Which reality in the psychoanalytic session?

The author discusses how the analyst's theory influences what happens in the psychoanalytic session, and, in particular, how it determines which of several possible realities become the focus of attention. An overview of Bionian thought and how it informs the author's way of working is provided. In elaborating his use of the narrative level in the session and other key concepts, the author presents three brief clinical vignettes.     

Toward a model of self pathology underlying personality disorders: narratives, metacognition, interpersonal cycles and decision-making processes

If we want to explain the links between the various and heterogeneous elements--symptoms, dysfunctional forms of behavior and poor social functioning--making up personality disorders, we need model a self pathology that portrays dysfunctions, the links among them, and how their interactions maintain disorders over time. In our view, the most likely elements of self pathology are: a. problematic contents (thoughts and emotions)--experienced subjectively as states of mind and organized in the form of narratives; b. shortfalls in the ability, termed meta-cognition, to reflect on mental states, both of oneself and of others; c. pathogenic interpersonal schemas; and d. maladaptive decision-making processes. These elements get altered in the various personality disorders and interact to form typical pathological organizations. This article seeks to describe a model of self pathology in personality disorders and discuss its current scientific status based on a literature review that spans several disciplines. The model is illustrated with an example of how the pathogenic elements can interact to form personality disorder. Lastly, the limitations and advantages of the model are discussed.     

Trauma, reverie, and the field

The author uses a clinical vignette to demonstrate complex concepts at work--concepts such as those derived from a productive grafting of Bion's thinking onto the concept of the psychoanalytic field. The underlying theory is narrated by the use of images, which the author finds to be the most appropriate way to demonstrate this theory at work--a theory of the mind based on the concept of digestibility of emotions, as well as the progressive introjection of instruments to render such an operation possible. Key points include the waking dream thought, the analyst's reverie, unsaturated interpretations, continual re-dreaming on the content of the session as permitted by the field, and the development of the ability to metabolize emotional contents.     

Gender differences in memory for object and word locations

It has been hypothesized that gender differences in visuo-spatial working memory (VSWM) are larger in tasks requiring active elaboration of the material. In the present study we explored this issue by using an object relocation task, with both verbal and visual stimuli. The involvement of active processes was manipulated through the type of transformation required on the stimulus and through the introduction of different kinds of interference. In the three experiments reported, participants were shown either words or cartoon object icons in different locations and had to relocate them in either the same format or in the opposite one (object icons could be transformed into words and vice versa). Males outperformed females in the most demanding conditions, in which object icons and words were presented together in the encoding phase, and both had to be transformed in the recall phase; or when more demanding interferences were used. Our data suggest that the retention strategy was similar for the two groups and that the gender effect is related to a selective female difficulty associated with the increase in active VSWM processing. These findings further support the hypothesized distinction between the passive and active components of VSWM and illustrate the role that this distinction might play in accounting for individual differences.     

Marcella: the transition from explosive sensoriality to the ability to think

The author discusses an analytic case in which it was necessary to first address the patient's need for containment of her protoemotions--her sensoriality--before the analysis could proceed along more standard lines, with interpretation of the transference, work on displacement and aspects of her childhood history, and so forth. Prior to treatment, the patient had resorted to a sort of affective autism in order not to experience dangerously overwhelming emotions, and her emotional lethargy in sessions at first engendered similar feelings in the analyst, making progress impossible until a container was established for her projective identifications.     

Coherence and recurrency: maintenance,control and integration in working memory

Working memory (WM), including a ‘central executive’, is used to guide behavior by internal goals or intentions. We suggest that WM is best described as a set of three interdependent functions which are implemented in the prefrontal cortex (PFC). These functions are maintenance, control of attention and integration. A model for the maintenance function is presented, and we will argue that this model can be extended to incorporate the other functions as well. Maintenance is the capacity to briefly maintain information in the absence of corresponding input, and even in the face of distracting information. We will argue that maintenance is based on recurrent loops between PFC and posterior parts of the brain, and probably within PFC as well. In these loops information can be held temporarily in an active form. We show that a model based on these structural ideas is capable of maintaining a limited number of neural patterns. Not the size, but the coherence of patterns (i.e., a chunking principle based on synchronous firing of interconnected cell assemblies) determines the maintenance capacity. A mechanism that optimizes coherent pattern segregation, also poses a limit to the number of assemblies (about four) that can concurrently reverberate. Top-down attentional control (in perception, action and memory retrieval) can be modelled by the modulation and re-entry of top-down information to posterior parts of the brain. Hierarchically organized modules in PFC create the possibility for information integration. We argue that large-scale multimodal integration of information creates an ‘episodic buffer’, and may even suffice for implementing a central executive.     

Processing abstract language modulates motor system activity

Embodiment theory proposes that neural systems for perception and action are also engaged during language comprehension. Previous neuroimaging and neurophysiological studies have only been able to demonstrate modulation of action systems during comprehension of concrete language. We provide neurophysiological evidence for modulation of motor system activity during the comprehension of both concrete and abstract language. In Experiment 1, when the described direction of object transfer or information transfer (e.g., away from the reader to another) matched the literal direction of a hand movement used to make a response, speed of responding was faster than when the two directions mismatched (an action-sentence compatibility effect). In Experiment 2, we used single-pulse transcranial magnetic stimulation to study changes in the corticospinal motor pathways to hand muscles while reading the same sentences. Relative to sentences that do not describe transfer, there is greater modulation of activity in the hand muscles when reading sentences describing transfer of both concrete objects and abstract information. These findings are discussed in relation to the human mirror neuron system.     

The neural basis of mirror symmetry detection: a review

The human visual system is extremely sensitive to the presence of bilateral (mirror) symmetry. In this review, I summarise the results of recent work investigating the neural basis of mirror symmetry detection, focusing in particular on brain stimulation evidence. Overall, available findings converge in pointing to the lateral occipital (LO) complex, especially in the right hemisphere, as a key region causally involved in symmetry detection. Interestingly, they also suggest that another region in the right extrastriate visual cortex, the occipital face area (OFA), is causally implied in symmetry detection, posing an interesting connection at the neural level between visual cortex responses to faces and to symmetry. Finally, this review also considers evidence on haptic symmetry detection in sighted and early blind individuals that points to LO as a multi-modal symmetry-sensitive region, and suggests that symmetry is a salient perceptual feature mediated by LO even when any visual experience is missing.     

Methodological evolution and clinical application of C.G. Jung's Word Association Experiment: a follow-up study

We became interested in the clinical application of the Word Association Experiment (AE) when we decided to use Jung's theory of complexes in the psycho-diagnostic evaluation and treatment of patients applying to our Psychotherapy Out-patients Unit (Psychiatric Clinic, Milan University). In psychopathological situations, complexes with a particularly high emotional charge become autonomous and disturbing, inhibiting the ego's functions. The representations and affective states corresponding to these complexes become dominant, conditioning the expression of symptoms and the subject's relational modes. In this experimental study we started out from the basic theory that our psycho-therapeutic work should lead to a progressive change in the patient's initial complex set up. Jung's Word Association Experiment allows us to identify those words which indicate and stimulate a specific activation of the complexes for each subject via specific markers of complexes. We therefore decided to determine whether AE, administered during the first phase of clinical-diagnostic evaluation and after one year of treatment, revealed any changes occurring in the patients' set up of complexes.