Mindfulness,physical impairment and psychological well-being in people with amyotrophic lateral sclerosis

Objective: Mindfulness is the process of actively making new distinctions, rather than relying on habitual or automatic categorisations from the past. Mindfulness has been positively associated with physical well-being, better recovery rates from disease or infections, pain reduction and overall quality of life (QOL). Amyotrophic lateral sclerosis (ALS) is a rare, progressive and fatal neurodegenerative disease, clinically characterised by progressively increasing weakness leading to death, usually within five years. There is presently no cure for ALS, and it is considered one of the most genetically and biologically driven illnesses. Thus far, the aims of psychological studies on ALS have focused on understanding patient – and, to a lesser extent, caregiver – QOL and psychological well-being. No previous study has investigated the influence of psychological factors on ALS.

Methods: A sample of 197 subjects with ALS were recruited and assessed online twice, with a duration of four months between the two assessments. Assessments included measurements of trait mindfulness, physical impairment, QOL, anxiety and depression. The influence of mindfulness as predictor of changes in physical impairments was evaluated with a mixed-effects model.

Results: Mindfulness positively influenced the change of physical symptoms. Subjects with higher mindfulness experienced a slower progression of the disease after four months. Moreover, mindfulness at first assessment predicted higher QOL and psychological well-being.

Conclusions: The available data indicate that a psychological construct – mindfulness – can attenuate the progress of a disease that is believed to be almost solely biologically driven. The potential implications of these results extend well beyond ALS.     

‘No entry’, an invitation to intrude,or both? Reflections on a group of anorexic patients

This paper describes the twice‐weekly psychoanalytic psychotherapy of a young woman who had undergone major bowel surgery in her early 20s, with no clear medical indication for the surgery. Whilst the concept of ‘No Entry’ described by Williams ( 1997a , b ) aptly describes many features of more ‘typical’ anorexic patients, this paper describes a particular group of anorexic patients, referred by their physicians for multiple medical procedures; and proposes there is a group of anorexic patients, repeatedly referred for medical investigations, into whom particular types of entries occur. These are entries into the body ‘legitimized’ as medical, with a trajectory towards multiple procedures, examinations and surgical operations. Other entries (outside the medical setting) may occur in a state of altered consciousness, under the influence of alcohol or drugs, such that any wish for intrusion is disowned and denied. In both sets of events, intrusion is both invited, and consciously denied. The case example illuminates some of these features, and aspects of the countertransference are also described. Attention is drawn to relevant research focusing on surgical intrusion. Finally, there is an exploration as to how such patients may invite intrusions into the body through surgery and medical procedures.     

The function of the object in the binding and unbinding of the drives

The author discusses the clinical consequences of the failure to structure ambivalence in terms of a conflict, and explains the paradoxical patterns that are then set up, particularly in the various kinds of negative therapeutic reaction. He then explores four instances of primary traumatism that contribute to the failure of the initial binding of the drives and to the individual’s subsequent inability to set up a conflict of ambivalence that could curb the clinical manifestations of destructiveness.     

End notes: two unpublished presentations by Michael Fordham

Following the publication in this journal of two of Fordham's unpublished papers selected by James Astor (2010, 55, 5), the editors have asked me to select a further two. I have chosen two clinical pieces, one clinical notes and the other notes that refine his previous thinking, which Fordham wrote at the end of his life. Both are examples of the way Fordham continued throughout his analytic work to turn to patients as his primary source of learning. Fordham presented the first piece, ‘A case study’, to Parkside Clinic in 1988. Its subject is his last child patient, a nine‐year‐old boy with behaviour problems that destroyed the analytic frame. The second is clearly for an SAP (Society of Analytical Psychology) audience and written probably around 1992–93. It is titled ‘Some comments on transference and countertransference’ and contains material from the patient who has become known through papers in this journal as ‘K’. The two pieces are presented together within a commentary rather than separately with footnotes, in order to provide some context for Fordham's thinking in his late years.     

Transference,relationship and the analyst as object: Findings from the North American Comparative Clinical Methods Working Party

Data from the North American Comparative Clinical Methods (CCM) Working Party a is used to 1) explore how psychoanalysts in North America conceive and address the transference and the relationship between analyst‐analysand and 2) to study what kinds of ‘objects’ psychoanalysts become, explicitly and implicitly, within psychoanalytic treatments. The North American CCM Working Party closely studied 17 clinical cases presented by North American psychoanalysts across the spectrum of analytic schools at their meetings. We found that the 17 analysts fell into three different groupings according to the internal consistency of their method and their approaches to transference, relationship and analyst‐as ‐object. We also found that analysts' individual work, while heavily influenced by their schools of thought, also involved unique interpretations of their particular paradigms.     

External and internal reality: The impact of the current socio‐economic crisis on the analytic dyad

This paper addresses the impact of the current economic crisis on the psychic functioning of the patient and the analyst, their relationship and collaboration. This intrusion of ‘external reality’ is multidimensional, and thus with multiple meanings. The critical role of the economic factor brings various dimensions of money into play, such as self‐preservation, power as well as aspects of psychosexual development. In addition, the crisis involves symbolic loss of basic ideals such as honesty and social responsibility. Patient and analyst are affected in similar and different ways in their respective roles as well as according to the specific intrapsychic functioning of each. Moreover, unique characteristics of the crisis often create a crisis in the analysis. In order to avoid deformation of the analytic relationship, the analytic dyad must examine and work through the multiple meanings of the crisis as well as the meaning of the impact of the crisis on the analytic relationship for both patient and analyst. This complex transference‐ countertransference interplay poses specific challenges to the analyst. After discussion of these issues, clinical material is presented that demonstrates how they appear in analytic practice today.     

Political and clinical developments in analytical psychology, 1972‐2014: subjectivity,equality and diversity—inside and outside the consulting room

Utilizing Jung's idea of theory as a ‘personal confession’, the author charts his own development as a theorist, establishing links between his personal history and his ideas. Such links include his relationship with both parents, his sexuality, his cultural heritage, and his fascination with Tricksters and with Hermes. There follows a substantial critical interrogation of what the author discerns as the two main lines of clinical theorizing in contemporary analytical psychotherapy: interpretation of transference‐countertransference, and the relational approach. His conclusion is that neither is superior to the other and neither is in fact adequate as a basis for clinical work. The focus then shifts to explore a range of political and social aspects of the clinical project of analytical psychology: economic inequality, diversity within the professional field, and Jung's controversial ideas about Jews and Africans. The author calls for an apology from the ‘Jungian community’ for remarks about Africans analogous to the apology already issued for remarks about Jews. The paper is dedicated to the author's friend Fred Plaut (1913‐2009).     

New developments in transference focused psychotherapy

This paper will summarize recent clinical developments in the treatment of borderline patients at the Personality Disorders Institute at Cornell. The experiences under review will include the careful, ongoing monitoring of developments in the patient's life outside the sessions, and their consideration in diagnosing affective dominance during the hours. Other issues include the discussion of a ‘second chance’ approach to contract violations; the assessment and concern with the patient's assumption of responsibility for himself; the contradictions between actual behavior patterns and life goals, and between personality potentials and present functioning; the technical implications of particular constellations of regressive narcissistic features; drug dependence and antisocial behavior; and life goals and treatment goals.     

DREAM DIAGNOSTICS: FRITZ MORGENTHALER'S WORK ON DREAMS

The unique approach to dreams of Swiss psychoanalyst Fritz Morgenthaler (1919–1984) is presented and discussed. Although rarely discussed in the English‐speaking psychoanalytic world, this approach is very alive in German‐speaking countries. Focusing on the distinction between the remembered hallucinatory experience of dreamers and the event of telling dreams within psychoanalytic sessions, Morgenthaler made two major innovations: first, he proposed a new understanding and handling of associations to dreams, and second, he offered what he called dream diagnostics as an instrument with which to integrate both resistance and transference into clinical work with dreams.