Mens sana in corpore sano: Psychotherapy with a cerebral palsy child aged nine months

This paper is the acount of the psychoanalytic understanding and treatment of a nine-month-old cerebral-palsy infant and her mother. When first seen, Abigail hung over her mother's arm, and would scream unceasingly if moved from this position. The mother-child relationship seemed to involve their sticking to each other without looking or losing contact. The mother's hidden hate, anger and resentment were communicated non-verbally and Abigail showed signs of finding it difficult or impossible to integrate experiences, given the amount of trauma she had suffered from an attempted abortion and the lack of enough experience of being loved to enable her to grow internally.

The process of assessing the internal world of the infant and her mother, and the thinking and planning of the psychotherapy that followed, are described. In order to promote the secure attachment of the mother-child dyad, and the emotional growth of both, the helping process focused on understanding both the baby's and mother's states in order to make sense of the child's inner world to the mother. Because of the acute pain this process involved for the mother, she was treated individually too, by a different therapist.     

Sensations as Representations in Kant

This paper defends an interpretation of the representational function of sensation in Kant's theory of empirical cognition. Against those who argue that sensations are ‘subjective representations’ and hence can only represent the sensory state of the subject, I argue that Kant appeals to different notions of subjectivity, and that the subjectivity of sensations is consistent with sensations representing external, spatial objects. Against those who claim that sensations cannot be representational at all, because sensations are not cognitively sophisticated enough to possess intentionality, I argue that Kant does not use the term ‘Vorstellung’ to refer to intentional mental states exclusively. Sensations do not possess their own intentionality, but they nevertheless perform a representational function in virtue of their role as the matter of empirical intuition. In empirical intuition, the sensory qualities given in sensation are combined with the representation of space to constitute the intuited appearance. The representational function of sensation consists in sensation being the medium out of which intuited appearances are constituted: the qualities of sensations stand in for what the understanding will judge (conceptualize) as material substance.     

Empathic Access: The Missing Ingredient in Personal Identity

Abstract

Philosophical discussions of personal identity depend upon thought experiments which describe psychological vicissitudes and question whether the original person survives in the person resulting from the described change. These cases are meant to determine the types of psychological change compatible with personal continuation. Two main accounts of identity try to capture this distinction; psychological continuity theories and narrative theories. I argue that neither fully succeeds since both overlook the importance of a relationship I call “empathic access.” I define empathic access and discuss its role in a complete account of personal identity.     

Reason explanation a first-order rationalizing account

In this article, I discuss whether intuitive moral judgements have epistemic value. Are they mere expressions of irrational feelings that should be disregarded or should they be taken seriously? In section 2, I discuss the view of some social psychologists that moral intuitions are, like other social intuitions, under certain conditions more reliable than conscious deliberative judgements. In sections 3 and 4, I examine whether intuitive moral judgements can be said not to need inferential justification. I outline a concept of moral intuition as a seeming whose seemingness resides in special, phenomenological features such as a felt veridicality, appropriateness, familiarity, or confidence, and whose justificatory force is influenced by the reliability of the belief-producing procedures and by a subject's competence in applying moral concepts. I argue that subjects can come to realise that the beliefs expressed in their intuitive judgements evoke a sense of non-inferential credibility. In section 5, I first discuss the contribution of moral expertise to the non-inferential credibility of a person's intuitions. Subsequently, I discuss whether Walter Sinnott-Armstrong is right in saying that we can never claim non-inferential justification for our intuitions because they are subject to all kinds of distorting influences.     

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.     

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.     

The 'secret cocoon': fantasies about the private self in the absence of consensual reality

Clinical material is presented from an analysand whose defense of withdrawal to 'a private internal space' was mobilized when she became confused, within her relationships and within the transference, about whose understanding of a shared event was 'real.' Analysis of the defense as resistance revealed a disrupted sense of connection to others and to the analyst in the face of the difficulty in determining a consensual reality. This was accompanied by emotional withdrawal, with a complex fantasy of retreat to a protective inner hiding place, or cocoon. The phenomenology and functions of such withdrawals, the fantasies accompanying them, and the ways in which they changed during the analysis are discussed in this paper. For the patient described, the analysis of her shifting 'cocoon' states and of the fantasies connected with them eventually enabled her to access her creative 'private self' more freely and with less conflict.     

Reading Susan Isaacs: toward a radically revised theory of thinking

The author views Isaacs's (1952) paper, The nature and function of phantasy, as making an important contribution to the development of a radically revised psychoanalytic theory of thinking. Perhaps Isaacs's most important contribution is the notion that phantasy is the process that creates meaning, and that phantasy is the form in which all meanings - including feelings, defense 'mechanisms,' impulses, bodily experiences, and so on - exist in unconscious mental life. The author discusses both explicit formulations offered by Isaacs as well as his own extensions of her ideas. The latter include (1) the idea that phantasying generates not only unconscious psychic content, but also constitutes the entirety of unconscious thinking; (2) the notion that transference is a form of phantasying that serves as a way of thinking for the first time (in relation to the analyst) emotional events that occurred in the past, but were too disturbing to be experienced at the time they occurred and (3) a principal aim and function of phantasy is that of fulfilling the human need to get to know and understand the truth of one's experience. The author concludes by discussing the relationship between Isaacs's concept of phantasy and Bion's concepts of alpha function and the human need for the truth, as well as the differences between Fairbairn's and Isaacs's conceptions of the nature of unconscious internal object relationships.     

Professional judgement in the assessment of risk: is there a role for systemic practice?

Risk assessment is an example of professional decision‐making pared to its stark essentials. Political pressures towards accountability and the need for defensible decisions encourage a ‘tick‐box’ approach to risk assessment, but this can create unrealistic expectations of certainty. In practice, as technological approaches produce ever more complex formal tools for assessing risk, their effectiveness remains dubious while our human decision‐making apparatus is marginalized. This article examines whether we should respect our ability to apprehend complex multi‐stranded narrative realities intuitively, with the hope that such intuitions might contribute to professional decision‐making. This idea is explored with reference to a case study.