Psychosomatic Health: The Body and the Word

Abstract

Why do men get firsts and women gets seconds? This question is currently being debated by some in Oxford University, but not elsewhere, where men's educational under-achievement - in secondary-school league tables, for instance (see, e.g., Phillips 1993) - is more often a matter of concern. Stephen Frosh (1998) has considered both issues in terms of the way young men are constructed and construct themselves through performing and acting on prevailing stereotypes about men and masculinity. These stereotypes include recklessness, not caution, which Maryanne Martin (1998) says contributes to men getting firsts at Oxford by virtue of this trait being rewarded by Oxford University's tutorial and examination system.

In the following pages I too will talk about the equation of men with recklessness. Or, more accurately, I will talk about the way in which men and women act on nightmares and dreams that often glorify men, not least as reckless heroes, in large part because, despite the gains of feminism, glory is still more often men's than women's prerogative in male-dominated society, of which Oxford University is a prime example. I too will consider how this might contribute to men more often getting firsts, and to women more often getting seconds in finals in Oxford. I will end with some implications of my findings for therapy - at least, for the kind of therapy I do as a Freudian therapist. I will therefore begin with Freud.     

Cognitive Analytic Therapy: time and process

Cognitive Analytic Therapy (CAT) is an increasingly popular brief therapeutic approach for use with a variety of types of clinical problem. This paper outlines the key components of CAT and demonstrates its use by case examples. The history of CAT is traced, particularly the concept of Reciprocal Roles which was developed from Object Relations Theory. It is suggested that CAT has considerable potential as a collaborative, active therapy, with particular application to difficult patients such as those with borderline personality disorder. Some of the differences from other psychodynamic therapies are described, and an assessment of its future role is provided.     

Dilemmas in brief therapy

This paper examines three central concerns for the short-term therapist at a time when therapy is widely available free of charge in the community, in a model that has been called ‘ serial life-span therapy’. Issues of referral-on, topping-up or extending contracts are experienced as dilemmas or as temptations, depending on what therapists believe their clients need and what their clients may demand of them. Short-term therapy has become accepted in many contexts, with therapy no longer used as a once-and-for all solution to clinical problems, but as a serial method over time which includes topping up and re-contracting. After an initial agreement of brevity, depending on the client's disturbance levels at assessment and on availability, there may be the need for referral-on at the end of a brief contract, when clients may be offered a different, long-term service, or they may be recommended to return later in life for more, if and when this becomes necessary. Flexible contracts rather than rigid rules about the termination of therapy are being practiced in many contexts, depending on ‘what works’ and how methods can be adjusted to new evidence. There is danger of collusion or control, and this can lead to therapeutic dilemmas, which involve taking acceptable risks, or to therapeutic temptations, which are due to the desire for narcissistic gratification, benefiting the therapist rather than the client in terms of power or Eros. Being able to let go of clients and manage issues of loss, grief and greed requires a measure of maturity in the therapist that aims for good-enough results rather than striving for perfect endings.     

Learning and teaching (briefly)

This paper was given as the Annual Ellen Noonan Counselling Lecture on July 2012 and retains some of the spoken style of the lecture. It uses examples of Ellen Noonan’s work to examine aspects of the process of teaching and learning psychodynamic practice. The difficulties of how to embed theoretical knowledge with its clinical application are discussed and the question of what are the key skills of the self-reflective practitioner is raised with reference to whether, and how, they can be taught or learnt. It is suggested that part of this process consists in helping students, and their teachers, to be more comfortable with not knowing, a concept that is both counter intuitive and counter cultural. From this aspects of contemporary therapeutic practice, with specific reference to psychodynamic short-term therapy, are addressed. The paper looks at the ambivalence felt by many psychodynamic clinicians towards working within a short-term paradigm in current workplace settings and how this might be addressed. The paper discusses the intrinsic qualities of a psychodynamic short-term approach and its relation to contemporary therapeutic modalities. It is suggested that the increasing managerial culture, leading to the ascendance of protocol driven, manualised and structured therapies, represents an attack on the relational and must be challenged.     

Multiple Attachment Representations in Clinical Practice: Case Study of a Six-Year-Old Maltreated Child

Research on attachment predominantly traces the effect of a single or primary attachment and/or attachment style on working models and behavior. However, most children form multiple attachments. This article reviews research on multiple attachment representations in children and considers how such information can usefully be applied to clinical settings. Through the case study of a six-year-old adopted boy with a history of maltreatment, it explores how those internal working models can be assessed in treatment and the clinical value of recognizing different attachment representations and styles. Implications for treatment interventions are explored.     

No Fault Couples Therapy

A conceptual framework for treating couples who come into therapy desirous of changing the behavior of their partner. A case history is cited wherein sensitivity towards equality of input, power and responsibility for the couples' plight is continuously emphasized for each member of the pair. The histories of both partners are described in order to stress the no fault nature of the couples' conditions.     

From Projective Identification to Empathic Connection

SUMMARY

This article examines the challenging journey of successful coupling by understanding the marital relationship within a developmental framework. The process of Projective Identification is viewed as a useful concept found at the confluence of family systems and psycho-dynamic streams of thought, bridging the interpersonal and intrapsychic experience of couples whose individuative strivings are stalled. A map is offered for the transformation of a marriage from the stages of Idealization and Disillusionment toward the stage of Acceptance and empathic connection.     

Couple Therapy and Spirituality and Religion

Abstract

The current state of the art of the integration of couple therapy with spirituality and religion is presented. Each of three waves of this integration identified in this article have seen an increase in the literature in this area, although only a limited amount in each wave has addressed couple therapy specifically. In the first wave, from 1990–1994, articles set forth arguments for why spirituality should be integrated in therapy. During the second wave, 1995–1999, publications focused on the ways that including spirituality in therapy can enhance as well as harm the therapeutic process. In the third wave, 2000-present, attention has shifted away from whether to include spirituality to how it should be included, and the literature of this period features many practical interventions and suggested guidelines for integrating spirituality and religion into therapy and training. The article concludes with recommendations for further developing the integration of spirituality and religion into couple therapy models, research, and training.     

Fostering Strength and Resiliency in Same-Sex Couples

Abstract

Same-sex couples are presented widiin tiieir cultural contexts to examine how those contexts might influence me strength and resilience of their relationships. We are particularly interested in the ability of the couple relationship to fulfill family functions that serve the social, psychological, and physical needs of each of the partners and society (Patterson, 2002a). Three family functions: family formation and membership, nurturance and socialization, and protection of vulnerable members, are particularly germane to same-sex couples. We examine several topic areas related to these three functions in order to assist clinicians in identifying factors that may prohibit same-sex couples from becoming and remaining strong and resilient.