On psychic reality and neutrality: Empathy and the work of construction in countertransference

Abstract

The clinical challenges faced in encountering patients who do not fit the standard treatment of Oedipus conflicts clearly show the limitations of the interpretative method, thus making indispensable the study of clinical concepts and techniques as a way to broaden the psychoanalytic horizons. In order to analyse the different psychopathological problems resistant to traditional clinical approaches, it is necessary to reorganise the technique on the basis of a better understanding of the ways in which subjectivity is rooted in early psychic constitution. In this way, empathy becomes important as a clinical tool. The use of empathy must be understood as a decisive factor in handling clinical cases and situations in which the treatment encounters obstacles that restrict the power of the analyst's verbal interventions.In this case, can we say that the use of empathy interferes directly with and changes the position of the concept of psychic reality? Moreover, as we use empathy, can we also say that the concept of neutrality is transformed, without being abandoned? The intention of this paper is to discuss these questions using clinical material taken from the analysis of borderline clinical cases and situations.     

Psychoanalysis is a two‐way street

The paper discusses psychoanalysis as a mutual exchange between the analyst and analysand. A number of questions are raised: What was Ferenczi's and the early psychoanalysts' contribution to the interpersonal relational dynamics of psychoanalytic treatment? Why did countertransference become an indispensable tool in relationship‐based psychoanalysis? Why is the transference‐countertransference dynamic seen as a special dialogue between the analyst and analysand? What was Ferenczi's paradigm shift in the trauma theory? How did he combine the object relation approach with Freud's original trauma theory? The paper illustrates through some case study vignettes the intersubjective and intrapsychic dynamic in the process of traumatization. We can look at countertransference as an indicator of the patient's basic interpersonal experiences and traumas. Finally the paper discusses countertransference in the light of attachment theory, connecting the early initiatives of inter‐relational approaches in psychoanalysis with recent research.     

Affective Constellations for Countertransference Awareness Following a Client's Suicide Attempt

Effective counseling with suicidal clients requires the development and maintenance of a strong therapeutic alliance. However, unmanaged countertransference (CT) can inhibit the alliance. This article provides strategies for enhancing CT awareness in counselors to support alliance building with clients after a client suicide attempt. The authors define CT in the context of suicide, introduce affective constellations as a method for CT awareness, and apply the method to a case vignette. A figure for self‐reflection and supervision is provided.     

‘THERE IS A WAR ON! SOMEONE IS GOING TO GET KILLED’

This paper describes the first three years of work providing consultation at the interface between adult mental health and children's services. It suggests that significant numbers of children, living with parents whose mental illness may be ‘severe and enduring’, remain hidden from services. The author applies psychoanalytic theory in an attempt to understand the unconscious factors, for organizations as well as for individuals, which may contribute to making it so difficult for services to work co‐operatively to recognize these children's existence and their emotional needs. She reviews some of the related fields in which the application of psychoanalytic thinking has occurred and also describes the context in which the work takes place. A series of vignettes demonstrate some of the difficulties encountered and the ways in which the presence of a neutral third or ‘other’ can contribute to their resolution. She suggests working relationships between adult's and children's services are profoundly affected by the psychotic processes operating in the minds of these parents and that the consultant acts as a container enabling staff to manage the fragmentation and splitting which would otherwise be inevitable.     

WOMEN'S CAREER DECISION-MAKING PROCESS

No abstract available for this article.     

What do psychodynamic therapists make of their reveries in the therapeutic encounter? A constructivist grounded theory study

ABSTRACT

The therapist’s mind can wander to daydreams, fantasies and preoccupations: mental events termed “reveries” in this study. As therapists attend to the current of their thought in the therapeutic encounter, the question of how to approach their reveries can arise. This qualitative study used semi-structured interviews with nine qualified psychodynamic therapists to investigate therapists’ attitudes to reveries. The research design and analysis followed the principles of Charmaz’s [Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage; Charmaz, K. (2014). Constructing grounded theory (2nd ed.). London: Sage] constructivist grounded theory. Results showed that therapists experienced diverse reveries sometimes felt to yield deeper clinical understanding. Reveries were also seen to have a “freeing-up” function for the therapist and patient, and to require mental freedom to operate. Implications for theoretical understanding and recommendations for clinical technique are discussed.     

Revising,Correcting, and Transferring Genes

Abstract

The distinction between germline and somatic gene editing is fundamental to the ethics of human gene editing. Multiple conferences of scientists, ethicists, and policymakers, and multiple professional bodies, have called for moratoria on germline gene editing, and editing of human germline cells is considered to be an ethical “red line” that either never should be crossed, or should only be crossed with great caution and care. However, as research on germline gene editing has progressed, it has become clear that not all germline interventions are alike, and that these differences make a significant moral difference, when it comes to ethical questions about research, regulation, clinical application, and medical justification. In this paper, I argue that, rather than lumping all germline interventions together, we should distinguish between revising, correcting, and transferring genes, and I assess the consequences of this move for the ethics of gene editing.     

An extract of the analysis of the Monkey Puzzle Boy

Abstract

A client who wants his story to be made into a case history presents for psychoanalysis. An artist all his adult life, he expresses his sexual trauma through his art. His more recent artistic output is in the form of avant-garde video montages. The analysis stalls, becalmed by a failure to understand a circumcision event, a punishment for sexual expression. If Ferenczi and the Budapest school model learning from therapeutic errors, freedom of thought, sincerity, and experimentation, then this case history illustrates those. Real sexual trauma and a real circumcision event are entangled with fantasy and art in attempts to come to terms with them. The circumcision event was better understood with multiple readings of Carlo Bonomi’s work, which became part of the analysis. The wider Ferenczi community also became part of the story of the analysis, and in a kind of mutuality the analysis wants to make a contribution to that body of knowledge.