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.     

On the edge: The psychoanalyst's transference1

Countertransference is a central topic in analytic work and in the literature. The concept of countertransference includes a basic question which has been understood in different ways. The author attempts to differentiate between the psychoanalyst's transference and his countertransference in the analytic process. It is hard to draw a line between them; analysts are always on the edge. The analyst's transference will be explored and described using three approaches: narcissism, regression profile and the analyst's phase of life. Regression profile is a new concept developed by the author, which may help us to understand the core of the analyst's transference in the analytic situation. She illustrates the topic by clinical vignettes.     

Reverie‐informed research interviewing

Drawing on Thomas Ogden's notion of ‘reverie’, the role of self‐reflection in research interviewing is explored. Ogden views reverie as a co‐created intersubjective phenomenon, a ‘third’, distinct from both analyst and patient. Two face‐to‐face research interviews with adolescent depression sufferers are described, showing how reverie can be used to help overcome impasse, and develop research hypotheses. Participant‐centred research interviews were thus shown to be enhanced by psychoanalytically informed self‐reflection as accessed through reverie. The role of reverie in research interviewing, in part spontaneous and ineffable, in part defined and systematic, is discussed.     

AFFECT,SYMPTOM, FANTASY,DREAM: CLINICAL AND THEORETICAL CONSIDERATIONS

A symptom being studied in the process of analysis can be seen as not unlike the unconscious affect it sprang from. The author presents a case in which a symptom, premature ejaculation, was analogous to the unconscious affect of guilt, which itself seemed to be a premature defensive transformation of a deeper current of anger. Guilt was interpreted as if it were a psychic premature ejaculation, a defensive derailment of anger. Fantasy and dream seemed to be engaged in similar transformations, with a fantasy of “premature incarceration” not unlike the symptom itself in its analogous functioning. Analysis of affect, symptom, fantasy, and dream in complex, integrative analytic process led not only to resolution of the symptom itself, but also to a deeper understanding of the mind's complex functioning in general.     

Changing lives in the classroom

This paper sets out to describe the search for solutions as the complexity of the teacher’s role with vulnerable pupils gradually became apparent. The aim is to demonstrate how the application of psychoanalytic theories examining the unconscious processes in individuals and their influence on classroom behaviour enhanced the capabilities of the teacher and helped her to look beyond mere management of behaviour in the classroom. The use of these theories provided a ‘thinking’ space for the teacher whereby teacher–pupil relationships and behaviours could be thought about and ‘contained’ thereby facilitating the teaching process for both teachers and pupils. Examples of classroom practice are provided whereby an applied psychoanalytic framework proved to be a potent source of renewal and increased capacity in the teacher. The active participation of the teacher in her own learning process of applying psychoanalytic concepts contributes to an ongoing, developing project with her pupils.