ATTACKS ON LINKING OR A DRIVE TO COMMUNICATE? TOLERATING THE PARADOX

The notion of attacks on linking, as described by Bion, may depict a patient's drive to communicate the internalization of a destructive relationship between a primary object and an infant. This may be enacted between patient and analyst in the here and now of the analysis, whereby fragmentation and numbing of thinking may point to a primitive catastrophe relived in the psychoanalytic setting. The patient's material may seem incoherent, but incoherence might be the communication the patient is unconsciously trying to convey. Thus, the notion of attacks on linking depicts a paradoxical, caesural experience in which the attack on linking is itself a link.     

‘And when you were a child?’: how therapists working with parents alongside individual child psychotherapy bring the past into their work

When a child is offered psychotherapy, it is common that regular meetings will be offered to the parents. However, there are debates in the literature about the degree to which such parent work should include a focus on the parents’ own childhood experiences. This study aimed to examine the way that those offering parent work as part of a study evaluating the treatment of adolescent depression dealt with this issue in their work with parents, both in the study and in routine clinical practice. Design: five therapists were interviewed on the subject of working with parents’ childhood experiences within parent work parallel to child psychotherapy. Data were analysed qualitatively, using Interpretative Phenomenological Analysis. Findings: participants described the need to consider the different parameters of this work to individual adult therapy; in addition, participants felt that it was necessary to negotiate permission to work on the parents’ childhood experiences. They also spoke of making use of insight into the repetition of the parents’ history, the analysis of parental projections and offering containment within the relationship; this varies from the ‘transference work’ of individual therapy and a different style of interpretation was described. Conclusions: there is a need to give more attention to the neglected field of working with parents alongside individual child psychotherapy, especially at a time when such work is under threat within many public services. There are particular technical issues related to work with parents’ own childhood histories that are different to how one might work in individual therapy with a parent.     

Being seen or being watched? A psychoanalytic perspective on body dysmorphia

The focus of this paper is on individuals who present as excessively preoccupied with their body, perceiving some aspect(s) to be 'ugly' such that they feel compelled to alter and/or conceal this 'ugly' body part. These difficulties are understood as symptoms of an underlying narcissistic disturbance. The author suggests that the relative pervasiveness of an identification with a 'super'-ego accounts for the degree of severity of the disturbance (increasing the compulsion to alter and/or conceal the hated body part) and that it has implications for the patient's accessibility in analytic treatment. Understanding the vicissitudes of the development of the body–self in the context of the earliest relationship with the 'object of desire' is core to helping these patients because of the quality of the identifications that ensue and that are then enacted the transference.