Discussion: Toward a social‐constructivist view of the psychoanalytic situation

The three papers by Modell, Aron, and Greenberg are discussed in terms of their relationship to a new paradigm for understanding the psychoanalytic situation. The paradigm is called social‐construct‐ivist to capture both the idea of the analyst's participation and the idea of construction of meaning. It is argued that these theorists, as well as many of the authors they cite as part of a broad movement in the field, do not consistently meet the criteria for this paradigm, although they seem to be aiming for it. An important source of inconsistency and confusion derives from the confounding of the two axes: drive‐relational and positivist‐constructivist. Many relational theorists who hold fast to the idea that analysts can grasp the truth of both their own experience and that of the patient are no closer to the constructivist point of view than was Freud. The call by Aron and Greenberg for greater attention to the patient's resisted experience of the analyst's subjectivity is discussed in terms of its potential benefits and problems. The ritualized asymmetry of the psychoanalytic situation is said to have important functions, including prevention of excessive involvement and protection of the unobjectionable positive transference and of a degree of idealization. Modell's notion of paradox, which makes the therapeutic relationship seem “real”; and “unreal”; at the same time, is seen as a special instance of the always precarious social construction of reality. It is argued, moreover, that the social and individual aspects of experience are interdependent. Neither is reducible to the other, and both should be understood, like many other issues in the new paradigm, in terms of a dialectical interplay of figure and ground in experience.     

Response to Slavin: Considering the Evolutionary and Existential Contexts of Dialectical Constructivism

Within his evolutionary framework, Slavin elaborates eloquently on the dialectic of construction of meaning and anticipation of death. Also within that framework he highlights the emergence of the universal dialectic of self-interest and care for others, perhaps finding its most poignant expression in the relation of parents and children. I raise questions about Slavin's attribution of a “sense of loss” to humans who allegedly long for the experience of evolutionarily earlier species, particularly their sense of automatic connectedness and automatic ways of relating to the world free of the burdens of uncertain, self-conscious choice. A longing for earlier states in human development is easier to grasp than a longing for the experience of less advanced species from which humans evolved. Nevertheless, Slavin's views and my own are otherwise deeply compatible, particularly his sense of what emerges as the uniquely human challenge of intersubjective construction of meaning in the context of individual self-interest and in the face of death. Slavin is also emphatic that the pervasiveness of absolute belief systems that preempt awareness of ambiguity, the anxiety of freedom, and the dread of death, does not gainsay their defensive nature. I argue, in accord with Altman, Butler, and others, that denial of death may promote dissipation of communal sensibility and replacement of it in a capitalist world (and perhaps others as well) with destructive splitting and fetishistic, competitive pursuit of money and power.     

Response to Safran: The Development of Critical Psychoanalytic Sensibility

Jeremy D. Safran feels that my views regarding the relative merits of case studies and systematic empirical research are unnecessarily polarizing. I feel that, on the contrary, I'm offering bridges between my perspective and those of researchers on psychoanalytic process and outcome in two ways. One is through my own constructivist critique of traditional positivist case studies and theorizing based upon clinical experience. The second is through conceptualizing the place of systematic research within a constructivist paradigm. I am arguing that its place can be no different than that of case studies. Both generate possibilities for any particular analyst or analytic therapist to have in mind as he or she works with a particular patient at a particular moment. Safran locates the destructive effects of scientism with “biologically oriented researchers and cognitive therapists.” In my view, it might be convenient if the problem could be located exclusively with them, but the fact is that psychoanalytic researchers, as I demonstrate, are working largely within the same paradigm as their adversaries in the research world. That paradigm erroneously privileges systematic research as hypothesis-testing, whereas case studies are relegated to the status of anecdotal, hypothesis-generating work. I describe what I call “nonlinear constructivist learning” as the kind of “generalization” that case studies can yield and that is optimal for our field.     

Care and Justice Moral Orientation: A Scale for Its Assessment

A quantitative measure of adult moral orientation, based on the theoretical frameworks of Kohlberg and Gilligan, was developed to measure preference for "justice" or "care"-oriented moral thinking. The Moral Orientation Scale Using Childhood Dilemmas (MOS), a short, objective measure, presents adults with a series of dilemmas frequently faced by children, each followed by two care-oriented and two justice-oriented responses to the dilemma. The procedures for developing and scoring the measure are discussed, and validity and reliability data are presented. Used with both male and female social work and law students, as expected, the MOS shows males to be more justice-oriented in their moral reasoning than females who are shown to be more care-oriented. Moreover, in further agreement with Gilligan's theory that gender and experience, taken together, are related to moral reasoning style, male lawyers and female social workers are shown to have the strongest preferences.     

A Bibliometric Analysis of the Quantitative Mental Health Literature in Occupational Therapy

ABSTRACT

A bibliometric analysis was performed to examine the impact and use of the peer-reviewed occupational therapy intervention effectiveness literature addressing adults with mental illness, 2000–2016. Of 2,597 articles, 68 were quantitative studies assessing an intervention for adults with mental illness. These studies had a collective citation count of 1,455 and were published in 29 journals in 14 countries. The majority (n?=?36; 52.94%) were randomized controlled and two-group controlled studies. The most commonly assessed interventions were life skills and community reintegration (n?=?20, 29.41%) and supported employment (n?=?16, 23.52%). Sixty-five (95.58%) studies found statistically significant results on the primary or secondary outcomes.     

The areas of change questionnaire: A cross-cultural comparison of israeli and american distressed and nondistressed couples

Abstract

This study examines Israeli couples' presenting complaints about their relationship, their perceptions of one another's complaints and perceptual accuracy between actual and perceived complaints, using the Areas of Change Questionnaire (ACQ). Samples were obtained of both distressed and nondistressed couples. Each sample met stringent criteria for categorization as distressed and nondistressed. Normative data for both samples are examined and areas of similarities and differences are discussed. The instrument is found to discriminate distressed and nondistressed Israeli couples. Results are compared with a previous study of American distressed and nondistressed couples. The American finding that women desire more change in marriage is not replicated in the Israeli sample, nor the American finding that distress and stage in the life cycle are related. However, there is an indication in both samples that men, compared to women, perceive more requests for change. Men in both cultures also feel more change is asked of them than they themselves ask in return.     

Countertransference and containment in a patient with a psychotic mother

The importance of countertransference reactions in the treatment of a borderline patient with a psychotic suicidal mother is discussed. In such a case containment can be seriously disrupted by the violence of the patient's projections into the therapist. Where a psychotic internal object has been brought for treatment it is particularly important that the therapist be able to identify not only with the sane and mad parts of the patient but with the destructiveness and cruelty of the patient and her primary object. The difficulties of tolerating these relentless projections of madness and despair are increased by the multiple and confusing aims of the patient's excessive use of projective identification. The invasive and hostile aspects of this are often heavily disguised beneath idealization of the self and object as well as of madness itself. For the patient, attempts to interpret the idealization are moreover felt as an assault on the lost loved object, and the therapy then unconsciously becomes a persecutory experience for the patient. The therapist can thus be drawn into feeling the full force of the anger and hatred towards the real disappointing object and the sense of hopelessness about the reparative task. Although such feelings need to be tolerated, eventually some distance from the often-unpleasant fluctuations in the countertransference must develop if a useful degree of containment is to be achieved.     

The Disappearing (or Ghost) Mother Transference: In Search of the Available Mother Within

As analysts, we speak of maternal transference as if it were a unitary phenomenon. We are trained to expect intense, powerful transference reactions. Yet there is a group of female patients who have a specific type of transference that lacks intensity. These patients often present by not presenting. I term this phenomenon the disappearing (or ghost) mother transference. This transference is quiet and does not create much stress. Using a case example, I will define this particular type of object relationship and discuss an alternative technique in treating these patients. It is my premise that these women must discover for themselves, at their own time and in their own way, the caring, living, available mother in the analyst.     

Expect the Unexpected? Variations in Question Type Elicit Cues to Deception in Joint Interviewer Contexts

We examined the effect of (i) a second interviewer's demeanour and (ii) asking expected and unexpected questions on cues to deception. We predicted that liars compared with truth tellers would provide more detail to expected questions and less detail to unexpected questions, particularly when the second interviewer is supportive. Liars prepare answers for expected questions, and a supportive interviewer will encourage them to provide more detail. By definition, liars have not prepared answers for unexpected questions, and their answers to such questions will be less detailed. Participants (N = 168) appeared before two interviewers: The first asked all the questions, and the second remained silent. The second interviewer exhibited either a supportive or a neutral demeanour. As predicted, liars provided more detail to expected questions and less detail to unexpected questions, particularly when the second interviewer was supportive. In conclusion, a supportive second interviewer elicits cues to deceit. Copyright © 2013 John Wiley & Sons, Ltd.