Psychoanalysis and the political process

The Political Process is Society's mechanism for debating value systems. The term can also be used to describe a debate in a variety of other settings — subsystems of Society — about value systems. This paper is about the contributions that psychoanalysis, both as a theory and in its various applications, can make to the understanding of the process of debate and its setting. It is also about the implications for our conduct that arise from this understanding.     

When it is not the patient who pays

This paper looks at the question of third-party payments in psychotherapy and psychoanalysis. This is of particular relevance in Holland, where the Dutch government makes substantial payments for psychoanalytic treatment via a state insurance system. The literature concerning third-party payments is reviewed. Freud himself was inconsistent about this matter and cannot therefore be relied on to give a clear guideline. The majority of writers are heavily in favour of ‘personal sacrifice’ and show a strong bias, especially against insurance payments for fees. These arguments are examined in detail and the two main conclusions are explored, namely that (1) certain unconscious conflicts cannot be mobilised where there is external financing, and (2) that the absence of personal sacrifice engenders too much wish-fulfilment. Both these arguments are rejected as being biased and are found not to stand up to detailed scrutiny.

The effects that different types of payment have on the development of the therapeutic situation, and the different types of transference and countertransference problems that each engenders, are explored. There is some speculation as to the reason for the persistence of this view if it is so patently false. Finally there is some consideration of the positive effects third-party payments can have on psychoanalytic practice.     

Manic-depressive psychosis: Psychopathology and individual psychotherapy within a psychodynamic milieu

Manic-depressive patients are not usually regarded by psychiatrists as suitable subjects for psychotherapy, and there are many reasons for this view. Psychological support tends to take the form of helping the patient adjust to his disability, to become more aware of the life situations which may disturb him, of warning symptoms, of the need for appropriate medication, and perhaps to explore the most significant life conflicts. Psychoanalytic psychotherapy aimed at conflict resolution and personality development is widely regarded as impracticable, or ineffectual at best, or, at worst, as a potentially dangerous intervention. Considering the fact that the risk of suicide in the depressive phases may be so great, the problems of containing the disinhibited manic episode so serious, and the social consequences of such episodes so disastrous, it is not surprising that pharmacological control of pathological symptoms is so often regarded as the only therapeutic aim.

This paper is based on an account of a single patient suffering from a severe manic-depressive disorder with schizoid features, and a family history of manic-depressive illness, who was treated with individual intensive psychoanalytic psychotherapy in a context of a psychodynamic psychiatric ward, with encouraging results. Some implications of this experience will be discussed.     

Development of the concepts of transference and counter-transference

SUMMARY

This paper traces the development of the concepts of transference and counter-transference over nearly a hundred years, from the origin of the concepts to current understanding of them. Clinical material will be given to illustrate some of the ideas held today.     

A new look at the vulnerability of puerperal mothers — A clinical study of two inpatient families at the Cassel Hospital

SUMMARY

The paper reviews some previous writings by Dr. Tom Main and Dr. Peter Lomas about the work of the Cassel Hospital with puerperal mothers. It goes on to describe the case histories and treatment of two patients recently treated with their families. The emphasis is on actual material produced in therapy but with reference to other aspects of the much wider treatment structures employed by the Cassel, for example the nursing and the community. Important aspects focussed upon include the essential experience of good mothering in becoming a mother, how closeness to the infantile impulses and urges of a real baby can lead to profound measures of identification and projection, and the effects of motherhood on femininity and sexuality.     

White-matter microstructure and language lateralization in left-handers: A whole-brain MRI analysis

Most people are left-hemisphere dominant for language. However the neuroanatomy of language lateralization is not fully understood. By combining functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), we studied whether language lateralization is associated with cerebral white-matter (WM) microstructure. Sixteen healthy, left-handed women aged 20–25 were included in the study. Left-handers were targeted in order to increase the chances of involving subjects with atypical language lateralization. Language lateralization was determined by fMRI using a verbal fluency paradigm. Tract-based spatial statistics analysis of DTI data was applied to test for WM microstructural correlates of language lateralization across the whole brain. Fractional anisotropy and mean diffusivity were used as indicators of WM microstructural organization. Right-hemispheric language dominance was associated with reduced microstructural integrity of the left superior longitudinal fasciculus and left-sided parietal lobe WM. In left-handed women, reduced integrity of the left-sided language related tracts may be closely linked to the development of right hemispheric language dominance. Our results may offer new insights into language lateralization and structure–function relationships in human language system.     

“Hotspots” in trauma memories in the treatment of post-traumatic stress disorder: A replication

“Hotspots” refer to memories of detailed moments of peak emotional distress during a traumatic event. This study investigates hotspot frequency, and the emotions and cognitions contained in hotspots of memory for trauma, to replicate a previous study in this area (Holmes, Grey, & Young, 2005). Participants were patients receiving treatment for post-traumatic stress disorder (PTSD) at a specialist outpatient clinic after experiencing a range of traumatic events. The main finding was that, after fear, the most common emotions reported were anger and sadness. Cognitions related to psychological threat to the self were more common than those related to physical threat.     

Long-term memory for the emotional gist and the emotional essence of an experience

We investigated accuracy in recalling past emotional behaviours and emotionality. Male couples discussed the history of their relationship, and coders rated the extent to which each partner engaged in behaviours such as complimenting or criticising. These ratings were combined into dimensions representing the deeper, emotional essence of that partner's discussion (expressions of We-ness, Fondness, Negativity, and Disappointment). Four years later, participants accurately recalled some of their own and some of their partner's emotional gist-level behaviours, but their answers indicated that they also remembered the emotional essence of the conversation. We conclude that individuals can retain the emotional essence of an experience for a long time, and that they may use this memory to infer, in part, gist-level details of the experience.     

Countertransference issues in psychotherapy with lesbian and gay clients

This article briefly reviews literature on responses towards same-sex (lesbian and gay) sexualities from psychoanalytic and ‘lesbian and gay affirmative’ psychotherapeutic perspectives. An analysis is presented of reports of countertransferential reactions to lesbian and gay clients, obtained from interviews with fourteen psychotherapists who work in a lesbian and gay affirmative manner and eighteen clients who had received affirmative psychotherapy. Data were subjected to grounded analysis. Participants consistently attended to the thoughts, feelings and values that therapists held in relation to lesbian and gay clients and how these affected the meanings and practices available to them. These were linked with the therapist's sexual identity among other factors. Negative countertransferential reactions were regarded as potentially occurring among heterosexual and lesbian and gay therapists and were seen as arising from therapists’ conscious and unconscious fears about same-sex sexualities. These findings indicate a need to continue debating these issues more widely in the professional arena.