are less intrusive and hence more acceptable to some patients. Selected empirical process and outcome research on cognitive and psychoanalytic therapies is discussed. Brief psychotherapies of either variety have a similar, modestly good outcome, and there is some evidence that this may be based more on ‘dynamic’ than ‘cognitive’ elements of treatment. Formal outcome studies of more typical psychoanalytic psychotherapy and of psychoanalysis itself begin to suggest that these long and complex treatments are effective in the more comprehensive ways predicted by the model.