Book reviews

Wilfred Bion is regarded as a psychoanalytic purist and his austere portrayal of the analytic aim and attitude is often considered to make impossible demands on patient and analyst alike. Not surprisingly, the applicability of Bion's theory and recommended practice to once-weekly psychotherapeutic work is often questioned. Bion is thus ambivalently regarded by psychotherapists as the embodiment of an analytic ideal, whose developmental theories are important, but whose practical utility is doubted, especially in the context of the typical therapeutic setting. This paper seeks to challenge these assumptions by presenting the once-weekly therapy of a woman with attenuated mentalizing capacity and a tendency to destructive acting out. The therapy was guided by the application of central concepts, models and ‘technical’ principles emerging from my understanding of Bion's work. The aim of the paper is to demonstrate that Bion's utility is not confined to formal psychoanalytic settings and that his work may be usefully applied in more modest psychotherapy contexts.     

DESIRE AND RESPONSIBILITY: THE ETHICS OF COUNTERTRANSFERENCE EXPERIENCE

The analyst's desire expressed in impactful wishes and intentions is foundational to countertransference experience, yet undertheorized in the literature. The “wider” countertransference view, associated with neo‐Kleinian theory, obscures the nature of countertransference and the analyst's contribution to it. A systematic analysis of the logic of desire as an intentional mental state is presented. Racker's (1957) talion law and Lacan's (1992) theory of the dual relation illustrate the problems that obtain with a wholesale embrace of the wider countertransference perspective. The ethical burden placed on the analyst in light of the role played by desire in countertransference is substantial. Lacan's ethics of desire and Benjamin's (2004) concept of the moral third are discussed.     

Does it matter how I perceive my nation? National symbols,national identification and attitudes toward immigrants

We examined how the ways of imagining one's own nation relate to the relationship between national identification and individuals’ attitudes towards immigrants. National imagination is studied through two types of national symbols representing the nation in terms of confrontation between groups (i.e., war and sports) and a unique entity (i.e., nature and traditional culture). We found that national identification was positively associated with the degree to which individuals perceived their nation through a historical war and sports, which, in turn, enhanced negative attitudes toward immigrants. Unexpectedly, the degree to which individuals perceived their nation through nature and traditional culture was positively associated with positive intergroup attitudes. The results emphasize that the degree to which individuals perceive their nation through different national symbols is an important factor for understanding intergroup relations.     

Projective identification fifty years on: A personal view

Since its introduction by Melanie Klein in 1946 the concept of projective identification has inspired, baffled, rankled, but always mesmerized its adherents and opponents alike. I offer in this paper a brief outline of the concept's development over the past fifty years by way of some thoughts on a personal journey of discovery surrounding its meaning and clinical usefulness to my work as a child therapist. I would like to suggest that definitions in current use seem to be derived more from adult work than from work with children, which has sometimes skewed the debate surrounding the concept in a particular direction. In both its conceptual guises, namely, as an unconscious 'phantasy' and as an interpersonal feature of the transference, projective identification is a logical extension of certain aspects of Klein's work with small children. In child work too the developmental status of the concept comes more into focus.     

You can't miss what you've never had: Can you?: The challenges and struggles of single parenthood from a psychoanalytic perspective

The issue of the growth of single-parent families has been in the forefront of political, social and moral debate in recent years. Children from single-parent families tend to be over-represented in clinic populations. Yet this state of My being may be no more potentially pathological than the nuclear family, which can become conceptually idealized The aim of this paper is to look behind the statistics and examine the impact on children of life in a single-parent family, to explore how this may be managed, and to look for potentiating factors which can enable good-enough development to unfold. Case material is used to illustrate the theme.     

Mirroring,imitation, identification: the sense of self in relation to the mother's internal world

The phenomenon of neonatal imitation, and the use of mutual imitation by mother and baby in the service of attunement, are considered in relation to psychoanalytic theories of mirroring, imitation and identification. Material from infant observation and from the treatment of two children on the autistic spectrum is discussed in terms of the suggestion that developmental imitation implies a perceived position of balance between the external baby and the mother's supposed internal occupant. This is seen as making possible introjective identification and assimilation, with the enrichment of the sense of identity, in contrast to the kind of imitation involving mimicry, in which adhesive or projective identification may be operative.     

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     

MODES OF IDENTIFICATION: FREUD'S CONCEPTS REORGANIZED

The author examines Freud's conceptualizations of identification, Melanie Klein's projective identification, and Anna Freud's identification with the aggressor and altruistic surrender of one's own instinctual impulses. After demonstrating that Freud's concept primary identification refers not to a process but to the state of being identified, he suggests the substitution of it with Sandler's term “oneness”. He notes that hysterical identification, narcissistic identification, and introjection are unconscious processes that lead to a state of oneness and that they can be distinguished clinically in terms of the emotional meaning that an object holds for the individual. Furthermore, it is shown that the concept of identification with the aggressor represents a defense mechanism of its own and a specific mode of narcissistic identification, which together with projections and hysterical re-identification play a decisive rôle in projective identification and altruistic surrender of one's own instinctual impulses.