Self-representing dreams

SUMMARY

Certain dreams are particularly striking for the way they represent themselves and the manner in which they are told within a psychotherapeutic relationship. Within such a dream is contained a picture of the dream's function and significance as part of the transaction between patient and psychotherapist. This phenomenon illustrates the nature and function of unconscious phantasy, the relations that hold between phantasy and mechanisms of defence, and the manifestations of phantasy within the transference.

Three examples are given of self-representing dreams which have been reported and re-enacted by trainee psychiatrists in psychotherapy supervision.     

Loss and change in primary care: Working with organisational anxiety

This paper will consider the identity of an inner voice that is experienced by everyone, but in very different ways. However, when working in the transference with psychotic patients the boundaries of personal identity and the question of choice and volition are so compromised by the illness that the phenomena are so to speak ‘writ large’. This allows the issues to be brought out with great vividness and intensity and it is the struggle with this that has led me to reconsider the identity of the inner voice in a way which I have found useful for the rest of my clinical work.

Prior to 1985, my clinical work with patients with psychotic illnesses was undertaken in the in-patient psychotherapy ward at Shenley Hospital that I was responsible for. With the movement of psychotherapy resources out of Shenley to set up the Willesden Centre, our ability to continue with this work was very compromised because the Centre is entirely an out-patient resource. However, a number of us persevered and gradually worked out ways to be able to continue to offer treatment to patients who had psychotic illnesses. This involved the establishment of a case-manager system to enable the therapist to work in the transference. This evolution has occurred in a specialist workshop that I have been running at the Willesden Centre since 1986.     

Coconstructing Mother–Infant Distress: The Microsynchrony of Maternal Impingement and Infant Avoidance in the Face-to-Face Encounter

This article takes a new look at the self-experience of creative artists. A five-step model of the creative process is put forth: preparation, inspiration, realization, completion, and objectification. The vicissitudes the creative self undergoes in each step are described, as well as the selfobject experiences needed to sustain the self through each phase. Of particular interest in this regard are the roles of the “muse” and of the artistic community. The article then describes three pathologies that the creative self is particularly prone to: addictions, vertical splits, and depression/isolation. The article concludes with a case example of a female patient who brought her paintings and stories into therapy.     

The concept of ‘mine‘ 1

Misunderstanding of the word mine and its shifting relations to ‘pro‐attitudes’ inspired much of Aristotle's attack on collectivism at Politics 1261B 15ff. Similar misunderstandings contribute to certain criticisms leveled by modern conservatives like Goldwater against ‘welfarism’, they presuppose confused psychological and ethical doctrines. Thus semantically necessary truths may be misconstrued as entailing contingent propositions about political and economic arrangements. Different confusions about mine and ‘pro‐attitudes’ lend a correspondingly specious aura of certainty to some Platonic and Marxist claims. The ownership model of mine impedes our understanding of men.     

Autoimmun-Enzephalitiden – eine Erkrankungsgruppe mit vielen Gesichtern

During the last 10 years a number of syndromes with antibodies against neuronal surface antigens have been characterized. Adults as well as children can be affected. Patients may suffer from amnestic syndrome, other cognitive deficits, seizures, or psychiatric symptoms. Some patients develop generalized encephalopathy with altered levels of consciousness, hyperkinesias, and hypothalamic disorders. In some patients, ovarial teratoma, thymoma, or small cell lung cancer can be diagnosed. However, in most patients no tumor is found. These syndromes were previously called autoimmune channelopathies. In fact, most antigens are not part of an ion channel but proteins or part of protein complexes on the cell surface of neurons, axons, dendrites, or synaptic terminals. These proteins are expressed throughout the nervous system. Interestingly, in limbic encephalitis very circumscribed brain regions are affected. This may be due to an increased vulnerability or accessibility of the affected brain regions. Limbic encephalitis is a well-characterized form of autoimmune encephalitis, which can be associated with different antibodies. Anti-NMDA-receptor encephalitis is not restricted to the limbic system. Characterization of other syndromes and auto-antibodies are expected in the future. In this review, aspects of limbic encephalitis and anti-NMDA-receptor encephalitis will be discussed.     

Intelligenzgeminderte Rechtsbrecher im Maßregelvollzug

Forensic patients with intellectual disabilities have so far received little attention which is reflected in the comparatively briefly written chapters in the standard textbooks and also the low scientific interest in this patient group. There are only few therapeutic concepts and even less information on their effectiveness. This article presents the Christophorus Clinic in Münster which was the first forensic institution in Germany to specialize in these patients. The institution incorporates 54 treatment places and started operating on 3 June 2011. In addition to the known fact that a therapy concept must (further) develop over the years, during the first year of operation some aspects have arisen which have cristallized as problem areas specific for this patient group, which are discussed.     

When in Rome… Identification and acculturation strategies among minority members moderate the dehumanisation of the majority outgroup

The study of humanness as a dimension of social judgment has received extensive attention over the past decade. Although the common reported finding is that people attribute more human characteristics to their ingroup than to the outgroup, similar tendencies are expected to be tempered for minority groups when judging the host society. In Study 1, carried out with Gypsy minority members, we tested the hypothesis that those group members who adopt an assimilative strategy identifying more with the host compared with the heritage culture will display the lowest levels of dehumanisation. In Studies 2 and 3, conducted with immigrants in Italy and in Portugal, respectively, the hypothesis was extended from an identification conceptualisation to an acculturation one. Despite significant variability in intergroup settings and measures, results confirmed our hypothesis that immigrants who choose to assimilate with the host culture dehumanise the outgroup less compared with those who adopt any of the other acculturation strategies. Implications for the ethnocentric nature of dehumanisation biases and for intergroup relations in general are discussed. Copyright © 2014 John Wiley & Sons, Ltd.