Mental models and language registers in the psychoanalysis of psychosis: An overview of a thirteen‐year analysis2

The author suggests that the use of mental models and language registers may help an analysis to proceed, especially in psychosis, when the patient has not yet developed a mental space that will allow him/her the functions of knowledge and containment of emotions. Models, according to Bion, are a primitive approach to abstraction and a manifestation of the analyst's reverie that enables him/her to transform sense data into alpha‐elements. Ferrari, in a further development of Bion's theories, hypothesises a relationship between the transference and the internal level of body‐mind communication, and proposes the use of language registers to sustain the psychoanalytic process. The author presents several clinical examples from a thirteen‐year, four‐session‐a‐week analysis of a psychotic analysand who was initially confused, paranoid and altogether unable to bring self‐reflective thought to bear on her overwhelming emotions and had, by the end of the analysis, completely recovered from her psychotic symptoms. The clinical material shows how the technical tools of mental models and language registers helped in the construction of a mental space and spatio‐temporal parameters, permitting the patient to tolerate overwhelming concrete emotions and finally to recognise and work through the emotions of an intense transference.     

The Inner World of the Genetic Counselor

The external experience of genetic counselors reflects and is processed in their personal inner worlds. A small window into that private interior is opened here revealing the strengths and frailties, vulnerabilities and sensitivities professionals bring to bear in their work. The relational, human interplay—between counselor and colleagues, counselor and clients, counselors in their nonprofessional roles relative to others—is the primary focus of the interior experience.     

A reappraisal of classical archetype theory and its implications for theory and practice

Abstract: This paper begins with an overview of contemporary approaches to archetype theory and notes the radical nature of certain deductions. Some argue that there is no ‘archetype‐as‐such’ as a pre‐existing entity at the core of a complex driving its formation whilst the findings of current neuroscience are calling into question one very thing on which the classical theory is built – innatism. Knox's argument for image schemas raises the question as to the extent to which archetypes can be conceived in any preformationist sense. The question is then posed – to what extent can Jung's classical theory of archetypes be read in light of these current models? The case examples Jung uses to evidence the existence of archetypes, his explications of synchronicity and his own Philemon experience are then reappraised. The conclusion is drawn that it is difficult to evidence the existence of autonomous archetypes unrelated to personal affective experience. Not only would this be expected by emergent/developmental models of archetype but it can explain many of Jung's disjunctive statements about archetype constellation; the difficulties in separating personal and collective psychic content and Jung's apparent Lamarckianism. The implications of these models for theory, clinical practice and analyst training are then offered for discussion.     

Going home: migration as enactment and symbol

Abstract :  The concepts of home and migration are briefly explored. Reference is made to the reflections of several writers on migration suggesting that migrants may experience alienation, even permanent melancholia. There is discussion of the need to mourn what has been lost and left behind, and of the challenge in analytic work with a migrant to relate to the pain of the individual's core self amid environmental and cultural losses. The paper outlines the history of an individual before her migration from Latin America to London, and tendency to idealize as a new arrival. The symbolization process is discussed and it is suggested that repetitive enactment in the analytic transference may have been needed for her internal reality of estrangement to be confirmed and differentiated from her culturally and socially isolated external life as a migrant. Only then could she mourn losses and symbolize her inner reality. It is suggested that through mourning and symbolization the significance of migration for the patient was worked with and transformed so that, following a second migration, an ordinary, good enough home could be made in a new place.     

Marcel's Testimony in Existential Psychotherapy with Couples and Families

In recent years a number of family therapists and teachers of family therapy have questioned the direction of the family therapy movement into relationship-distant and procedurally based treatment orientations. The purpose of this article is to outline Gabriel Marcel's concept of testimony and to show how this concept can be utilized to facilitate an increased emphasis upon the treatment relationship during marital and family psychotherapy.     

Our Moral Universe

The application of psychoanalysis to social issues began with Freud's late writing. Understanding of racial and religious prejudice offers a social science application of psychoanalysis, but also has important implications for clinical practice. This paper supports and illustrates Dorothy Holmes' contention that examination of race and ethnicity in clinical work are important even when these issues are not apparent in patients' manifest content. It describes resistance to these factors in psychoanalysis and society.     

The analyst's countertransference to the psychoanalytic process1

There is countertransference, not just to individual patients, but to the process of psychoanalysis itself. The analytic process is a contentious topic. Disagreements about its nature can arise from taking it as a unitary concept that should have a single defi nition whereas, in fact, there are several strands to its meaning. The need for the analyst's free associative listening, as a counterpart to the patient's free associations, implies resistance to the analytic process in the analyst as well as the patient. The author gives examples of the self‐analysis that this necessitates. The most important happenings in both the analyst's and the patient's internal worlds lie at the boundary between conscious and unconscious, and the nature of an analyst's interventions depends on how fully what happens at that boundary is articulated in the analyst's consciousness. The therapeutic quality of an analyst's engagement with a patient depends on the freeing and enlivening quality, for the analyst, of the analyst's engagement with his or her countertransference to the analytic process.     

“A Failure of Curiosity”

ABSTRACT

This essay discusses the clinician's defense against and resolution of the experience of boredom in the countertransference as an incident of projective identification in the treatment of a woman with dissociative identity disorder. The essay details the inner mind of the therapist as she discovers both her own feelings and judgements of those feelings. As the essay progresses, she begins to grasp the significance of her discomfort in informing the therapeutic process. We watch as this material is made use of to move forward a stalled therapy into new territory.     

Psychoanalytic Psychotherapy for Severely Disturbed Borderline Patients: Observations on the Supervision Group of Psychotherapists

The authors describe the role of a supervision group of psychotherapists within a wider therapeutic field for severely disturbed borderline patients. The group concentrates on the transference and countertransference, seen according to Racker’s distinction between concordant and complementary identifications. The implications of the prevalence of the complementary identifications over the concordant identifications of the therapists to their patients and the resulting regression to primitive defense mechanisms can be counterbalanced by the group’s integrative functioning as receiver (1) of a variety of information about the patient, (2) of the therapist’s attempt to understand and synthesize, and (3) of the therapist’s countertransference reactions to his patient. The major discrepancies between the various conceptions of the borderline patients’ psychic world and the appropriate therapeutic technique to be applied are also discussed, as well as the way the group filters the information and integrates the therapeutic thought. It might be said, therefore, that, in the “inpatient” phase of the individual psychotherapy, the group of psychotherapists functions, for the patient and the treatment, in a synthesizing context, as it provides the therapist with a space of integration for his split-off part of self and object representations, which the therapist makes use of for his patient.*Members of the Athens University Project for Borderline Patients’ research team consisting of psychoanalysts and psychotherapists, Eginition Hospital, 74 Vas Sophias Avenue, Athens 11528, Greece.Maria Chatziandreou, M.D., is a member of the Hellenic Psychoanalytical Society.Haris Tsani, M.D., is a candidate of the Hellenic Psychoanalytical Society.Nikos Lamnidis, M.D., is a candidate of the Hellenic Psychoanalytical Society.Claire Synodinou, Ph.D., is a member of the Paris Psychoanalytical Society and an associate professor at Panteion University, Athens.Grigoris Vaslamatzis, M.D., is a training analyst of the Hellenic Society of Psychoanalytic Psychotherapy and an associate professor of psychiatry at Athens University.Address correspondence to: Maria Chatziandreou, M.D., 1-3, Skippi Street, 11525 Athens, Greece.