Interpretation as Shaped by Projective Identification

How to make interpretations during the course of psychoanalytic treatment is a recurring clinical question. Certain aspects of the analysis serve as helpful signposts along the way. Patients have particular interpersonal ways of presenting themselves. The unique intrapsychic manner the patient has of relating to us (transference) and our feelings (countertransference) to these matters give us clues to study. Our understanding of these situations may lead to the development of a hypothesis we may or may not choose to share with the patient. Projective identification is a complex mental mechanism that can often shape the content and manner of an interpretation.     

PLS model building: A multivariate approach to personality test data

The aim of this study was to demonstrate how personality test data can be plotted with a multivariate method known as Partial Least Squares of Latent Structures (PLS). The basic methodology behind PLS modeling is presented and the example demonstrates how a PLS model of personality test data can be used for diagnostic prediction. Principles for validating the models are also presented. The conclusion is that PLS modeling appears to be a powerful method for extracting clinically relevant information from complex personality test data matrixes. It could be used as a complement to more hard modeling methods in the process of examining a new area of interest.     

‘Telepathic’ phenomena and separation anxiety

By discussing a treatment characterized by its difficult ending, the author strives to show the dynamic impact of separation on phenomena that can be seen as ‘telepathic’. Led to develop some inalienable attachment to her analyst in the primary transference, the analysand found herself caught up in the contradiction of her visceral dread of dependency, which compelled her to interrupt the work in progress. She then began to work out her analyst's comings and goings and to run into him in public places, as if to be assured of his immovability. This phenomenon arose with high frequency as the effect of some idealization of the maternal object aiming to deny the spatiotemporal gap. The chance that the experience of rejection via indifference may be repeated also entailed the transferential unfurling of a fantasy involving a double, undifferentiation counterbalancing the lived experience of separation. Furthermore, a ‘telepathic’ dream occurred as confirmation of this twin relationship which illustrates the analysand's refusal to renounce her narcissistic object. Projective identifications, agglutinated ego nuclei along with primitive cross‐identifications could, among other concepts, account for such phenomena which are projective in nature yet real all the same. Such mechanisms could have the power to relay thoughts the moment undifferentiated parts of the ego – if not unborn parts of the self – were activated in a potentially symbiotic zone. Marked by a feeling of dispossession, the analyst's countertransference not only seemed to underscore this hypothesis, it also gave a partial explanation for it. Until the analyst could recognize his own nostalgia for a symbiotic relationship, he had to encourage the occurrence of those unexpected meetings which stemmed from a convergence between the transference and the countertransference.     

Some technical implications of Klein's concept of 'premature ego development'

In this paper, the author revisits the problem of 'premature ego development' first introduced by Melanie Klein in 1930. She also highlights several developments in post-Kleinian thinking since the publication of that paper, which can be seen as offshoots of or complements to Klein's work. The author proposes a link between this category of precocious development and the absence of the experience of what Bion termed the 'containing object.' She puts forward several technical considerations relevant to analytic work with patients who suffer as a result of early developmental failures and presents various clinical vignettes in order to demonstrate the ways in which these considerations take shape in the analytic setting.     

The impact of intrusive identification in the analytic process: Some implications of real trauma and phantasy1

In this paper, the author aims to show a possible understanding of very primitive identifications, especially intrusive identifications, when associated with traumatic situations and expressed through current phantasies related to these experiences. At first glance, this understanding could be considered quite straightforward. However, the original contribution offered by the author is the participation of this special kind of combination in the formation of the primitive intrusive identifications and its association with the imprisonment inside the primitive object of identification, especially the mother. The author proposes the amplification of the clinical use of the concept of ‘life in the claustrum’, originally described by Meltzer, moving beyond persecutory claustrophobic situations. He illustrates the phenomenon with the analytic work carried out with a patient whose narcissistic and intrusive character was structured on the basis of primitive intrusive identifications and phantasies related to the claustrum inside the mother. The patient's imprisonment inside the maternal compartments has, as its background, the phantasies related to the infantile traumatic experience of the death of the patient's brother, which are reproduced in the analytic relationship.     

All holes are the same: Emerging from the confusion

The author describes a type of mental development in which the primitive libidinal value of faeces and urine is kept unaltered all through adulthood. In this instance, individuals harbour fantasies of projective identifi cation with the internal parents, denying their real dependence, which leads to a pseudomaturity. These fantasies are usually accompanied by anal and genital masturbation and have intense aggressive content. Furthermore, there is a signifi cant confusion among all body orifi ces, leading to an inability to distinguish the self from the object, the inner world from outside reality. Individuals with this type of development can only maintain limited object relations and have highly erotized excretory activities. Manipulation of faeces may occur. This structure works as a defence against breakdown, but may also provide pleasure as it gives the illusion of omnipotent control of the object, as typical in pathological organizations. The author presents clinical material and discusses the diffi culties of the analysis, in which the patient tries to seduce the analyst into colluding with his mental functioning, primarily as a means of communication as well as a projection of his despair and his disbelief in the analyst's ability to help him.     

Psychotic withdrawal and the overthrow of psychic reality1

The author attempts to distinguish between the world of fantasy and the imagination (which fuels our capacity to ‘dream’) from a withdrawal into fantasy. In this withdrawal, the foundations of which are laid in childhood, a dissociation from psychic reality starts and from it the delusional world arises and constitutes the adult illness. During therapies of adult patients who have experienced a psychotic state, it is often possible to reconstruct the state of infantile withdrawal and understand how their dissociation from reality was ignored or unknowingly encouraged by their parents. Children destined to develop psychosis enter into the dissociated world not just as a defence against anguish or loneliness, but also for the pleasure of experiencing a delusional self‐suffi ciency and a gratifying omnipotence in which anything is possible. Mental workings that take place in the withdrawal do not follow the rules governing normal psychic functioning. Those fantasies cannot be either repressed or ‘dreamed’ in order to be transformed into thoughts. These psychopathological structures, which develop early and autonomously, have to be understood during analytical therapy in their origins and ‘deconstructed’ in order to help the patient to escape from their dominion. By means of clinical examples, the author tries to shed light on the possible ways of reaching patients in their psychotic shelters, thereby helping them to re‐emerge into a psychic reality.     

The Phenomenology of Early Psychosis Elicited in an Occupational Therapy Expressive Evaluation

Expressive assessments facilitate sharing, and the therapeutic understanding of youth. The experiences of nine young adults seeking help for psychosis were explored with an arts-based, occupational therapy expressive evaluation. The study used participant-observation methods. Data analysis drew on hermeneutic phenomenology. The findings illustrate the challenges these participants have in feeling connected to a shared world of doing, and in locating themselves within the temporal flow of time. Of significance was the potential to read the unfolding of creation in clay media as an acted narrative to tap into “constellations of meaning.” Implications for clinical practice and professional reasoning are highlighted.     

From the Couch to the Street: Applications of Psychoanalysis to Work with Individuals Who Are Homeless and Mentally Ill

Current-day psychiatric treatment of severely disturbed populations tends to focus on the biological, behavioral, and social dimensions of rehabilitation. This paper addresses the relative neglect of the complex psychodynamic and interpersonal aspects of treatment of individuals who are homeless and mentally ill by presenting two clinical cases that are discussed from various psychoanalytic frames of reference. Based on their clinical experiences, the authors conclude that psychoanalysis offers valuable frameworks to guide the treatment process and the structure of the treatment setting for individuals who are homeless and suffering from severe psychiatric illness.     

Critical Issues in the Assessment of Child Sexual Abuse

This article explores the feasibility of using standardized psychometric methods in the initial stages of an investigation of child sexual abuse; methods that are less intrusive and therefore less damaging to children and their families. We review the complex conceptual and research issues that arise from attempts to assess the many-sided aspects of child sexual maltreatment. Among those considered in both the clinical and research spheres are problems of definition and diagnosis; limitations of clinical interviews, and a variety of direct and indirect psychological instruments used for investigating sexual maltreatment and risk assessment; the inadequacies of experimental designs; and also the political, practical, and ethical restraints that hinder research in this area. It is argued that there is insufficient evidence based on controlled studies or standardized normative tests to advocate any simple, unidimensional methodology for the screening task. However, recommendations are put forward for the cautious, conjoint use of several procedures in a multidimensional approach to assessing child sexual abuse. Suggestions are also made for future research and development.