Contemporary transference work and the analytic attitude: aims and methods--a clinical workshop

There are various ways of working as an analyst, and there are various ways of utilizing the concept and the phenomena of transference‐countertransference. I hope to draw an adequate picture of a way of working that is called ‘working‐in‐the‐transference’ as distinct from ways of working that ‘analyse transference’. The former has long been practised by many Jungians as well as by many psychoanalysts. As a method, it has aroused controversy in both groups, and is frequently both misunderstood and imitated. It can arouse strong anxiety. It can appear narrow and restrictive. It famously precludes a gamut of activities in which many analysts engage. Is working‐in‐the‐transference old fashioned, or does it deserve to be increasingly appreciated? Can it offer support and validation whilst remaining true to its conception? It was hoped that these questions would be addressed in the clinical material brought to the workshop. The emphasis in the workshop was on active participation and it was hoped that those attending would bring their clinical concerns for discussion.     

Inference of personality projected onto fictional characters having an author's first name

Jane Austen projected some of her personality characteristics onto her fictional namesakes Jane Bennet in the novel Pride and Prejudice and Jane Fairfax in the novel Emma. Wishful fantasy seems satisfied by two attributes of both Janes. They are very beautiful, and they marry rich men they love. A feeling of inferiority was expressed by two attributes of both Janes, depicted as deficient in social communication and subordinate to the heroine of the novel.     

The Self and the Phenomenal

As is widely appreciated and easily demonstrated, the notion that we are essentially experiential (or conscious) beings has a good deal of appeal; what is less obvious, and more controversial, is whether it is possible to devise a viable account of the self along such lines within the confines of a broadly naturalistic metaphysical framework. There are many avenues to explore, but here I confine myself to outlining the case for one particular approach. I suggest that we should think of ourselves (or our essential cores) as being composed of experience‐producing systems, and that such systems belong to the same self when they have the capacity to contribute to unified streams of consciousness. The viability of this proposal rests in turn on a particular conception of the structure of consciousness, both at and over time; this conception is defended in the first part of the paper     

Colic and fussing in infancy,and sensory processing at 3 to 8 years of age

The purpose of this follow‐up study was to examine whether a group of 28 clinic‐referred infants with colic, excessive crying, or both at 4 to 12 weeks demonstrated sensory processing, coping, and behavioral/attention regulation difficulties at 3 to 8 years of age. Seventy‐five percent of the sample demonstrated atypical behavioral responses to sensory experiences. Hours of fussing during infancy significantly correlated with inattention, emotional reactivity, touch processing, environmental coping, and externalizing behavior at 3 to 8 years, but not hours of crying. The most striking result was that children with more hours of early fussing showed less efficient sensory processing, poorer coping with the environment, and more attention/hyperactivity problems compared to those with less hours of fussing. Results suggest that hours of fussing rather than crying could be an early marker for infants at risk.     

The Psychiatric Diagnosis of Alcohol Abuse and the Medical Diagnosis of Alcoholic Related Liver Disease: Effects on Liver Transplant Survival

The present study investigated whether differing diagnostic criteria for alcoholism used by mental health professionals versus hepatologists lead to different outcomes in predicting liver transplant survival as determined by the medical record and without a priori judgments. This was in contrast to past studies, particularly in the liver transplant literature, demonstrating comparable survival rates between alcoholics and non-alcoholics that have typically employed a diagnosis of Alcoholic Liver Disease (ALD), which does not capture the salient maladaptive behavioral and interpersonal features associated with DSM-IV-TR diagnoses of Alcohol Abuse (AA) and Alcohol Dependence (AD). A series of survival analyses were conducted using data culled from the psychological and medical records of 358 first-time liver transplant recipients at Barnes-Jewish Hospital in St. Louis, Missouri. The primary outcome investigated was liver graft survival following transplant surgery. Follow-up times varied from 0 days to 13 years, depending on the time of transplant and length of graft survival, with a median follow-up time of 6.2 years. Diagnoses of AA and AD predicted significantly poorer survival rates, while diagnoses of ALD did not. DSM-IV-TR alcoholism criteria appear to have greater utility for predicting survival differences beyond pathophysiologically defined alcoholic liver failure.     

The basolateral amygdala and nucleus accumbens core mediate dissociable aspects of drug memory reconsolidation

A distributed limbic-corticostriatal circuitry is implicated in cue-induced drug craving and relapse. Exposure to drug-paired cues not only precipitates relapse, but also triggers the reactivation and reconsolidation of the cue-drug memory. However, the limbic cortical-striatal circuitry underlying drug memory reconsolidation is unclear. The aim of this study was to investigate the involvement of the nucleus accumbens core and the basolateral amygdala in the reconsolidation of a cocaine-conditioned stimulus-evoked memory. Antisense oligodeoxynucleotides (ASO) were infused into each structure to knock down the expression of the immediate-early gene zif268, which is known to be required for memory reconsolidation. Control infusions used missense oligodeoxynucleotides (MSO). The effects of zif268 knockdown were measured in two complementary paradigms widely used to assess the impact of drug-paired CSs upon drug seeking: the acquisition of a new instrumental response with conditioned reinforcement and conditioned place preference. The results show that both intranucleus accumbens core and intrabasolateral amygdala zif268 ASO infusions at memory reactivation impaired the reconsolidation of the memory underlying a cocaine-conditioned place preference. However, knockdown of zif268 in the nucleus accumbens at memory reactivation had no effect on the memory underlying the conditioned reinforcing properties of the cocaine-paired CS measured subsequently, and this is in contrast to the marked impairment observed previously following intrabasolateral amygdala zif268 ASO infusions. These results suggest that both the basolateral amygdala and nucleus accumbens core are key structures within limbic cortical-striatal circuitry where reconsolidation of a cue-drug memory occurs. However reconsolidation of memory representations formed during Pavlovian conditioning are differentially localized in each site.Through Pavlovian association with the effects of addictive drugs, a conditioned stimulus (CS) acquires both general motivational and sensory-specific conditioned reinforcing properties (Everitt et al. 2000). These associations contribute to the high likelihood of relapse in addicted individuals, yet the extinction of drug CSs by nonreinforced exposure has proved to be of limited therapeutic utility (Conklin and Tiffany 2002). In abstinent humans, drug CSs evoke salient and persistent memories of drug-taking experiences, inducing craving and relapse (Childress et al. 1988; O''Brien et al. 1992), while in animals they also precipitate relapse to, or reinstatement of, drug-seeking behavior (de Wit and Stewart 1981; Meil and See 1996; Fuchs et al. 1998; Weiss 2000). Thus, disrupting drug-related memories might significantly diminish relapse propensity on subsequent exposure to drug-paired CSs, and thereby promote abstinence.Exposure to a drug-associated CS also triggers a process of memory reconsolidation, which restabilizes the reactivated and labile memory (Nader 2003). While reconsolidation may adaptively update memories (Dudai 2006; Hupbach et al. 2007; Rossato et al. 2007; Lee 2009), its disruption may reduce the impact of intrusive or aberrant memories on behavior subsequently (Lee et al. 2005, 2006; Brunet et al. 2008; Kindt et al. 2009; Taubenfeld et al. 2009). The reconsolidation of CS–cocaine memories has been shown to depend upon protein synthesis and expression of the plasticity-associated immediate-early gene, zif268, in the basolateral amygdala (BLA), since zif268 knockdown at memory reactivation disrupted the acquired conditioned reinforcing properties of the CS measured in drug-seeking tasks days or weeks later (Lee et al. 2005, 2006).Although the BLA has an established role in CS-drug memory reconsolidation, it remains unclear whether other sites within limbic cortical-ventral striatal circuitry participate in this process. The nucleus accumbens core (AcbC) is a primary candidate, as zif268 is up-regulated in the AcbC as well as in the BLA following exposure to cocaine CSs (Thomas et al. 2003). Furthermore, the AcbC, which is strongly implicated in Pavlovian influences on drug seeking and relapse (Cardinal et al. 2002; Kalivas and McFarland 2003), has been shown to be a site where the reconsolidation of a drug conditioned place preference (CPP) memory can be disrupted (Miller and Marshall 2005).Given the evidence of increased zif268 expression in the AcbC following CS-drug memory reactivation, we investigated its requirement in the reconsolidation of cocaine-associated memories. To address this issue, we employed two different but complementary paradigms widely used to measure the conditioned effects of CSs associated with drugs of abuse: the acquisition of a new instrumental response with conditioned reinforcement (ANR) and CPP. These procedures have been used successfully to investigate the mechanisms underlying the reconsolidation of appetitive Pavlovian memories, but it is likely that they depend upon different associative mechanisms (Everitt et al. 1991; White and McDonald 1993) that in turn depend upon different neural loci within limbic cortical-striatal circuitry (Cardinal et al. 2002). Therefore, to enable a full comparison with the functional involvement of the BLA, we investigated the necessity for BLA zif268 expression in drug memory reconsolidation as assessed in the CPP paradigm.