Beyond the representation field

Abstract

This article outlines the importance of representation and several Freudian concepts such as Vorstellung, Trieb, and word and object representations. The author refers to the division of the analytical process into two main fields: the field of representation, and the field of the Real, which is characterized by impossibility. He then states that this field is the proper field of psychoanalysis. The author presents two clinical vignettes in an attempt to demonstrate the significance of the analytical act as a tool to deal with such extreme psychic situations.     

In dialogue with Daniel Stern: A review and discussion of The Present Moment in Psychotherapy and Everyday Life

Abstract

Daniel Stern's concepts of “present moment” and “now moment,” with impending kairos, are described. In the latter, the patient demands the authentic presence of the analyst. If the analyst can open himself to the patient, he proposes that this will result in more profound changes in the patient's implicit knowing than verbal interpretations in the narrative domain would lead to. The value of intersubjectively relating and dwelling more in the phenomenal than in the narrative dimension is highlighted. A similarity to the works of the existential psychoanalyst Harold Kelman is shown. The author agrees with, but also problematises, a tendency to favour the implicit, devaluing verbal understanding and interpretation, which may result in the patient not seeing the primitive levels in his inner life. For this purpose, works from D. W. Winnicott, Jessica Benjamin and Christopher Bollas, as well as others, are used. The author concludes that object relations and intersubjective theory need to complement each other that further, there is a need to give words to the middle-ground between the phenomenal and narrative dimensions.     

Method Effects: The Problem With Negatively Versus Positively Keyed Items

Using confirmatory factor analyses, we examined method effects on Rosenberg's Self-Esteem Scale (RSES; Rosenberg, 1965) in a sample of older European adults. Nine hundred forty nine community-dwelling adults 60 years of age or older from 5 European countries completed the RSES as well as measures of depression and life satisfaction. The 2 models that had an acceptable fit with the data included method effects. The method effects were associated with both positively and negatively worded items. Method effects models were invariant across gender and age, but not across countries. Both depression and life satisfaction predicted method effects. Individuals with higher depression scores and lower life satisfaction scores were more likely to endorse negatively phrased items.     

Correction for faking in self‐report personality tests

Faking is a common problem in testing with self‐report personality tests, especially in high‐stakes situations. A possible way to correct for it is statistical control on the basis of social desirability scales. Two such scales were developed and applied in the present paper. It was stressed that the statistical models of faking need to be adapted to different properties of the personality scales, since such scales correlate with faking to different extents. In four empirical studies of self‐report personality tests, correction for faking was investigated. One of the studies was experimental, and asked participants to fake or to be honest. In the other studies, job or school applicants were investigated. It was found that the approach to correct for effects of faking in self‐report personality tests advocated in the paper removed a large share of the effects, about 90%. It was found in one study that faking varied as a function of degree of how important the consequences of test results could be expected to be, more high‐stakes situations being associated with more faking. The latter finding is incompatible with the claim that social desirability scales measure a general personality trait. It is concluded that faking can be measured and that correction for faking, based on such measures, can be expected to remove about 90% of its effects.     

Primary shame,mortal wound and tragic circularity: Some new reflections on shame and shame conflicts

Invited to contribute some thoughts on recent developments in psychoanalytic thinking about shame, the author starts off with Aristotle's prescient analysis of shame and then focuses on accumulating experiences in the psychoanalytic treatment of patients with severe neuroses, in particular the close relationship of severe traumatization and chronic states of shame, and how this is reflected in shelfdestructive repetitions. Reminiscent of what we know from tragedy and the tragic dimension of human existence, this repetition compulsion shows a built‐in circularity. These circular dynamics have at their core struggles with deep woundedness that can variably be conceived of as primary pain, primary shame and primary anxiety. Consequently, throughout the experiences with these patients goes the absoluteness both of their conscience and of their ideal, what we know as the “archaic superego:”     

Using the Theory of Gender and Power to Examine Experiences of Partner Violence,Sexual Negotiation,and Risk of HIV/AIDS Among Economically Disadvantaged Women in Southern India

This article uses the Theory of Gender and Power to examine women's vulnerability to HIV/AIDS in order to: understand the vulnerability of female sex workers/poor women due to poverty and lack of educational resources; explore women's vulnerability in the context of client/partner violence, alcohol use, male partner's high-risk behaviors, and women's lack of control in their intimate relationships; and explore the role of traditional heterosexual gender norms in the outcomes of sexual negotiation. Ethnographic data were collected from 32 women and 38 men in India as part of an ongoing National Institute of Mental Health study. Results highlighted women's vulnerability to HIV/AIDS stemming from partner violence, alcohol use, poverty, dangers of sex work environments, and tacit acceptance of cultural/gender norms.     

Psychoanalyse mit Traumatisierten

Extreme and complex traumatisation represents a severe problem in today’s world. There is a need to develop treatment approaches that are efficient for traumatised persons who often live under very difficult circumstances. There are moreover certain societal conditions that are important for the treatment and rehabilitation of the traumatised patient. The paper will discuss how psychoanalytic therapy may be helpful for severely traumatised patients and what are the mechanisms of change in the therapeutic process. A focus is on how traumatic experiences are actualised in the transference and brings the analyst in a situation where enactments inevitably occur. It will be demonstrated how these processes may lead to symbolisation of these traumatic experiences. What are the therapeutic and societal preconditions for treating traumatised patients?     

Beyond Randomized Controlled Trials in Attempted Suicide Research

There is a lack of evidence about what is the best treatment for people who present to hospital after self harm. Most treatment trials have been small and involved unrepresentative groups of patients which result in inconclusive findings. Here we note some of the characteristics of attempted suicide which make it a difficult subject to study. We describe the problems of doing randomized controlled trials in attempted suicide and outline the advantages and difficulties of randomized controlled trials, Zelen designs, patient preference designs, and cluster randomized trials in attempted suicide intervention trials. Researchers and consumers should consider other research designs when asking what is effective after self harm.     

Risk for Suicide among Medicaid Beneficiaries

Demographic, diagnostic, and service expenditure characteristics of Florida Medicaid enrollees who died by suicide were investigated. Among persons receiving Medicaid and Supplemental Security Income (SSI), findings indicate the most powerful predictors of suicide were involuntary psychiatric examination, mental health hospitalization, and high mental health service use. Among Medicaid enrollees not receiving SSI, strongest suicide predictors were mental health hospitalization, high expenditures for physical health medications, and involuntary psychiatric examination. Findings suggest reducing involuntary psychiatric examinations and mental health hospitalizations while improving physical health may reduce suicide in the Medicaid population. Comprehensive hospital discharge planning, adherence monitoring with follow‐up care, training mental health providers in assessing suicide lethality, and providing adequate assessment time are all crucial to achieve these objectives.