Zwischen Tod und Urszene

Are there psychoanalytic ideas about what it means to be fully and creatively alive? Thoughts about this are prompted by Winnicott’s account of living by compliance or by creative apperception. A necessary aspect of independent, creative aliveness is a capacity to be interested in what disturbs our usual thought processes. Clinical examples show the truth of this for therapists in the clinical situation and it applies to life in general as well. Being fully alive involves a particular use of memory so as to move actively up and down one’s life experiences between past and present and also the ability to extend this imaginatively into the future, including particularly the experience of one’s own death which is ultimately and inescapably ‘uncanny’. Such freedom of internal movement makes it possible to see the present as a point of encounter between the past and the future. The past is bounded by the primal scene and the future by death, which represent the beginning and end of time. The present is thus also an encounter between time and timelessness. To tell a dream in an analytical session is to bring the timelessness of the unconscious into a time-bound framework. A clinical example shows how a sense of this crossover between time and timelessness helped a patient use his dream experience to develop a greater sense of aliveness. Vermeer’s painting of ‘The Kitchen Maid’ pouring milk is analysed as a visual representation of the intersection of time and timelessness. A case in a clinical seminar is described, which produced a disorienting sense of timelessness in the seminar group. The seminar leader then needed to help the discussion stay poised at a crossing-point between timelessness and time. A discussion of the myth of Orpheus considers Orpheus’ compulsion to look back at Eurydice as a failure of aliveness because he could not dream Eurydice at the intersection between the timelessness of the underworld and the linear temporality of everyday existence.     

„Es waren ja fast alle weggegangen“

The complex and partly disputed history of German psychoanalysis during the Third Reich has been thoroughly investigated to date. There are various stages of historical analysis which are distinguished by differing discourses that are presented as part of this work. The first stage of historical analysis was characterized by conflicts within the German psychoanalytical societies and marked by two antagonistic narratives about the transformation of German psychoanalysis during the Third Reich. This study investigated which discourses on the history of German psychoanalysis were integrated into the professional biographies of the first generation of post-war psychoanalysts. In this study 23 narrative interviews were conducted with psychoanalysts who where born before 1st January 1937 focusing on the professional biography and the results were analyzed. The interviewees stressed the ‘damage’ to German psychoanalysis in general and on their training in particular. The ‘damage’ was described as an uncontrollable result of National Socialism and the structural and theoretical changes that were connected to it whereby its effects continued to impact on post-war psychoanalysis. Especially the discourses of the first stage of historical analysis appear to have been integrated into professional biographies and are still having an impact on the interpretation of history for the post-war generation to this day. The history of psychoanalysis is presented as a narrative of ‘rescue’ or ‘liquidation’ of psychoanalysis during the Third Reich depending on the professional identity of the psychoanalysts.     

Supervision zwischen Differenz und Triangulierung

The author outlines some aspects helpful for a better understanding of supervision processes, which focus on difference, e.g. between perspectives of the analyst and the supervisor and take place in a triadic setting. Based on his experience he assumes that this triangulation allows for a differentiation high enough to effectively work on the treatment deliverer’s countertransference. In order to shed some light on this assumption the term “difference” as well as the history of the terms “difference” and “differentiation” are discussed. Furthermore, the concept of early triangulation as understood in developmental psychology is introduced and applied to the process of supervision. An exemplary report of a supervision session with a psychoanalyst in training follows which is intended to underline how supervisory work on countertransference processes within the framework of difference and triangulation can benefit the patient.     

Wie stehen Psychoanalyse und Neurowissenschaften zueinander?

In order to achieve a definition of the subject of both sciences, the author differentiates the practical from the natural side of our existence: our natural, neurophysiological configuration permits our way of life, in which we use those in the form of an instrument, in a similar way to that which a singer would use a voice. The differentiation between conditional and causal relations then leads to a basic criticism of neuroscientific positions. The interest of psychoanalysis in neuroscience is ultimately characterized as a pragmatic interest.     

A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.     

Becoming dependent again: The fears of some elderly persons and their younger therapists

In this paper I shall be discussing only a few of the many aspects of dependency in later life that cause difficulties for some elderly persons and for their younger therapists. I shall be particularly emphasising the fear of dependency in both partners in the therapeutic relationship, and the central role that this fear can play in both bringing the elderly person to the mental health professional for help, and in interfering with the provision of help.     

APP conference summary

This is an account of the extended assessment of a 22-year-old man who was initially sent for a court report, having been accused of setting fires. He had a history both of delinquency and, importantly, of childhood asthma. Although he proved unable to engage in psychotherapy, some management was provided, such as Winnicott advocates in cases of delinquency. This paper explores the symbolic meanings and functions of the patient's delinquent acts, drawing upon theoretical concepts from Freud, Aichhorn, and Deutsch. Of particular importance is the link between this patient's delinquency, his asthma, and the unresolved mourning for his dead mother which he carried not simply for himself but for his whole family.     

The aim of psychoanalysis

The changing aims of psychoanalysis are discussed with reference to Money-Kyrle's paper on the subject. The theory of dammed-up libido, the theory of moral conflict and the theory of misrepresentations and perversion of reality which he described, all imply different aims. It is argued that, in addition, the theory of projective identification leads to a radical change in the aim of treatment which can now be formulated in terms of helping the patient regain lost parts of the self.     

Cases to cases: A study of psychotherapy

The background to the study was a research project on psychotherapy (279 subjects) in the context of the Finnish Student Health Service. Patients were divided into three groups by duration of treatment. For each group, a hypothetical case was constructed. The hypothetical case in relation to short-term treatment (less than six months) is someone whose temporarily disturbed mental balance is supported by the therapist. The hypothetical case in relation to medium-term treatment (one to two years) exhibits recovery through release from self-objects. The hypothetical case in relation to long-term treatment (two to five years) was marked by the partial working through of object relationships.