‘Paralysed associations’: countertransference difficulties in recognising meaning in the treatment of children on the autistic spectrum

Children with autism can have a paralysing effect on the clinician’s capacity to associate freely: connections that seem obvious on reflection may be impossible to notice in the child’s presence. The author argues that this situation can be reached by more than one pathway, and that the degree of the child’s bodily and emotional cohesion is an important factor. Children may seek to immobilise the therapist’s thought processes through projective identification, whether to communicate their own experience of paralysis or because these thought processes are equated with a parental intercourse that produces a ‘baby’ (as described by Bion and Britton). Vignettes are offered to illustrate how the therapist may be nudged into overlooking this baby as well as a potentially growing part of the child that is identified with it, with important consequences for development. A second possible pathway appears to involve the much more primitive mechanism of adhesive identification, in which the child’s sense of continuing existence depends on sticking to the therapist’s surface and any movement can lead to a sense of bodily disintegration. In the clinical illustration, the therapist felt physically constrained and unable to recognise links in the material: it is suggested that this was in resonance with the child’s fear that movement, whether physical or mental, meant losing parts of his body and must be avoided at all costs. These levels can mask each other, and it seems essential to attend to both in order to avoid impasse or the overlooking of essential aspects of the child’s experience.     

Adult attachment theory and Rorschach Inkblot Method: A systematic literature review

This critical appraisal and synthesis review explores the literature on the evidence of Rorschach Inkblot Method variables as measures of the attachment theory. We searched for publications making use of EBSCO Discovery Service (EDS) which included 41 databases of which Academic Search Premier, ScienceDirect, PsycARTICLES, and PsycINFO yielded the most results. Inclusion criteria were published studies concerning Rorschach and attachment theory where participants were older than 18 years. Non-academic literature and studies not published in English were excluded. We synthesised the evidence following the narrative approach of Petticrew and Roberts (2006 Petticrew, M., & Roberts, H. (Eds.). (2006). Systematic reviews in social sciences: A practical guide. Oxford, UK: Blackwell Publishing Ltd. https://doi.org/10.1002/9780470754887[Crossref] , [Google Scholar]). Findings suggest texture, oral responses, and Rorschach oral dependency strongly associated with attachment security, with other variables indicating weaker associations with attachment.     

Agoraphobic and claustrophobic anxieties two problems in leaving university for some final-year students

Abstract

This article considers the way final-year students present with agoraphobic and claustrophobic symptoms which have caused them to break down academically before the end of their courses. It presents a brief theoretical discussion of these anxieties in students, and offers a way of thinking about them in terms of a particular understanding of projective identification. Fragments of casework with three students are used to show that the anxieties are brought about when the desire for invisibility for part of the self, the motive for projective identification in these cases, is more exposed by the arrival of the final months leading up to the end of the students' courses.     

The Symbolic Object

Abstract

The term “symbolic object” is introduced as a way to understand the moments between analyst and patient where “something” new and dynamic emerges within the dyadic relationship. The symbolic object is the bridge between the idealized, all-good object and symbolization proper. The intrapsychic atmosphere between self and object representations is in a relatively non-conflicted state during this process. By reformulating the Nirvana principle and the principle of constancy as ways in which the organism economically strives for the most organized and homoeostatic state possible, the infant or adult can be seen to be searching for the position of lowest unpleasure possible. This is the optimum balance between the libidinal and aggressive forces in the self and object representational field. These moments of “truce” between often highly conflicted phantasies usher in a more refined use of projective identification as a form of intrapsychic/interpersonal communication. This is a particular atmosphere from which both parties, within the projective/introjective, back-and-forth dyadic world, can begin to co-create and rediscover assorted amalgams of self and object functioning. This newly awakened psychic entity is the symbolic object. This outgrowth of something fresh to the dyadic orbit is a mutative moment that propels the relationship into a different direction. Within the pairing of minds, a novel and mutual understanding is produced. Both parties share this new symbolic object and each is shaped by it.     

Projective identification in Othello and Verdi's Otello

In this paper I explore how projective identification is depicted in Shakespeare's Othello (1603–4 [2006]) and in Verdi's Otello (1887). Both the play and the opera can be seen as studies in projection – in the evacuation into others of feelings that the subject finds unbearable, such as envious and jealous exclusion or unbearable sexual excitement. The essential issue is the same in both the play and the opera, which is that the very sight of love between Othello and Desdemona, or of contentment in anyone's mind, drives Iago mad with envy and jealousy, which he has to expel and project into others, particularly into Othello, who is susceptible to this attack because of his own narcissistic vulnerability. I take two episodes, which appear in both the play and the opera, to explore in detail how projective identification is represented both verbally and musically. I suggest that music, and words used musically, are particularly suited to conveying complex inter‐ and intra‐personal processes such as projective identification.     

Orientation,containment and the emergence of symbolic thinking

Orientation is viewed in this paper as an important dimension of containment for the development of thinking. Orientation refers to the particular positioning in space and time of mother and infant so they can find one another and then containment can take place. Bion's container–contained model for the development of thinking is based on the capacity of the mother's mind to function as a ‘home’ for the infant's primitive projections. Containment and orientation are explored in relation to an ancient Greek object called ‘σ?μβολον’ [symbolon], which I use here as a metaphor for the early negotiation between mother and infant to achieve a correct matching to each other's orientation. This is then mobilized and re‐enacted between analyst and patient in the psychoanalytic process. Orientation as part of the container–contained model enables us to view the development of thinking from a new perspective with greater integration of cognitive and emotional aspects. The clinical implication of the concept of orientation is explored in relation to the process of engagement/disengagement between analyst and patient and is illustrated by clinical material.     

Neuropsychological assessment with the Visual Gestalt Test: psychometric properties and differential diagnostic probabilities

The Visual Gestalt Test is a neuropsychological instrument developed for evaluation of learning and memory of visuo-spatial material. A revised strategy of scoring has motivated the present study, where data from 153 normal persons, 99 epilepsy patients, and 24 depressed patients are presented and compared. The Visual Gestalt Test is observed to discriminate between normal and diagnosed groups in several ways. Additionally it is found to discriminate between depressed and brain damage subgroups of patients. Data are presented in order to supplement previously published ways of scoring and norms. Practical guidelines for the clinical applications of the test are suggested as perspectives.     

Analysis of Cognitive Dysfunction in Patients with Low-Grade Glioma

All living adults with histopatologically proven diagnosis of low-grade glioma in a Swedish county were identified with help of the Regional Cancer Register, half of them (n = 24) participated in a neuropsychological evaluation. A considerable variation was found in cognitive function within this group of patients, ranging from good ability to severe disturbance. Different patterns of cognitive dysfunction emerged resulting in three subgroups; patients with severe, mild, and minimal selective dysfunction. The patients with severe disturbance had a global dysfunction covering most assessed cognitive domains. Slow information-processing speed was obvious in the subgroups with both severe and mild dysfunction. Cognitive problems present in the best performing group seemed related to tumor localization. Cognitive function in the whole sample was related to histopathological diagnosis of the tumor, as well as to educational level of the patients. The nonworking patients had significantly poorer performance than the working patients.     

Individuation: finding oneself in analysis--taking risks and making sacrifices

This paper looks at some of the processes that are at work in finding oneself in analysis. It explores Jung's unique contribution to our thinking about the self and its dynamic of individuation. The author attempts to show how the Self, in its quest for consciousness, requires the surrendering of ego inflation--the narcissistic delusion that the ego is the self. A case is made for seeing analysis as an individuation process which offers the opportunity for experiences of a more authentic sense of oneself. Jung stated that individuation requires the ego to enter into service of the Self. For this to happen, the author argues that both patient and analyst must be prepared to make sacrifices and take risks. Using clinical examples, he illustrates that, although purposive, the Self can be experienced as violent and destructive if the ego is unable to facilitate its expression. This may result in an individuation crisis for both analyst and patient. The paper demonstrates how impasse in analysis can evoke the transcendent function, which also requires sacrifices to be made and risks to be taken for analysis to proceed.