Moved to tears: Technical considerations and dilemmas encountered in working with a 13-year-old boy with acquired quadriplegia 1

This paper is about therapeutic work with David, a 13-year-old boy who, at the age of 5, was the victim of a hit-and-run road traffic accident resulting in quadriplegia. The circumstances leading to the accident and its sequelae reveal a particularly complex picture, which combines early emotional deprivation and trauma. Although cognitively intact and able to speak, David could not move. Yet he created movement in others through a desperate necessity, by communicating via the employment of extreme projective forces. The highly complex presentation of emotional, psychic and bodily damage in the child, and in particular, David's physical paralysis, has had a profound impact upon what I have come to think of as the ‘mindbody’ of the therapist. Winnicott has talked of the infant's ‘psyche/soma’. Here I want to extend the notion and consider the bodily impact of projections in particular and how these have a powerful emotional and physical resonance on the ‘mindbody’ of the therapist, especially in therapy with a young person whose body is damaged. In this paper, I consider technical challenges and dilemmas encountered in the work, including the complex interplay of transference/countertransference phenomena. This unusual presentation of a boy in extraordinary circumstances led to considerations of psychoanalytic method and interpretative activity, which may be viewed as being inspired by ‘emotional truthfulness’.2 2 Alex Dubinskey (Chair ACP conference 2004) commenting on aspects of this work used the term ‘emotional truthfulness’.

Dans cet article, l'auteur raconte son travail thérapeutique auprès de David, âgé de 13 ans, qui à l'âge de 5 ans fut victime d'un accident de la circulation avec délit de fuite, accident qui le laissa tétraplégique. Les circonstances qui aboutirent à l'accident et à ses séquelles forment un tableau particulièrement complexe mettant en jeu des carences affectives précoces et des traumatismes. Bien que ses capacités cognitives ne fussent nullement atteintes et qu'il fut capable de parler, David ne pouvait pas bouger. Par l'urgence désespérée de son discours, transmise grâce à des projections extrêmement puissantes, il réussissait à susciter du mouvement chez ses interlocuteurs. La présence conjointe et extrêmement complexe de dommages affectifs, psychiques et corporels chez cet enfant – et notamment sa paralysie physique – eut un impact profond sur ce que l'auteur en vient à appeler l'“ esprit-corps ” du psychothérapeute. D. W. Winnicott a parlé du “ psyché-soma ” du jeune enfant. Dans son texte, l'auteur élargit cette notion, notamment pour prendre en considération l'impact corporel des projections, ainsi que leur résonance émotionnelle et physique massive sur l'“ esprit-corps ” du thérapeute, surtout lorsque son patient est une personne jeune dont le corps est endommagé. L'auteur explore les défis et dilemmes techniques rencontrés au cours de son travail, y compris le jeu complexe de phénomènes transférentiels et contre-transférentiels. Ce traitement, inhabituel, avec un garçon dans des circonstances sortant de l'extraordinaire soulève des questions concernant la méthodologie psychanalytique et l'activité interprétative, questions qui peuvent être considérées comme étant inspirées par la “ véracité émotionnelle ”.

Dieser Artikel ist über die therapeutische Arbeit mit David, einem 13-jährigen Jungen, der im Alter von 5 Jahren das Opfer eines Unfalls mit Fahrerflucht war, der zu einer Querschnittslähmung führte. Die Umstände, die zu dem Unfall führten und seine Folgen legen ein besonders komplexes Bild dar, das frühe Vernachlässigung und Trauma kombiniert. Obwohl David kognitiv intakt war und sprechen konnte, konnte er sich nicht bewegen. Doch schaffte er Bewegung aus verzweifelter Notwendigkeit in anderen, indem er mit mithilfe der Benutzung von extremen projektiven Kräften kommunizierte. Die höchst komplexe Präsentation von emotionalem, psychischem und körpelichem Schaden in dem Kind und insbesondere Davids körperliche Lähmung, hatte eine tiefe Auswirkung auf das, was ich nun den ‘mindbody’ (Gemütskörper) des Therapeuten nenne. Winnicott sprach vom Psyche/Soma des Babies. Hier möchte ich diesen Begriff ausweiten und besonders die köperliche Auswirkung der Projektionen betrachten und wie diese eine starke emotionale und physische Resonanz auf den ‘mindbody’ des Therapeutens haben, insbesondere in der Therapie mit einer jungen Person, deren Körper beschädigt ist. In diesem Artikel betrachte ich technische Herausforderungen und Dilemmas, denen man in dieser Arbeit begegnet, einschliesslich der komplexen Wechselwirkung von Übertragungs/ Gegenübertragungsphänomenen. Diese ungewöhnliche Behandlung mit einem Jungen in aussergewöhnlichen Umständen führten zu Überlegungen zur psychoanalytischen Methode undzur Deutungsaktivität, die von ‘emotionaler Wahrheit’ inspiriert wird

Riassunto: In questo articolo si parla del lavoro terapeutico con David, un bambino di 13 anni che, all'età di 5 anni, fu vittima di un incidente stradale che portò alla quadriplegia. Le circostanze che portarono all'incidente e la sua sequela rivelano un quadro particolarmente complesso, nel quale emerge un misto di deprivazione emotiva precoce e trauma. Sebbene David fosse abile cognitivamente e potesse parlare, egli non poteva muoversi. Eppure il bambino generava movimento negli altri attraverso una disperata necessità, comunicando con l'uso di estreme forze proiettive. Il presentarsi di un danno nel bambino altamente complesso nella sua dimensione emotiva, psichica e corporea, ed in particolare, la paralisi fisica di David, hanno avuto un profondo impatto su ciò che ho iniziato a pensare come il ‘corpomente’ del terapeuta. Winnicott ha parlato dello ‘psiche/soma’ del neonato. L'autrice vuole nell'articolo estendere la nozione e considerare l'impatto corporeo delle proiezioni e come queste abbiano una risonanza emotiva e fisica molto forte sul ‘corpomente’ del terapeuta, soprattutto nella terapia con un ragazzo giovane il cui corpo è stato danneggiato. Nell'articolo considero le sfide tecniche e i dilemmi incontrati nel lavoro, compreso il gioco complesso dei fenomeni transferali e controtransferali. Il trattamento insolito con questo bambino in circostanze molto particolari ha portato a considerazioni riguardo al metodo psicoanalitico e all'attività interpretativa, che si possono considerare come ispirati da ‘verità emotiva'¹     

To know or not to know: an application of Bion’s K and –K to child treatment1

The authors discuss an application of Bion’s conceptualisation of thinking and non-thinking states (K and –K links) to the treatment of a nine-year-old girl. The authors consider Bion’s interrelated concepts such as K and –K, container/contained, maternal reverie, and the development of thinking through alpha function to be highly applicable to child treatment. The afore-mentioned conceptual elements are used to elucidate case material over two consecutive hours. A K link is established between therapist and patient, the fragility of which link is then demonstrated by its deterioration into a –K link. Complex issues about knowing and not knowing are central in this girl’s clinical presentation. She was conceived through in vitro fertilisation (IVF), and subsequently diagnosed with cerebral palsy. The authors consider the emotional impact of this origin story and how the parents relate to it. The authors discuss how parents sometimes cope with perceived losses by wishing to shield or protect their children. This can have repercussions for children’s efforts to know (K) and not to know (?K). The fear that emotional knowledge will be too painful to bear can interfere with ‘learning from experience’. Bion’s premise that the purpose of analysis is the growth of the mind is synonymous with the child analyst’s goal of fostering development and understanding impediments to development.     

Some Evidence is False

According to some philosophers who accept a propositional conception of evidence, someone's evidence includes a proposition only if it is true. I argue against this thesis by appealing to the possibility of knowledge from falsehood.     

中学生知识获得过程是从情景记忆向语义记忆转化的过程

本研究探讨中学生的知识掌握过程。针对2001—2002年度上学期教学内容,对初中二年级学生的四门课程分别进行两次测验。对于每道选择题,学生首先选择正确答案,然后指出记忆的意识状态：记住的、知道的、猜测的。结果发现,学生记忆意识类型的转变(由记住向知道)取决于课程类型、保持时间和学生等级。对于不同课程,学生占优势的意识类型不同,自然学科知道的反应占优势,社会学科记住的反应占优势;优等生知道的反应多于其他学生;随着学习时间的延长,中学生的意识类型发生了由记住向知道的转变,这表明知识掌握过程中,中学生的知识表征发生了由情景记忆向语义记忆的转变。     

Establishing discriminative stimulus control within generalized oddity performance,without reinforcement

In two oddity learning studies with children, subjects were reinforced for oddity (or nonoddity) responding on line-tilt or dot numerosity problems. Interposed form and color problems were not reinforced. No instructions to make oddity choices were given. In Experiment I it was found that reinforcement for oddity or nonoddity responding on tilt and numerosity problems produced the corresponding tendency toward oddity or nonoddity performance on these problems and also on the nonreinforced form and color problems. These results show a generalized oddity phenomenon similar to generalized imitation. In Experiment II a third type of nonreinforced problem was presented in this same format: compound stimuli permitting either a color or a form solution. It was found that immediate prior training with nonreinforced form problems, interpolated among the reinforced tilt and numerosity problems, led to form-oddity choices in the compound problems. Similarily, color pretraining produced color-oddity choices. These results show that selective discriminative stimulus control can be obtained in oddity learning, without reinforcement for choices on either of the two dimensions involved.     

Perceived characteristics of “competent” people

The purpose of this research was to determine the specific behaviors and cues which 104 assessors perceived as indicating the presence of psychological variables shown to be related to competent job behavior. The cue systems utilized were found to be reminiscent of theory Y conceptions of effective job behavior. Implications of the lack of correlation of cue utilization with assessor characteristics are discussed.     

The child's memory for actional, locational, and serial scenes

Three-, four-, and six-year-old children (N = 180) were tested for recall of a toy missing from a previously seen display of four toys. Toys were displayed initially as a series (StoS), as a unit (UtoU), or moved from a series to a unit as S watched (StoU). There was a significant increase in memory for the missing toy with age. In addition, children viewing StoU displays remembered significantly more toys than did children viewing the other displays, independent of age. Twenty-five percent of the 6-year-olds rehearsed spontaneously while viewing the displays. Results indicated that the nature of a memory unit does not change with age, that memory improves with age, and that separate visual and verbal memories are operative in Ss in this age range.     

Sometimes frequently means seldom: Context effects in the interpretation of quantitative expressions

Subjects supplied numerical definitions for five quantitative expressions embedded in two high-frequency contexts, one moderate-frequency context, two low-frequency contexts, and with no context specified. Mean definitions differed significantly across contexts and expressions with a Context-Expression interaction (p < .01). The variance in definition of an expression embedded in a context generally increased with the discrepancy between its no-context definition and the context event's estimated frequency (p < .05). Variance in the definitions of the sampled expressions gathered over diverse contexts increased with the expression's no-context definition (p < .05). Thus, the mean and variance of an expression's numerical definitions depended upon both the expression and its context.