Private selves and shared meanings: Or forgive us our projections as we forgive those who project into us

Abstract

This paper explores the difficulty university counselling services experience in finding common purpose with their institutions at the present time. It draws on a review of the relevant literature and personal experience to argue that it is extremely difficult to sustain depressive-position functioning in the current organizational culture, which, the author suggests, is dominated by fears about survival. The paper examines some defensive strategies counsellors may use to protect themselves against prevailing anxieties and argues for the importance of recognizing and working with these.     

Challenges in treating patients with psychosomatic disorders: some patterns of resistance

The treatment of people suffering from psychosomatic disorders poses important clinical challenges to psychoanalytic practice, including early abandonment, difficulties in engagement and superficial involvement in the treatment. The lack of systematic research on the subject suggests that a better understanding of the resistances and dynamics involved in such episodes is needed. Using supervision group to study treatments and inspired by action-research paradigm, this paper presents the results of an 18-month mixed-method qualitative clinical research on treating 22 cases. Thematic analysis revealed a frequent pattern of resistance to experience emotions that presented in two states: failure of repression (thin-skin) and massive repression (thick-skin). Narcissistic dynamics in the therapeutic relationship taking the form of ‘resistance to transference’ and a tendency to action were evident in both presentations. Symmetric and complementary counter-transference reactions, which compromised treatment, were also identified. Some technical implications are highlighted, such as the need to focus in the recovery of the patient's actual emotional experience and to understand such experience in the context of the ‘here and now’ of the therapeutic encounter. These findings suggest the need for a flexible approach to therapeutic work that moves between an ‘intrapsychic’ and a ‘relational’ focus.     

The partnership between the Early Intervention Institute,St Petersburg,and the Anna Freud Centre,London

The authors describe study and teaching links between the Early Intervention Institute in St Petersburg and the Anna Freud Clinic in London. Some brief clinical examples from a variety of settings are given as well as a longer case presentation. The impact of widespread institutional care, alcoholism and terrible housing conditions on child mental health are illustrated. This raises questions about the role of child psychotherapy when social conditions are so harsh. The case material indicates that, despite this, children can be helped in some measure to feel more secure, by the therapist providing constancy and reliability within an often frightening and dangerous external world.     

Revisioning Fordham's ‘Defences of the self’ in light of modern relational theory and contemporary neuroscience

This paper explores the evolution of Michael Fordham's ideas concerning ‘defences of the self’, including his application of this concept to a group of ‘difficult’ adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a ‘self‐care system’ in the psychological material of early trauma patients (Kalsched 1996 ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a ‘real person’ to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.     

Greenscreen teaching: Institutional instability and classroom innovation

“Greenscreen Teaching” explores how the stresses of institutional and social change impact teaching and learning, and the creative resourcefulness born out of instability. In precarious institutions and social contexts, relevant outcomes for theological learning include developing attentiveness, robust moral discernment, and courageous speech seasoned by maturing convictions and pastoral sensitivities. I utilize greenscreen acting as a suggestive metaphor for describing four creative teaching strategies targeting these outcomes. Subsections gather insights from:

• Etymology of disaster‐related words: Capitalize on the moment and “go big.”
• Creative method: Improvise and keep it sharp.
• Ritual theory: Creatively repurpose familiar but underutilized traditions.
• Service learning: Widen the networks of community connection.

Each subsection also revisits moments and learning activities from a graduate course in feminist theology. Navigating constant transition impacts every aspect of the classroom. Nevertheless, a teaching scholar can resource this precariousness as creative agency for voice, solidarity, and mutual learning.     

From acting to communicating: The analysis of a boy with a pathological organization1

The author presents the analysis of an 8 year‐old boy prematurely born after a high‐risk pregnancy, then hospitalized for two weeks. He was never breastfed and presented vomiting, intense activity and inadequate behaviour as symptoms. His highly dysfunctional family is composed of a non‐productive father and a homely, though aggressive, mother. The patient displayed a rigid defensive structure with perverse aspects and a cruel superego. His constant interest in magical characters frequently disguises an avoidance of reality. By means of transference interpretations, a trustworthy link with the analyst now allows him his own mental space, where hidden psychotic states come to light. In the clinical material, this boy's skills for insight mingle with oscillations from severely defensive states to integration and vice versa. The analytic relationship in this often hostile scenario has become strong. The analysis is hampered by constant demands from family and school‐both expect the analyst to prevent his frequent acting out. Whereas some perverse polymorphism is part of childhood and may persist throughout life, it is likely that the patient's pathological organization may yield to reality and facilitate reparation, relinquishing the world of make‐believe as well as the intense projective mental functioning.     

Anorexia and the Trojan Horse: a reflexive review of written psychoanalytic encounters with anorexic patients

A selective and limited sample of clinical case studies of psychoanalytic psychotherapy with anorexic patients, focussing on the author/therapist’s experience of working with such patients, is examined. Patients’ depressive and often angry states of withdrawal, and projections, are frequently noted. A summary of more hopeful interactions, as selected from the literature reviewed, is offered. An understanding of anorexic defences is explored in relation to the ‘Trojan Horse’ mythology, in the sense that that which purports to be emotionally nourishing and sublime can be suspiciously viewed as seeking to enter and conquer, through subterfuge. Some existing challenges to traditional tenets of psychoanalytic clinical practice with anorexic patients are presented.     

Ecological and ethical issues in virtual reality research: A call for increased scrutiny

We argue that moral judgment studies currently conducted utilizing virtual reality (VR) devices must confront a dilemma as a result of how virtual environments are designed and how those environments are experienced. We first begin by describing the contexts present in paradigmatic cases of naturalistic moral judgments. We then compare these contexts to current traditional (vignette-based) and VR-based moral judgment research. We show that, contra to paradigmatic cases, vignette-based and VR-based moral judgment research often fails to accurately model the situational features of paradigmatic moral judgments. In particular, we compare and contrast six recent VR studies to support our view that only simulations high in context-realism and perspectival-fidelity can produce “virtually-real experiences.” After analyzing the constituents of a virtually-real experience, we go on to propose guidelines for the creation of VR studies. These guidelines serve two purposes. First, we aim to increase the ecological validity of such studies to advance our understanding of moral judgments. Second, we believe that such guidelines should inform how Institutional Review Boards assess VR research. We show that our guidelines are urgently needed, given the current lax review standards in place.     

美国人体研究的监督：科学发展中的伦理与规定

美国保护人体受试者的制度建立在伦理学基础之上,并正式通过相关法律。对人体研究的监督是保护受试者个人的健康和权益,确保研究的有效性,整体性,以及科学与社会更大范围的利益,监督审查机构是联邦卫生部下属的两个机构-食品与药品管理局（FDA）和人体研究保护办公室（OHRP）,大部分人体研究受两机构监督。美国人体受试者保护系统的基础部分是伦理审查委员会（IRB）及知情同意,IRBU电在提供一种机制,以进行客观的审查,同意和研究过程听持续监督;知情同意意在保证个人在了解与实验相关的风险,不适,收益后能自由做出参加与否的决定,美国人体研究保护制度正面临着挑战。美国也为促进人体受试者保护在进行新的努力。     

制度伦理:建构和谐社会的伦理支撑——论制度伦理与和谐社会伦理生态之共契

制度伦理是对建构和谐社会“良序情结”的一种回应,不管从制度伦理对建构和谐社会的功能助益,甚或二者在理性诉求和终极眷注方面的公度与通约,都可以看出,制度伦理与和谐社会二者之间是一种互构互益性的关系。制度伦理与和谐社会伦理生态之契合还体现了人类社会共同的美学期待。