The Violation of Inner and Outer Boundaries in Political Persecution

One of the consequences of persecution for the individual is the experienced confusion of inner and outer worlds. With the help of a broadened concept of the transitional space, derived from Winnicott, we could understand the various psychological consequences of structural physical violence. The violation of the transitional space during physical violence can result in a transformation to an inorganic state, an introjection or incorporation of the bad object into the self, intrusive re-experiencing and shattered assumptions often seen long after psychotrauma. In this article a broadened and elaborated concept of transitional space is described. Therefore, several theoretical concepts, such as inner and outer world are discussed and defined which makes it possible to put them into practice of psychotherapy and research. An example is given of a documented case of imprisonment under extreme conditions in which the prisoners were able to build up a common transitional space in order to survive. In this case, the transitional space is not an aid for the passage from one developmental phase to another, but instead a way of keeping open the connection between the psychic inner world, the world of the prison and the free world outside the prison walls. It is suggested to extend the concept of the transitional space to this meaning.     

Scharffs' Application of Hopper's Concept: “Incohesion: Aggregation/Massification”

We begin by stating our understanding of the concepts presented in Hopper's paper, then comment on the clinical illustration, and conclude by describing two group situations in which we have applied the concepts we have taken from Hopper's paper. Hopper's fourth basic assumption applies to our work as individual psychoanalysts, family therapists, and group leaders because it integrates psychoanalytic and social understanding. We demonstrate how and why we find Hopper's idea to be a useful advance.     

Joseph and His Brothers: A Biblical Paradigm for the Optimal Handling of Traumatic Stress

The long-lasting effects of emotional trauma and the important role of unconscious emotional defenses have become increasingly recognized only in the past century. Yet their role is actually manifest, although still overlooked, in one of the most well-known of biblical stories. This paper presents the story of Joseph and his brothers, and the important lessons it teaches about unconscious defenses and the optimal handling of emotional trauma.     

Children's Testimony: A Review of Research on Memory for Past Experiences

This review of children's testimony focuses on research related to memory for past experiences. The aspects of the memory system that are involved in testimony are discussed and the development of autobiographical memory is examined. Relevant research findings are summarized in the context of an information-processing model of memory and the implications of this work for clinical practice are outlined. We conclude that (1) under certain conditions, even very young children can remember and report past experiences with some accuracy over very long periods of time; (2) substantial and significant developmental differences have been demonstrated in children's abilities to provide eyewitness testimony; (3) children can be influenced in a variety of ways to provide complete and elaborated reports of events that never occurred; and (4) even experts cannot always tell the difference between true and false reports.     

The Understanding and Treatment of Immigrant Trauma Survivors: Finding the Right Mix

This paper reviews attempts by three authors to describe psychoanalytic conceptualizations and treatment of torture victims. It argues that because the transference-countertransference configuration with immigrants who have not suffered torture is very similar to that of torture survivors, that no special diagnostic categories, theories, or treatment methods are needed to work with torture survivors. Second, the paper contends that newer psychoanalytic paradigms such as Hoffman's Social Constructivism may assist clinicians to capture the richness and complexity of clinical work with torture survivors better than do traditional analytic conceptions such as neutrality. Via an analysis of the three papers in this volume, I conclude with a consideration of the strengths and the weaknesses of the field of cross-cultural psychotherapy in general.     

A Witness Breaks His Silence: The Meaning of a Therapist's Response to an Adolescent's Self-Destruction

I describe the case of a self-mutilating adolescent girl and my dilemma, as her therapist, about telling her parents about her self-abuse. I use two complementary, mutually enhancing relational theories of trauma—Ferenczi's (1933) and Davies and Frawley's (1994)—to help understand the minefield I was in. Davies and Frawley describe certain relational configurations that are typical of trauma victims. I believe that it is not only unavoidable but therapeutically vital for therapists to participate in these configurations so they can know the patient's experience in a personal way. It is also crucial that they be witnesses who provide recognition for the patient's pain and, in so doing, relieve the intolerable feeling of isolation that Ferenczi proposed was the most basic trauma. In addition, I discuss the observation that some people who have not been previously traumatized in any gross way manifest characteristics of trauma.     

Are Newborns Morally Different from Older Children?

Policies and position statements regarding decision-making for extremely premature babies exist in many countries and are often directive, focusing on parental choice and expected outcomes. These recommendations often state survival and handicap as reasons for optional intervention. The fact that such outcome statistics would not justify such approaches in other populations suggests that some other powerful factors are at work. The value of neonatal intensive care has been scrutinized far more than intensive care for older patients and suggests that neonatal care is held to a higher standard of justification. The relative value placed on the life of newborns, in particular the preterm, is less than expected by any objective medical data or any prevailing moral frameworks about the value of individual lives. Why do we feel less obligated to treat the premature baby? Do we put newborns in a special and lesser moral category? We explore this question from a legal and ethical perspective and offer several hypotheses pertaining to personhood, reproductive choices, “precious children,” and probable evolutionary and anthropological factors.     

Introduction

Cognitive behavioral therapy evolved from systematic studies testing learning theories. This research led to the development of effective treatment approaches for a variety of disorders. In more recent years we have moved away from relying on experimental psychopathology studies to directly inform our treatment approaches. This paper describes why the alienation from experimental psychopathology studies is detrimental to the advancement of treatment approaches. Examples of how systematic research can be conducted to address questions regarding treatment mechanisms and moderators are provided. Drawing on experimental psychopathology research can also lead to a better understanding of core processes of psychopathology, which in turn can lead to transdiagnostic treatment approaches.     

Doubt in the psychoanalysis of a paedophile

In this single case study, I will address the question of how incestuous sexual abuse causes doubt of three distinct types: (1) honest doubt that is essential to the pursuit of knowledge; (2) inherent doubt that can result from a trauma that leaves the victim's mind fragmented and confused; and (3) the sadistic imposition of doubt intended to deceive, disorient and attack unbearable knowledge in the victim or another person familiar with the abuse (in this case, the analyst and the victim's later victims). During the course of my psychoanalysis of a paedophile, it became clear that this third form of doubt played an integral role in the patient's sexual abuse of children, a role I will link to the nature and function of paedophilia and to the experience of working psychoanalytically with a paedophile.     

Intersubjectivity and the creation of meaning in the analytic process

By means of a clinical illustration, the author describes how the intersubjective exchanges involved in an analytic process facilitate the representation of affects and memories which have been buried in the unconscious or indeed have never been available to consciousness. As a result of projective identificatory processes in the analytic relationship, in this example the analyst falls into a situation of helplessness which connects with his own traumatic experiences. Then he gets into a formal regression of the ego and responds with a so‐to‐speak hallucinatory reaction—an internal image which enables him to keep the analytic process on track and, later on, to construct an early traumatic experience of the analysand.