Moved to tears: Technical considerations and dilemmas encountered in working with a 13-year-old boy with acquired quadriplegia 1

This paper is about therapeutic work with David, a 13-year-old boy who, at the age of 5, was the victim of a hit-and-run road traffic accident resulting in quadriplegia. The circumstances leading to the accident and its sequelae reveal a particularly complex picture, which combines early emotional deprivation and trauma. Although cognitively intact and able to speak, David could not move. Yet he created movement in others through a desperate necessity, by communicating via the employment of extreme projective forces. The highly complex presentation of emotional, psychic and bodily damage in the child, and in particular, David's physical paralysis, has had a profound impact upon what I have come to think of as the ‘mindbody’ of the therapist. Winnicott has talked of the infant's ‘psyche/soma’. Here I want to extend the notion and consider the bodily impact of projections in particular and how these have a powerful emotional and physical resonance on the ‘mindbody’ of the therapist, especially in therapy with a young person whose body is damaged. In this paper, I consider technical challenges and dilemmas encountered in the work, including the complex interplay of transference/countertransference phenomena. This unusual presentation of a boy in extraordinary circumstances led to considerations of psychoanalytic method and interpretative activity, which may be viewed as being inspired by ‘emotional truthfulness’.2 2 Alex Dubinskey (Chair ACP conference 2004) commenting on aspects of this work used the term ‘emotional truthfulness’.

Dans cet article, l'auteur raconte son travail thérapeutique auprès de David, âgé de 13 ans, qui à l'âge de 5 ans fut victime d'un accident de la circulation avec délit de fuite, accident qui le laissa tétraplégique. Les circonstances qui aboutirent à l'accident et à ses séquelles forment un tableau particulièrement complexe mettant en jeu des carences affectives précoces et des traumatismes. Bien que ses capacités cognitives ne fussent nullement atteintes et qu'il fut capable de parler, David ne pouvait pas bouger. Par l'urgence désespérée de son discours, transmise grâce à des projections extrêmement puissantes, il réussissait à susciter du mouvement chez ses interlocuteurs. La présence conjointe et extrêmement complexe de dommages affectifs, psychiques et corporels chez cet enfant – et notamment sa paralysie physique – eut un impact profond sur ce que l'auteur en vient à appeler l'“ esprit-corps ” du psychothérapeute. D. W. Winnicott a parlé du “ psyché-soma ” du jeune enfant. Dans son texte, l'auteur élargit cette notion, notamment pour prendre en considération l'impact corporel des projections, ainsi que leur résonance émotionnelle et physique massive sur l'“ esprit-corps ” du thérapeute, surtout lorsque son patient est une personne jeune dont le corps est endommagé. L'auteur explore les défis et dilemmes techniques rencontrés au cours de son travail, y compris le jeu complexe de phénomènes transférentiels et contre-transférentiels. Ce traitement, inhabituel, avec un garçon dans des circonstances sortant de l'extraordinaire soulève des questions concernant la méthodologie psychanalytique et l'activité interprétative, questions qui peuvent être considérées comme étant inspirées par la “ véracité émotionnelle ”.

Dieser Artikel ist über die therapeutische Arbeit mit David, einem 13-jährigen Jungen, der im Alter von 5 Jahren das Opfer eines Unfalls mit Fahrerflucht war, der zu einer Querschnittslähmung führte. Die Umstände, die zu dem Unfall führten und seine Folgen legen ein besonders komplexes Bild dar, das frühe Vernachlässigung und Trauma kombiniert. Obwohl David kognitiv intakt war und sprechen konnte, konnte er sich nicht bewegen. Doch schaffte er Bewegung aus verzweifelter Notwendigkeit in anderen, indem er mit mithilfe der Benutzung von extremen projektiven Kräften kommunizierte. Die höchst komplexe Präsentation von emotionalem, psychischem und körpelichem Schaden in dem Kind und insbesondere Davids körperliche Lähmung, hatte eine tiefe Auswirkung auf das, was ich nun den ‘mindbody’ (Gemütskörper) des Therapeuten nenne. Winnicott sprach vom Psyche/Soma des Babies. Hier möchte ich diesen Begriff ausweiten und besonders die köperliche Auswirkung der Projektionen betrachten und wie diese eine starke emotionale und physische Resonanz auf den ‘mindbody’ des Therapeutens haben, insbesondere in der Therapie mit einer jungen Person, deren Körper beschädigt ist. In diesem Artikel betrachte ich technische Herausforderungen und Dilemmas, denen man in dieser Arbeit begegnet, einschliesslich der komplexen Wechselwirkung von Übertragungs/ Gegenübertragungsphänomenen. Diese ungewöhnliche Behandlung mit einem Jungen in aussergewöhnlichen Umständen führten zu Überlegungen zur psychoanalytischen Methode undzur Deutungsaktivität, die von ‘emotionaler Wahrheit’ inspiriert wird

Riassunto: In questo articolo si parla del lavoro terapeutico con David, un bambino di 13 anni che, all'età di 5 anni, fu vittima di un incidente stradale che portò alla quadriplegia. Le circostanze che portarono all'incidente e la sua sequela rivelano un quadro particolarmente complesso, nel quale emerge un misto di deprivazione emotiva precoce e trauma. Sebbene David fosse abile cognitivamente e potesse parlare, egli non poteva muoversi. Eppure il bambino generava movimento negli altri attraverso una disperata necessità, comunicando con l'uso di estreme forze proiettive. Il presentarsi di un danno nel bambino altamente complesso nella sua dimensione emotiva, psichica e corporea, ed in particolare, la paralisi fisica di David, hanno avuto un profondo impatto su ciò che ho iniziato a pensare come il ‘corpomente’ del terapeuta. Winnicott ha parlato dello ‘psiche/soma’ del neonato. L'autrice vuole nell'articolo estendere la nozione e considerare l'impatto corporeo delle proiezioni e come queste abbiano una risonanza emotiva e fisica molto forte sul ‘corpomente’ del terapeuta, soprattutto nella terapia con un ragazzo giovane il cui corpo è stato danneggiato. Nell'articolo considero le sfide tecniche e i dilemmi incontrati nel lavoro, compreso il gioco complesso dei fenomeni transferali e controtransferali. Il trattamento insolito con questo bambino in circostanze molto particolari ha portato a considerazioni riguardo al metodo psicoanalitico e all'attività interpretativa, che si possono considerare come ispirati da ‘verità emotiva'¹     

Origin Stories: Same-Sex Sexuality and Christian Right Politics

In this paper, we examine dominant Christian conservative narratives of the origins of same-sex sexuality. Critics of the Christian right usually focus on a narrative of choice that Christian right organisations and activists use to explain the origins of same-sex sexuality. A choice narrative grounds a range of political positions and, in many contexts, effectively neutralises both claims of discrimination and public support for potential legal remedies. On the other hand, a narrative of development receives less attention from critics of the Christian right. Although it cannot be reduced to its political efficacy, the narrative of development has a political as well as therapeutic function. Indeed, this narrative circulates tacitly through a different set of public debates than those usually associated with the narrative of choice, including debates over programmes geared to eliminate antigay harassment in public schools. The two narratives create tensions within Christian conservative thought that can destabilise antigay social and political projects.     

‘Wholeness,Dignity and the Ageing Self’: A Conversation Between Philosophy and Theology

SUMMARY

Winifred Wing Han Lamb: My philosophical interest straddles the areas of education, religion and theology. As a teacher involved in school philosophy programs, I have also been interested in the philosophy of childhood and particularly in the recurring notion of the ‘whole child’ in education. In considering what ‘wholeness’ could mean for children's education, I have also been led to consider what meaning it holds for the self through the ‘changing scenes’ of life, especially in the face of the challenges of ageing.

The notion of ‘wholeness’ holds an intuitive appeal and invites articulation of the deep truths of our faith with respect to persons in all ‘sorts and conditions.’ In section one of this chapter, I attempt that articulation. But this conversation needs to be complementary. Our chapter is the beginning of a dialogue between philosophy and theology in which both affirm the ageing self in the light of the human search for wholeness and dignity.

Heather Thomson: My theological research into humanity as an image of God led me to inquire about the way in which we could speak meaningfully of ageing and dying in terms of imaging God. This challenged how God-likeness was to be understood in relation to glory, honour and power, terms associated with imaging God and exerting dominion. In searching for a theological view of the self that would confer dignity on the ageing, I was led into conversation with various philosophies of the self, some very helpful for my task.

It seems to me that, if ageing people are to be counted as having dignity and worth, and not discounted, then one's theory of the human person was significant. In pondering the issue, it appeared that a conversation between philosophy and theology would be fruitful. Hence, this joint paper. We each speak from our own discipline but find resonance with each other's work. We see this as a first step in a constructive conversation.     

History and Analysis of Delayed Discovery Statutes of Limitations in Adult Survivor Litigation

Summary

In this chapter, attorney Mary R. Williams examines how while Childhood Sexual Abuse (CSA) cases share many of the types of facts for which delayed discovery, mental incapacity, equitable estoppel and other legal statutes of limitations doctrines were created, the combination of factors of CSA cases, including unusual social dynamics and long-term psychological effects, does not fit exactly with any of these legal doctrines. She explores the historical development of delayed discovery statutes of limitations, evaluates the different types of statutes and case law, and analyzes the problematic use of the concept of repression in legislation. This chapter interprets her ground-breaking state-by-state tabulations of delayed discovery statutes of limitations and reported appellate decisions on limitations in CSA actions, published in this volume as appendices A, B, and C.     

Waldo reveals cultural differences in return fixations

ABSTRACT

Humans routinely perform visual search towards targets to adapt to the environment. These sequences of ballistic eye movements are shaped by a combination of top–down and bottom–up factors. Recent research documented that human observers display cultural-specific fixation patterns in a range of visual processing tasks. In particular, eye movement strategies extracting information from faces clearly differs between Western Caucasian (WC) and East Asian (EA) observers. However, whether such cultural differences are also present for visual scene processing remains debated. To this aim, we recorded the eye movements of WC and EA observers while they were solving visual search problems parametrically varying in difficulty: Where’s Waldo. Both groups had a comparable familiarity with the Waldo books reaching a comparable level of accuracy in target detection. Both cultural groups also showed a comparable temporal effect on inhibition of return, with longer fixation durations when saccades were performed to a return location compared to other locations. Westerners, however, located Waldo faster than Easterners. Interestingly, this modulation of speed was likely related to differences occurring on the low-level mechanisms of spatial inhibition of return, with EA observers returning more often to previously visited locations than the WC observers. This suboptimal eye movement strategy in the Easterners might be engendered by their cultural perceptual bias consisting in? a greater use of extra-foveal information. Overall, our data point towards the existence of a subtle, but significant difference in the processing of visual scenes across observers from different cultures during active visual search.     

中小学生阅读图文课文的眼动实验研究

本研究采用眼动方法,对85名小五、实二和高二年级学生阅读图文课文的阅读理解指标和眼动指标进行考察。结果表明：（1）学生阅读不同呈现方式和难度课文的阅读理解指标和眼动指标,一般都具有明显的年龄发展特征;（2）学生阅读不同呈现方式课文的阅读理解指标和眼动指标,有图课文大多显著优于无图课文;（3）学生阅读不同难度课文的阅读理解指标和眼动指标,易课文显著优于难课文。     

The body in analysis: authentic movement and witnessing in analytic practice

This paper will describe a form of active imagination called authentic movement, in which attention is given to the somatic unconscious. In authentic movement, patients are encouraged to focus inward and attend to any bodily sensations, images and feelings which may arise. In the process of focusing inward on one's bodily-felt experience, images, somatic memory and the accompanying feelings which arise are then available to be explored as a communication from the patient's unconscious. Authentic movement supports the individual in linking image with affect in that the individual re-experiences the somatic aspect of symbolization. What was previously conserved on the somatic level as unmentalized experience, can now begin to be taken up into the mind, thought about, and made available for analysis. In authentic movement, the analyst acts as a silent witness to the patient's explorations. The quiet focused attention of the witness helps to create a secure containing environment in which the person moving can experience a sense of feeling held and seen. The function of the witness is to hold the patient's experience in his own mind, particularly what is not yet mentalized. The witness utilizes his somatic countertransference, including any images, feelings and bodily responses which are generated by what is being communicated non-verbally, as a means of understanding and responding to the patient's material.     

A study of a bimanual synergy associated with holding an object

The task of supporting an object with one or two hands was used to test the applicability of the notion of synergy. Subjects sat with their dominant forearm supported up to the wrist while holding a cylindrical “cup” between their thumb and fingers. Force transducers recorded the grip force applied normal to the cup's side by the thumb and the force applied normal to the cup bottom. On different series, a supporting force was added to and released from the bottom of the cup by the subject's non-dominant hand or by the experimenter. As predicted, the results indicated feedforward adjustments of the grip force, and of the EMGs, and significant correlations between grip force and supporting force when they were produced by two hands of one person, and the lack of such closely tied changes when the two forces were produced by two different persons. In the latter case, different subjects could demonstrate grip force changes in different directions. The findings suggest that grip force adjustments represented peripheral patterns of a single central process (a single synergy) rather than being separately controlled focal and postural components of the action.PsycINFO classification: 2330     

The effects of stimulus movement and attention on peripheral stimulus localization by 8- to 26-week-old infants

This study examined the effect of stimulus movement on localization probability and latency during attention and inattention. Forty infants, 10 each at 8, 14, 20, and 26 weeks of age were presented with a central stimulus. Then, a peripheral stimulus was presented (static or dynamic checkerboard). Stimulus movement did not affect localization probability. Infants localized the dynamic peripheral stimulus more quickly than the static peripheral stimulus when there was no focal stimulus. Focal stimulus attention attenuated this difference in localization latency between static and dynamic stimuli. Signal detection analysis showed that sensitivity to the peripheral stimulus increased over this age range along with a decrease in the bias against responding. The effects of attention were on response bias rather than stimulus sensitivity. These results imply attention affected the localization response to the peripheral stimulus but did not affect the sensitivity of the sensory and perceptual pathways to peripheral stimuli.