Action across emptiness

This paper examines how autism may affect the processing and containing of emotions and sensations. At the beginning of life we can hypothesise that the baby develops two means of processing experience: containment that involves a sensory and mimetic trace of relational experience (proto-containment) and containment which, through the α function and projective and introjective functions translates feelings into meaning (♀/♂). Both these means of processing emotional experience remain active throughout life but oscillate the one with the other. The main hypothesis of this work is that the autistic child is not able to oscillate between real containment (♀/♂) and a primitive form of proto-containment. The author aims to explore, through clinical material, the factors which may promote this oscillation. Autistic children often use non-verbal communication. The author examines how a particular type of action can cross the relational void in the therapeutic relationship through a process that can transform feelings of great distress in the analyst via acts that can be described as an Act of Faith, as described by Bion. This form of action that can cross the void is like an artistic performance.     

Exposed: phallic protections,shame and damaged parental objects 1

Using ideas derived from Dana Birksted-Breen (‘Phallus, penis and mental space’, International Journal of Psycho-Analysis, 77: 649–57, 1996), this article explores the clinical experience with ‘Tommy’, a young boy who suffered multiple traumas and neglect. Birksted-Breen describes a phallic state of mind, which, amongst other things, serves to repudiate the potential for a creative link between internal parental objects and a capacity for thinking. In order to survive psychically, Tommy frequently turned to a phallic state of mind. The deficits in his internal and external objects meant that helpful parental qualities, linked with the development of psychic bisexuality, were not available for introjection and identification. The paper suggests a link between Tommy's employment of phallic (and at times perverse) ways of thinking, related to his intrusive attempts to expose and humiliate his psychotherapist, and to an experience of shame associated with inadequate internal objects. The serious compromise to the development of a creative psychic bisexuality in the patient is reflected in the countertransference strain on the psychotherapist's own internal couple.     

The conceptual distinction between projective identification (Klein) and container-contained (Bion)

This paper describes the use of play in the psychotherapy of a latency child from a severely traumatised background. It considers the meaning of play in relation to the role of the psychotherapist and to psychotherapeutic technique and explores its functions in terms of the child's development. The paper documents the psychotherapist's learning experience about the difficulty of trying to make the ‘right’ interpretations and her consequent realisation of the intrinsic value of play in psychotherapy. In considering these themes, the author explores how, by placing interpretation secondary to play, the therapy enabled the development of the child's creativity and self-agency, facilitating a movement from primarily paranoid–schizoid defences towards the beginnings of a depressive position.     

Out of the body: embodiment and its vicissitudes

Body‐mind dualism and the consequent neglect of the body of the analyst can have important negative effects on the analytical process leading all too often to misinterpretations of the analysand's verbal and non‐verbal communications and to disturbances of analytical temporality. This is intensified when we are dealing with individuals where disembodiment and states of psychic deadness are central features. The paper explores the philosophical roots of the idea of a disembodied mind and the way in which this impacts our relationship with the world. While André Green's concept of the dead mother and disturbances in the sense of self‐agency have been held to play an important role in states of psychic deadness, I suggest that it is rather disturbances in the sense of body ownership and of the body image which are more central. The paper then discusses the particular kinds of countertransference that can be evoked in the analyst when we find ourselves dealing with this type of patient and suggests how we can use our embodied countertransference to become aware of and elaborate our own feelings of deadness in order to overcome the loss of temporality that is characteristic of such states. This is illustrated with reference to my work with a young man with a masochistic perversion and a severe disturbance of the body image with an accompanying profound sense of psychic deadness.     

Critical Success Factors of Rural and Urban Special Education Administration

Perceptions and opinions are reported of special education administrators in Indiana and Massachusetts. The data that are presented reflect administrators' ratings of factors that they consider critical to their personal success on-the-job and factors they see as essential to successful functioning of their organizational unit. Discussion occurs within the context of operation of special services programs in single district units and those found in cooperative or intermediate unit structures.     

Health,Healing and Wholeness in Frail Elderly People

ABSTRACT

This article explores the relationship between health, healing and wholeness in a group of twenty frail older residents of nursing homes, using in-depth interviews. While the participants in this study were all frail and lived with a number of disabilities, they demonstrated signs of transcendence in their responses to their disabilities. While independent living older adults in a previous study had all expressed fears of future vulnerability, only 45% of these nursing home residents said they had fears. Failure to thrive is discussed as one area of concern for frail older people, noting that this may stem from a lack of nourishment of the soul. Pastoral care is described as a multidisciplinary intervention for these residents, forming part of their wholistic care.     

Recovery opportunities,work–home conflict,and emotional exhaustion among hematologists and oncologists in private practice

Hematologists and oncologists in private practice play a central role in the care provided for cancer patients. The present study analyzes stress and relaxation aspects in the work of hematologists and oncologists in private practice in Germany in relation to emotional exhaustion, as a core dimension of burnout syndrome. The study focuses on the opportunities for internal recovery using breaks and time out during the working day, the frequency of working on weekends and on vacation, and the physician’s work–home and home–work conflict. Postulated associations between the constructs were analyzed using a structural equation model. If work leads to conflicts in private life (work–home conflict), it is associated with greater emotional exhaustion. Working frequently at the weekend is associated with greater work–home conflict and indirectly with greater emotional exhaustion. By contrast, the availability of opportunities to relax and recover during the working day is associated with less work–home conflict and indirectly with less emotional exhaustion. These results underline the importance of internal recovery opportunities during the working day and a successful interplay between working and private life for the health of outpatient hematologists and oncologists.