Different origins and meanings of acute acting-out in an inpatient psychotherapeutic setting

In this paper I describe four different sources of acute acting-out behaviour as may be observed in long-term hospitalised patients suffering from severe personality disorders. I hope to demonstrate that acute psychological distress does not happen in a vacuum, but that specific intrapsychic and interpersonal dynamics within the hospital setting are at the root of what appears overtly as nonspecific emotional and behavioural disturbance. I argue that the hospital team's correct insight into the factors underlying acute acting-out is crucial to the implementation of therapeutic interventions aimed to decrease the patient's disturbed state of mind.     

Remembering and repeating in multiple personality

This paper is a case-history of a student in his early twenties tortured by different personalities of different ages and sexes vying for control of his body. Guilt over an incestuous relationship with his mother is uncovered and understood in the context of his whole life. Confusion between memories of fantasies, memories of sleep dreams, memories of daydreams, and memories of actual memories are described, the elucidation of which lead to clearer thinking and memory, and more tolerance for the previously distorted affectladen situations of his past. Thus his belief that he was experimented on in an alien spaceship becomes the memory of an operating-room diagnostic experience.

A hypothesis is put forward that the separate personalities in the multiple personality are not simply the products of ego splits, but are at the instant they are formed a ‘doubling’ of the personality that is being copied. Immediately thereafter, splitting mechanisms create differences between the two separate personalities, using projective and introjective mechanisms. Integration of the various personalities, the ultimate goal in treatment, is made difficult by the patient's fear of loss of self through fragmentation, when the self is felt to be in danger of being intruded upon.     

On some types of hallucinatory experience

There are types of non-visual hallucinatory experience which occur in the psychoses other than those which have a critical and derogatory content. Wish-fulfilment plays an important part in the formation of the content of these hallucinations. In others, ‘persecutory’ anxiety also occurs. A comparison is made between hallucinatory and dream content. An hypothesis is presented to account for the perceptual quality of these hallucinatory experiences. The therapeutic implications of these considerations concludes this presentation.     

Some Historical Conditions of Narrative Work

Written to honor the immense contribution of Michael White as a leader in the development of narrative therapy, this historical essay contrasts the origins of psychoanalysis, family therapy and narrative therapy. Changes in the understanding of therapeutic strategies, methods of training and supervision, styles of leadership, the involvement of audiences in the therapeutic and training processes, and conceptions of the nature of the mind are described. A style of direct demonstration of methods, especially of the formulation of questions, is important in narrative work. The central master-role of the therapist in analysis and family therapy is replaced in narrative work by eliciting local knowledge, and the recruitment of audiences to the work. This is consistent with narrative therapy's "de-centered" image of the therapist.     

The application of prospective strategies to family therapy

Among the most frequently used theoretical orientations for administering family therapy are the systems, interactional, structuralist, problem-centered, and attachment approaches. Each of these methods proposes a theory concerning the etiology and resolution of conflict, a protocol of assessment, and a view on the therapist's role in advocating intervention techniques. Despite the success of these methods, however, families often leave treatment lacking the interpersonal skills for predicting potential conflict and for overcoming episodes of transition. This paper explores how the prospective approach may rectify this problem by enhancing the family members' use of intuition for experiencing transition and predicting upcoming change. As such, the application of the prospective technique may be beneficial for strengthening family relationships.     

Projective identification: Pros and cons. An essay review of Samuel Slipp,the technique and practice of Object Relations Family Therapy

This paper is a critical appraisal of Samuel Slipp's book on Object Relations Family Therapy (ORFT), which uses the concept of projective identification as a central thesis in explaining interpersonal influence. Slipp's book is praised for its excellent review of the literature of object relations theory and the major schools of family therapy, classification of families according to complementary projections, and revealing case material. Interpersonal-Systemic (I-S) theory and methodology with its use of the concepts of empathy, interpersonal influences, search for intimacy, maintenance of self-esteem, selective inattention, and reflected appraisals is offered as an alternative view to projective identification.     

Looking for reconciliations between anecdotes and causalities: The stoical model

Our bias in establishing causality ties which attribute to one consequence a unique cause make circular causality difficult as a way of thinking. Philosophy shows many theories about causality which all are ways to reduce anxiety. Our experiences sometimes require us to go farther than the instrumental (causal) level and to discover a place where disorder may be reestablished in the movement and contradiction. The Stoical model of expressive causality gives a different meaning to our work. In practice the anecdote becomes the essential element in a chair of expressive causalities. A clinical example shows how the anecdote can be the intersection between the family and therapist, offering a new dimension to circular causality and helps the therapist to understand and create another way of thinking about disorder and confusion.     

Observing groups as seen from both sides of the looking glass

Conclusion This paper attempts to make a contribution to an area of the literature on group therapy about which very little has been published—the effects of the therapy group upon the observing group and the dynamics of the observing group as an entity in itself. Although work on which this paper is based took place in training institutions where education is the primary function, it is important to emphasize that education and personal change are interrelated. Psychotherapeutic activity takes place spontaneously with the observers and needs to be constructively utilized. This wealth of process and reaction is an untapped training opportunity for the observing group. The challenge of method, personal reactions, and group process responses are all opportunities for its members to both learn more as therapists and mature as individuals. At this juncture, we are trying to establish ways of