Some psychoanalytic and philosophical reflections on the signification of residence in the therapeutic care of people with schizophrenia

Last year saw the 20th anniversary of the Wagner report Residential care: A positive choice. The report tried to shift the emphasis away from the view that residential care is the last resort and to value its role as a vital part of community care. However, over the last few years there has been a move away from residential care for people suffering from mental ill-health. The rationale for this shift has been the prevailing idea that it is better to treat people in their own homes. Although this is to a large extent driven by financial constraints on the part of health and social service commissioners, running parallel is the development of policy informed by ideas of normalization, anti-stigma and the increasing drive to empower service users, and diminish the authoritarian relationship that professionals have with them. While much of this is commendable, there has been very little serious thinking about the meaning of residence or dwelling in relation to care and treatment. This has resulted in the ensuing ideological shift often amounting to little more than a fashionable mantra. In this paper the author discusses the meaning of residence and its relation to care, with reference to the work of Lacan and Heidegger, in an attempt to re-situate the debate about the therapeutic potential of residential care at a more fundamental level.     

How the mind understands other minds: cognitive psychology, attachment and reflective function

Jung's epistemological relativistic attitude was very advanced for his time and very much in line with the contemporary philosophy of science. Further, Jung states that the patient's unconscious has the capacity to represent itself by creating metaphors which give the therapist all the help he might need in treating his patient. As such, Jungian analysts have not been encouraged to embark on theoretical work and as a result, the Jungian movement has been lacking those theories that connect general psychological principles with clinical practices. In an attempt to enlarge our 'middle-range theories', we shall discuss Peter Fonagy's concept of reflective function. In our opinion, the theoretical hypothesis regarding the instinct of reading the mind (Baron-Cohen 1995) and Fonagy's idea of reflective function are extremely useful in our Jungian clinical practice and these concepts are utilizable because they are not at odds with analytical psychology's general epistemological and theoretical framework.     

Symbolic attitude and reverie: problems of symbolization in children and adolescents

In comparison to the 1970s and 1980s, we now treat more children and adolescents who, because they have had traumatic experiences of violence, child abuse, deprivation or chronic physical illness, are not able to adequately use their symbolizing function. The question is which qualities and which analytical attitude we should and can offer in analysis to help a child regain his or her capacity to symbolize, irrespective of how poorly developed or blocked this capacity may be. In contrast to Jung and some Jungians, the author argues that although the transcendent function is a 'natural process' and hence archetypally grounded as Jung maintained, the transcendent function does not work spontaneously. Rather it requires a matrix based on the child's earliest relationship, which can later be re-enacted in treatment. Jung's general concept of a 'symbolic attitude' can be complemented and focused in a specific way through the use of Bion's concept of 'reverie', which contributes in a fundamental way to symbol formation within the transference/countertransference. This idea is illustrated by clinical material from a nine-year-old boy who suffered from a severe congenital intestinal disease and was blocked in his capacity to symbolize. From the perspective of treatment technique, the author shows how the drawing of 'comic book' narratives in a reciprocal exchange was brought into the treatment. The drawings evolved in a way that he understood as a modified form of active imagination with children. The drawing process helped the boy gradually to develop a symbolic space in the therapy and to contain a psychic space in his mind.     

Auto-sensuous shapes: prototypes for creative forms

The author looks at some of the more normative, adaptive, and creative aspects of what have been called autistic' or auto-sensuous' shapes by Tustin and others. She explores the construct from several frameworks, including the literature on early sensory experience and that on the empathic attunement between infant and caretaker in which interpersonal rhythms and meanings are built. The views of Bion and Matte-Blanco are utilized to help explore the processes by which meaning is created from experience, while the works of Segal and Milner are used to focus more explicitly on the role of symbol formation in the creative process. Finally, it is suggested that these auto-sensuous shapes can become prototypes for creative endeavours, including the creative process we call psychoanalysis. The author uses examples from her own experience in deriving pattern from basic sensory experience, toward the creation of poetry, drawings, and the establishment of attunement and meaning-making' within the analytic setting.     

Enhancing parental reflective functioning: A special tribute to the life and work of Nancy E. Suchman,PhD

Nancy E. Suchman's contributions to the fields of infant mental health, maternal reflective functioning, and attachment-based intervention will have long-lasting impacts. In particular, through the development and dissemination of her intervention program, Mothering from the Inside Out (MIO), she innovated a way of working with mothers with substance use disorders that represented a paradigm shift within the field of addiction. In this introduction to the special issue, written to honor her life and work, we review Nancy's background and briefly describe her academic accomplishments. The special issue contains nine qualitative and quantitative research reports written by Nancy's colleagues and their collaborators. All nine papers pertain to the theme of understanding, measuring, and promoting parents’ capacity for reflective functioning. Four provide findings that advance our understanding of parental reflective functioning. The other five highlight insights from continuing evaluations of MIO, including new adaptations of the model. To introduce the special issue, we provide an overview of the scope of the work done within these projects. Finally, the special issue concludes with two commentaries contributed by Linda Mayes and Arietta Slade, leading scholars within the field who were also Nancy's close colleagues. Both provide insight into Nancy's impact on the field.     

Self-reported reflective functioning and father–child interactions in a sample of fathers who have used intimate partner violence

Reflective functioning (RF) has been found to be associated with mother–child interactions, but less is known about the association of fathers’ self and child-focused RF and father–child relationships.  Fathers who have histories of intimate partner violence (IPV) are known to have poor RF, which may impact their father–child interactions.  The current study was designed to examine how types of RF are associated with father–child relationships.  Pretreatment assessments and recorded, coded father–child play interactions were used to examine associations among fathers’ history of adverse childhood experiences (ACES), RF and coded father-child play interactions in a sample of 47 fathers with a history of IPV use in the last 6 months with their coparent.  Fathers’ ACES and their child's mental states (CM) were associated with father-child dyadic play interactions.  Fathers with greater ACES and higher scores on CM had the most dyadic tension and constriction during play interactions.  Those with high ACES but low CM had scores similar to those with low ACES and low CM.  These results indicate that fathers who have used IPV and have a history of significant adversity may benefit from interventions to increase their child-focused RF and further improve their interactions with their children.     

The Human Meaning of the Brain

This study attempts to show that brain research brings to light religious meanings. There is a physical basis of religion in that the way the brain has evolved makes possible the religious meanings of human experience. The brain grows out of and reflects the universe. The brain is an icon of God. In the analysis of the brain's various parts and functions the relational dimensions of reality are uncovered in their physical basis. This points to ultimate reality as social and to a social God. As such, the structures of reality, experienced through the brain, reflect the reality of God.     

Rule-Consequentialism's Dilemma

This paper examines recent attempts to defend Rule-Consequentialism against a traditional objection. That objection takes the form of a dilemma, that either Rule-Consequentialism collapses into Act-Consequentialism or it is incoherent. Attempts to avoid this dilemma based on the idea that using RC has better results than using AC are rejected on the grounds that they conflate the ideas of a criterion of rightness and a decision procedure. Other strategies, Brad Hooker's prominent amongst them, involving the thought that RC need contain no overarching concern to maximize the good are acknowledged to avoid the original dilemma, but lead to further problems of motivating and justifying RC in the absence of such a concern. The paper argues that Hooker's attempt to deal with these problems by using a 'Reflective Equilibrium plus method is unsuccessful.     

Art within analysis: scapegoat, transference and transformation

Through clinical example and pictorial illustration, the author examines ways in which art offers a particular means of psychological transformation in states which may otherwise be in expressable. A transference to the art work itself is proposed. It is submitted that, mediated within the transference/ countertransference dynamic, this 'scapegoat transference' facilitates a particular process of psychological differentiation. The aesthetic qualities of art presented within analysis will resonate with other countertransference affects. Clinical material demonstrates how observation of this--aesthetic countertransference--leads to a distinction between the 'diagrammatic' and the 'embodied image. The process of integration of shadow material is furthered by the temporary safe-keeping of the art work by the analyst.     

Short‐term psychodynamic infant–parent interventions at Child health centers: Outcomes on parental depression and infant social–emotional functioning

Randomized controlled trials (RCTs) demonstrate efficacy of parent–infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short‐term Psychodynamic Infant–Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social–Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers’ questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect‐sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.