The analyst's implicit alpha-function, trauma and enactment in the analysis of borderline patients

The present paper discusses situations in which patient and analyst are involved in obstructive collusions, non-dreams-for-two, shaping enactments. Specifically, it describes explosions in the analytical field, acute enactments, which the analyst assigns, at first sight, to his faulty conduct. The subsequent amplification of the analytical dyad's capacity of symbolization makes the analyst investigate his presumed fault. The present work shows how acute enactments revive traumatic situations that were concealed by previous obstructive collusions, or chronic enactments. During chronic enactments unconscious exchanges occur between the dyad, in which the analyst provides implicit alpha-function to the patient, little by little recovering the traumatized parts. When there is enough recovery, the protective collusion is undone and the trauma is revived as acute enactment. This revival will not be traumatic because there are mental resources ready at hand to symbolize it. These situations are articulated with borderline patients. The patient clings to the analyst, using him as a protective shield against reality traumas. The implicit and explicit alpha-function exerted by the analyst contributes to the processing and symbolization of this reality, recovering the injured mind and elaborating the trauma. So the patient creates a triangular space to dream and think.     

Psychoanalytic process and thought: Convergence of Bion and Matte‐Blanco1

Using the convergence between Bion and Matte‐Blanco, in this article the author attempts to stress the view of the psychoanalytical method as promoter of expansion of the ability of the patient to think his emotional experiences. After a brief résumé of the ideas of both Bion and Matte‐Blanco, certain points of congruence between the two are emphasised: the way of perceiving the range of phenomena observed by psychoanalysis, intuition as a method for observing this field, the feelings as the raw material for thinking, and the importance of the concept of infinity in psychoanalysis. The way in which the ideas of Matte‐Blanco assist in the understanding of Bion's propositions is highlighted. Following these correlations, the author discusses certain questions pertinent to the psychoanalytical method and proposes a model in which the analyst acts as a mediator/catalyst in the process of revision of the ways in which the patient has organised his emotional experiences and the theories constructed to support these hypotheses. Samples of clinical material are presented.     

规范美容医学临床技术--略谈《临床技术操作规范·美容医学》分册的编写体会

从现代医学模式转变出发,探讨了<临床技术操作规范·美容医学>分册的编写体会,阐明了该<规范>分册的指导思想、基本原则,介绍了美容医学临床技术实施效果评价的主要内容和要求.     

Technical Considerations When Handling Questions in the Initial Phase of Psychotherapy

Responding to patients' questions throughout the therapeutic process can be challenging. Questions posed at the beginning of treatment have unique features which make them especially difficult to negotiate. When handled skillfully and tactfully, questions asked during this phase can provide the therapist with important opportunities to foster engagement in treatment. Questions can provide valuable information about the patient's internal world, afford the opportunity to socialize the patient to the therapeutic process, and aid in rapport-building. This article will focus on ways to understand and handle questions patients ask during the initial phase of treatment. Vignettes will be presented and specific responses therapists can offer to patients will be discussed.     

On understanding projective identification in the treatment of psychotic states of mind: The publishing cohort of H. Rosenfeld, H. Segal and W. Bion (1946–1957)

A publishing cohort of Kleinian analysts – Rosenfeld, Segal and Bion – implemented Klein's (1946) notions of projective identification and the 'paranoid ' and 'schizoid ' positions in the understanding of a group of psychotic disorders. The author differentiates Klein's (1946) Notes on some schizoid mechanisms paper from its revised version of 1952, maintaining that it was Rosenfeld's clinical work during this period that helped to centralize Klein's redefinition of projective identification. The stage was set for Segal 's contribution in terms of 'symbolic equations,' where the psychotic's attack on the breast left him incarcerated in internal torment and persecution, where things-in-themselves were confused with what they symbolically represented. Segal in turn linked psychotic to normal, paranoid–schizoid to depressive positions, where by means of projective identification and symbolic imagination, the patient could arouse feelings in the analyst related to sadness, guilt and loss. Bion assumed that psychotic pathology reflected disordered thinking, when the severely disturbed used language as a mode of action. The psychotic was profoundly confused between the use of thought and action in the natural world – where thought was required, he preferred action and vice versa. Bion also drew upon projective identification in a new, broader way, so that analysis could now become more of an intersubjective, bi-directional field of projective and communicational influence between patient and analyst. The paper concludes with the impact of the work of Rosenfeld, Segal and Bion and variations on the technique of analyzing psychotic states in terms of the patient's early history, transference and countertransference.     

TEACHING SEVERELY MULTIHANDICAPPED STUDENTS TO PUT ON THEIR OWN HEARING AIDS

Two experiments were conducted with six severely multihandicapped students with hearing impairments to: (a) train the six students to put on their own hearing aids independently, and (b) provide an empirical evaluation of a comprehensive instructional program for putting on a hearing aid by assessing acquisition, maintenance, and generalization of that skill across environments. All six students acquired the skill rapidly, with two students requiring remedial training on one step of the program. Because for two of the original three students the newly learned skill failed initially to generalize to other environments, a second experiment was initiated to assess generalization across environments as well as to replicate the efficiency of the acquisition program. When a variation of the multiple-probe baseline technique was used, the behavior of three additional students generalized to other settings without direct training in those settings.     

Book reviews

Palmer, Michael, Freud and Jung on Religion Kawai, Hayao, Buddhism and the Art of Psychotherapy Young-Eisendrath, P., Gender and Desire: Uncursing Pandora Hamilton, Victoria, The Analyst's Preconscious Hinshelwood, R. D., Therapy or Coercion? Does Psychoanalysis Differ from Brainwashing? Gallant, Christine, Tabooed Jung: Marginality as Power. Kulkarni, C., Lesbians and Lesbianisms     

Language transfer and blocking in second language vocabulary learning

The influence of different vocabulary instructional techniques upon the acquisition of different language words was examined in two experiments. In Experiment 1, comparisons were made between the learning of Chinese and French words employing both paired-associate presentations and spacing procedures. The results supported the view that language transfer affects the acquisition of second language words, with more French words being learned than Chinese words. The superiority of the spacing procedure over the paired-associate presentation found in these results suggested that the spacing method diminished the adverse effects of blocking and thus enhanced learning. However, no significant interaction between the teaching procedures and different language words was detected. That is, under the spacing procedure, greater improvement in learning of Chinese words was not found. The experiment was thus modified by substituting the spacing procedure with aural feedback in Experiment 2. In this experiment, a significant interaction between these two factors was detected. That is, the recall for French was more than Chinese in the paired-associate condition, however, under the aural feedback, performance in Chinese was statistically equivalent to that in French. Hence, these findings may contradict the prediction of language transfer. It appears that the phenomenon of language transfer may be far less important in vocabulary learning than the use of a method of instruction which neutralises the negative effects of blocking.     

Cerebral asymmetry in autonomic conditioning to facial expressions: Sex differences

In the present experiment, sex differences in hemispheric asymmetry during classical conditioning to emotional stimuli are reported. 125 subjects (62 females and 63 males) were shown a slide of a happy face in the right (or left) visual half field (VHF), and simultaneously a slide of an angry face in the left (or right) VHF. Eight groups were formed by the combination of male and female subjects; left and right VHF positions of the angry/happy faces; and the administration/omission of the shock unconditioned stimulus (UCS). Dependent measures were skin conductance responses recorded from both hands. The results during extinction showed a significant larger SCR magnitude to the shock compared to the no-shock groups only for the female subjects. CS position during conditioning was also important in revealing differential responding to either the happy or angry faces. A right hemisphere effect was found for the angry face CS for both the male and female subjects, however with a greater difference for the females.