Who speaks? Who looks? Who feels? Point of view in autobiographical narratives1

In this paper, the author aims to substantiate Freud's claim that neurotic illness creates gaps in autobiographical narratives in terms of the narrator's stating and inducing perspectives. He sketches out the role of narrative perspective and the joint taking of a shared perspective by analyst and patient in psychoanalytic therapy. He introduces four ways of representing perspectives in narratives. Three degrees of narrative distortion are exemplifi ed by three excerpts from life narratives and explored in terms of narrative perspective representation. The most comprehensive perspective representation is achieved in the fi rst example by explicitly stating the present perspective of the narrator as well as the past perspective of the story's protagonist by use of mental verbs. In the second narrative, exclusive use of linguistic forms for inducing the protagonist's perspective both overwhelms the narrator and gives the listener an incomplete picture of what happened. Inconsistent motives, denial of responsibility and omission of detail render the third narrative even more diffi cult to follow. The author discusses the clinical signifi cance of this exploratory analysis of perspectives in narratives in terms of claiming responsibility for one's past action and of level of defence mechanisms, and by highlighting the emotional impact on listeners, which the author suggests is the stronger the more perspectives are left out. He discusses analogies to countertransference. The analysis of narrative perspectives offers an approach for systematic research in psychoanalytic practice.     

Cultural function and psychological transformation in psychoanalysis and psychoanalytic psychotherapy

Cultural experience of silence and individual vicissitudes between talking and being silent infl uence the way individuals form an alliance and pursue the analytic process. This is of relevance both for the patient and for the psychoanalyst/therapist. The author describes a patient, whose silent phase occurred in the fi fth and sixth year of intensive psychoanalytic psychotherapy. She suggests that a) the silence functioned as a protection of a space for the core self and promoted inner transformation and psychologicaldevelopment;b)thesilenceinvolvedatransference-countertransference matrix with projective identifi cations of the patient's internalized mother- and father-related objects that caused a tenuous balance between maintaining and erasing the relationship between the patient and the author; c) the silence phase was highly infl uenced by the author's own cultural background and what she brought into the relationship of tolerance of being silent in the presence of another, and understanding of the many complex functions of silence. During the silent phase the patient moved from simply describing and naming her affects and inner experiences or expressing them as somatic processes, to being able to internally access and verbally convey her own affects and experiences in the therapeutic alliance. This process involved both affect desomatization, affect differentiation, and affect verbalization.     

‘The newspaper reader’: On the meaning of concrete objects in a psychoanalytic treatment1

The author investigates the meaning of concrete objects in the psychoanalytic treatment of a severely disturbed patient for the development of his inner world and the analytic process. She includes a survey of relevant theoretical concepts with an emphasis on Winnicott and Bion. It is shown that the objects served basic defensive functions both within the analytic relationship and for the precarious intrapsychic state of the patient. The author describes the technical dealing that led to a structural change. From the comparison of the initial dream and a later dream, Mr N's inner development from total inclusion in the object to triadic reality of separated, repaired objects becomes discernible. The author shows how this progress was facilitated by his use of concrete objects as links between his psychotic and non‐psychotic parts, as well as by the specifi c way the analyst handled the paradoxical transference‐ countertransference. She also illustrates the thesis that the developmental steps described are crucial for the capability to digest psychic pain by symbolization instead of discharging it in a destructive‐violent way.     

Teaching medical staff psychological concepts via a hospital newsletter

Despite the increased recognition of the critical role of social and psychological factors in health and illness, the teaching of psychology is rarely integrated in medical education. Staff generally have minimal formal training in psychological concepts. Patients on the inpatient rehabilitation unit frequently present with unexpected reactions in response to acute trauma and resulting changes in identity and capabilities. Rehabilitation goals therefore, must be based on psychological, as well as physical, capacities. A one-page, user-friendly newsletter was designed to illustrate basic psychological principles via case vignettes. The topics of fear, countertransference, and resistance were selected as critical issues staff frequently encounter in their work with patients. The newsletters provided the staff with basic conceptual tools for effectively treating patients, and the work of psychologists was demystified. The newsletter format is proposed as a creative adjunct to didactic teaching.Copies of the newsletter Insight can be obtained by request from Dr. Gold.     

The case of Marcello: transference and the unfolding of the analytical relationship

The analytical process of a male patient is herein described, the main focus being on the phase when the transference develops and transference projections are modified, leading to a transformation of the personality, which was previously characterized by severe obsessional defences. The specific aim of the discussion is to evaluate when and what to interpret, in relation to the importance of the transferential patterns and with regard to the role of the analyst as a container.     

Psychological aspects of genetic counseling. VIII. Suffering and countertransference

Two common forms of countertransferential problems seen in genetic counseling, associative and projective, are described and illustrated. Both forms have the potential of reducing the quality of empathy counselors provide counselees. When counselors experience the same problems as the counselees they counsel it is virtually impossible to avoid facing countertransferential reactions which may not always promote the counselees' interests and/or redound to their benefit. Genetic counselors, like other personal counselors and psychotherapists, have a professional responsibility to be aware of, monitor, contain, and learn from their countertransferential experiences.     

Leaps of faith: Is forgiveness a useful concept?

Using detailed clinical vignettes, the author argues that, despite the current idealization of the concept of forgiveness, the term has no place in psychoanalytic work, and there are some hazards to giving it one. Clinically, the concept of forgiveness is seductive, implying that there should be a common outcome to a variety of injuries, stemming from different situations and calling for different solutions. Every instance of what we call forgiveness can be seen to serve a different defensive function. While the conscious experience of what is called forgiveness is sometimes confused with the unconscious process of reparation, the two can only be described at different levels of psychic life. Despite the fact that in ‘the unconscious’ there is no such thing as forgiveness, the term has an adhesive quality in our thinking that also blunts the analyst'’s appreciation of the aggressive components in the work. In a final vignette, the author illustrates an analytic outcome that has the appearance of forgiveness, but is best understood as the complex result of the everyday work of analysis.     

Five Key Topics on the Frontier of Theology and Science Today

Abstract : This article explores the creative mutual interaction between Christian theology and the natural sciences through five key issues: (1) the relation between creation ex nihilo and Big Bang cosmology; (2) biological evolution and continuous creation; (3) the search for non‐interventionist objective divine action in light of physics and biology; (4) the problem of suffering in nature and with it the turn to redemption theology via the bodily Resurrection of Jesus; and (5) the challenge raised for its eschatological implications by scientific predictions for the future of the universe. The article concludes with a brief suggestion for the ways Christian theology, reformulated in light of these sciences, might offer creative suggestions for future scientific research, and, in doing so, complete the loop promised by the phrase “mutual creative interaction.”     

Performance as annihilation or integration?1

What happens when the analyst has the impression of being annihilated by the patient? Analysts have a tendency to use more general, i.e. simplifying, constructions such as destructiveness, psychosis or death instinct as explanatory models. In the authors' view, these constructions in the end evade rather than mirror clinical reality. More recent research points to promising possibilities of differentiation, e.g. psychotic mechanisms which are‐as yet undiscussed‐based on Freud's notion of the partial ‘rent in the relation between ego and external world’. These findings emphasize the restitutive function of a symptom or disturbance, i.e. destruction of a relationship which hinders the therapeutic process and which is not understood initially, instead of solely stressing the destructive meaning in a tabooing gesture. The concept of performance attempts to replace simplifying models with a discriminant process, and will be preliminarily defined and explained in delineation to terms already in use such as acting out, enactment, and role responsiveness. The authors explore the question of how the perception of unthought certainty in the performance can either be recognized as a blueprint, i.e. organizing activity, or as the destruction of the relationship so that a new one can emerge. The evidence from a detailed clinical example shows that many treatments can fail at this point and demonstrates how an understanding of performance in this sense offers a chance for integrating processes that otherwise impede treatment.