Within or without: negotiating psychic space with an adolescent at risk of developing a narcissistic personality structure

This paper examines a 22-month once weekly psychotherapy with an adolescent young man. My patient was one of a group of adolescents who, due in part to excessive aggression, envy, anxiety or confusion, has chronically evaded the intimate and dependent psychic contact with others that is necessary for psychological development. In my view, this comes about through a combination of external factors and internal predisposition, with the quality of care received during infancy playing a crucial role. These adolescents appear to be developing narcissistic modes of being in the world which if allowed to persist into adulthood would be seen as deeply entrenched clinical psychopathology. Managing separation and loss is one of the central aspects of adolescence, but these young people tend to intrude or merge with others with such aggressive force that recognising difference between self and other becomes difficult. In psychotherapy, this often takes the form of the patient’s inability to tolerate experiencing the therapist as a separate person, and when knowledge of the therapist as separate impinges on their view, they frequently react in a variety of primitively destructive ways. This paper seeks to explore these central ideas through a detailed examination of psychotherapy with a young man in whom such struggles predominate.     

Cultural function and psychological transformation in psychoanalysis and psychoanalytic psychotherapy

Cultural experience of silence and individual vicissitudes between talking and being silent infl uence the way individuals form an alliance and pursue the analytic process. This is of relevance both for the patient and for the psychoanalyst/therapist. The author describes a patient, whose silent phase occurred in the fi fth and sixth year of intensive psychoanalytic psychotherapy. She suggests that a) the silence functioned as a protection of a space for the core self and promoted inner transformation and psychologicaldevelopment;b)thesilenceinvolvedatransference-countertransference matrix with projective identifi cations of the patient's internalized mother- and father-related objects that caused a tenuous balance between maintaining and erasing the relationship between the patient and the author; c) the silence phase was highly infl uenced by the author's own cultural background and what she brought into the relationship of tolerance of being silent in the presence of another, and understanding of the many complex functions of silence. During the silent phase the patient moved from simply describing and naming her affects and inner experiences or expressing them as somatic processes, to being able to internally access and verbally convey her own affects and experiences in the therapeutic alliance. This process involved both affect desomatization, affect differentiation, and affect verbalization.     

‘The newspaper reader’: On the meaning of concrete objects in a psychoanalytic treatment1

The author investigates the meaning of concrete objects in the psychoanalytic treatment of a severely disturbed patient for the development of his inner world and the analytic process. She includes a survey of relevant theoretical concepts with an emphasis on Winnicott and Bion. It is shown that the objects served basic defensive functions both within the analytic relationship and for the precarious intrapsychic state of the patient. The author describes the technical dealing that led to a structural change. From the comparison of the initial dream and a later dream, Mr N's inner development from total inclusion in the object to triadic reality of separated, repaired objects becomes discernible. The author shows how this progress was facilitated by his use of concrete objects as links between his psychotic and non‐psychotic parts, as well as by the specifi c way the analyst handled the paradoxical transference‐ countertransference. She also illustrates the thesis that the developmental steps described are crucial for the capability to digest psychic pain by symbolization instead of discharging it in a destructive‐violent way.     

Obituaries

Obituary notices for:
James Seddon (1 June 1920–9 January 1999)
Elizabeth Osterman (27 July 1919–3 July 1998)     

The manifestation of transference during early psychotherapy sessions: Exploring an alternate data source for therapist narratives in transference research

Introduction: Previous transference studies have compared in‐session client narratives about significant others to in‐session client narratives about the therapist, limiting data to the information that clients are willing to share with the therapist. Method: The first three sessions of 30 therapies with high‐functioning individuals were examined using the Core Conflictual Relationship Theme (CCRT) method. Client narratives about others were drawn from the psychotherapy sessions and client narratives about the therapist were drawn from a Participant Critical Event (PCE) interview conducted after the third session of therapy. Results: Factor analyses of the CCRT components indicated several relational patterns: a complementary pattern of relating characterised by a devaluation of the therapist and idealisation of others; a concordant relational transfer where clients feel bad with both the therapist and others; and as clients experience control issues with significant others, they wish to adopt a submissive stance toward the therapist. The results suggest that the source of therapist narratives may influence the results of transference research.     

THE WIDENING SCOPE OF INDICATIONS FOR PERVERSION

Much has changed in clinical practice and theory that bears on the diagnosis and treatment of perversion since Freud's Three Essays on the Theory of Sexuality (1905). Definitions of perversion have been freed from assumptions of a heterosexual normality and from moralistic interpretations. The authors endorse the current emphasis on aggression and early narcissistic problems and include the notion of splitting and sexualized scenarios in their definition of perversion. They present several vignettes of male and female patients to demonstrate the debts owed to Freud's theories and the way in which their thinking differs. They emphasize the understanding of the transference‐countertransference picture and the patient's management and control of excitement.     

Sonya turned her skin outside in

In the case of a young woman, it was evident that she had difficulties in approaching her pregenital experiences during analysis and that she had defended herself against pregenital anxiety. While these defences were aimed at denying and repressing early oral and bodily fantasies end experiences, they had also influenced and inhibited her subsequent bodily and genital development. Psychosomatic symptoms had both absorbed and represented archaic feelings and fantasies which had not found a more precise mental expression. Consequently, her female inner space had been repressed and excluded by skinerotic defences.     

Braving the erotic field in the treatment of adolescents*

Abstract

The psychoanalytic literature on erotic transference and countertransference in adolescence is notably sparse, despite the centrality of the developing sexual body/mind. Erotic feelings in the consulting room with an adolescent can feel taboo, causing the analyst to avoid the immediacy of these feelings. Excessive timidity on the part of the analyst can limit the growth of the capacity for containment of sexual feelings and yield what I term ‘erotic insufficiency’ in our work with adolescents. I offer clinical material from a period of erotic transference and countertransference with a 12-year-old boy to consider these ideas. Further, I suggest that the very terms ‘erotic transference’ and ‘erotic countertransference’ can feel defensively remote and antiseptic. I suggest that ‘erotic field’ better captures the subtle, nuanced interplay of feelings.     

努力控制及其神经基础

本文对努力控制的概念、发展及其神经基础进行了归纳和总结。我们发现努力控制涉及的脑区主要包括背外侧和腹外侧前额叶,前扣带回,顶上和顶下小叶以及辅助运动皮层等。此外,通过分析对比后发现努力控制与执行功能之间在行为表现和神经基础上有密切关系：两者都与个体的学业成绩、情绪状态和攻击行为等有关;努力控制涉及的脑区有很大部分处于具有执行功能的突显网络和额顶控制网络。这些证据表明两者之间可能有共同的脑结构基础。