Therapists’ experiences with internal representations of clients

Fourteen therapists were interviewed via telephone regarding their experience of “carrying around” their clients with them between sessions (i.e. internal representations, or IRs, of clients), a phenomenon about which little empirically based knowledge exists. Data were analyzed using consensual qualitative research. Findings indicated that overall, therapists have IRs infrequently, most often have IRs of clients struggling with severe or challenging presenting problems, and do receive some training about IRs. When describing a specific IR experience, therapists typically noted a strong therapy relationship, and stated that the IRs typically had specific triggers. The IRs generally consisted of feelings about the client, and typically consisted of thoughts about the client or the felt presence of the client. The IRs generally yielded positive effects, typically both personally and professionally, and were typically discussed with supervisors/consultants. Implications for research, training, and practice are presented.     

One Foot in the Ditch: A Discussion of “Accompaniment in Jazz and Psychoanalysis”

This commentary threads the ideas about accompaniment in the lead paper (Markman, this issue) with linked areas of thinking. It looks at synchrony, musicality, and the importance in therapeutic technique of achieving a healthy balance right between closeness and distance. It looks at some of the neurobiology which sheds like on musicality, improvisation as well as thinking about trauma and hyper-vigilance, as well as what developmental capacities need to be in place, or developed, for a healthy accompaniment to take place on a therapeutic journey.     

The role of gesture in children's learning to count.

The role of spontaneous gesture was examined in children's counting and in their assessment of counting accuracy. Eighty-five 2-, 3-, and 4-year-olds counted 6 sets of 2-, 4-, and 6-object arrays. In addition, children assessed the counting accuracy of a puppet whose gestures varied as he counted (i.e., gesture matched the number words, gesture mismatched the number words, no gesture at all). Results showed that the correspondence of children's speech and gesture varied systematically across the age groups and that children adhered to the one-to-one correspondence principle in gesture prior to speech. Moreover, children's correspondence of speech and gesture, adherence to the one-to-one principle in gesture, and assessment of the puppet's counting accuracy were related to children's counting accuracy. Findings are discussed in terms of the role that gesture may play in children's understanding of counting.     

A dark talent: silence in analysis

This paper is presented jointly by two analysts who have worked with patients whose silence stretched over years. They taxed our professional selves and our therapeutic repertoire of responses and techniques to the limit. Partly in response to these experiences, each analyst found herself needing to talk with another who could verify disturbing countertransference reactions from the standpoint of similar experience. The patients' (largely silent) attacks on analysis and their inability to use it conventionally constellated the need in us to talk, in an effort to relieve projected anxiety. Our conversations provided some containment of the destructive fantasies which we found developing in response to lack of verbal interaction with our patients. Unlike patients who project into an analyst in the unconscious hope of finding containment, silent patients project the need for containment, which they then disavow, leaving the analyst carrying the need, and feeling helpless, baffled and undermined in their therapeutic identity (Colman, private communication). In keeping with the theme of this conference, we found that our collaboration about what chronic analytic silence may mean helped to counteract its destructive effect on the analyst-patient relationship