‘Black holes’: escaping the void

The ‘black hole’ is a metaphor for a reality in the psyche of many individuals who have experienced complex trauma in infancy and early childhood. The ‘black hole’ has been created by an absence of the object, the (m)other, so there is no internalized object, no (m)other in the psyche. Rather, there is a ‘black hole’ where the object should be, but the infant is drawn to it, trapped by it because of an intrinsic, instinctive need for a ‘real object’, an internalized (m)other. Without this, the infant cannot develop. It is only the presence of a real object that can generate the essential gravity necessary to draw the core of the self that is still in an undeveloped state from deep within the abyss. It is the moving towards a real object, a (m)other, that relativizes the absolute power of the black hole and begins a reformation of its essence within the psyche.     

A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.     

‘To return,to eat,to tell the story ’: Primo Levi's lessons on living and dying in the aftermath of trauma

This article invites Primo Levi, the internationally esteemed citizen of Turin, Italy and survivor of the Auschwitz to instruct post 9/11 psychoanalysis in five lessons on living and dying in the aftermath of severe trauma. Relying on excerpts from Levi's writings, the author invites Levi to speak to the reader words of warning concerning contemporary psychoanalysis' benign omnipotence in embracing overly simplistic theories of cure, resiliency and psychic repatriation of the human spirit in the aftermath of severe trauma.     

The clinical revolution of the ‘wise baby’

In an historical context focused on a close examination of the complex relationship between Freud and Ferenczi, the author shows Ferenczi's contribution to the evolution of psychoanalysis. He describes how his ideas and his therapeutic sensitivity anticipated modern clinical thought (for example, Winnicott and Bion), especially the understanding of borderline and narcissistic pathology. The paper considers the following topics: transference and countertransference; early affectivity; the different psychic trauma; phenomena connected with dissociation; the healing factor of the analysis.     

The role of childhood sexual seduction in the development of an erotic transference: Perversion in the psychoanalytic situation

Abstract

Based on Ferenczi's Confusion of Tongues theory of trauma we proposed the following hypothesis: “An erotic transference is an enactment in the here-and-now of the psychoanalytic situation of a childhood seduction of sexual trauma”. We delineate the relational approach to the analysis of the incest trauma, both theoretically and clinically. The concept of enactment helps us understand the emergence of the incest trauma in the psychoanalytic situation as an indication of an earlier childhood experience. Three clinical examples are discussed which illustrate ways of using the hypothesis within the analytic process. The clinical examples demonstrate the value of enactments that are contained in the unconscious communication that the erotic transference represents.

Rachman AWM et al. Die Rolle sexueller Verführung in der Kindheit bei der Entwicklung einer erotischen Übertragungsperversion in der psychoanalytischen Situation

Basierend auf Ferenczi′s Konfusion der Zungen Trauma Theorie schlugen wir die folgende Hypothese vor: Eine erotische Übertragung ist eine Inszenierung im Hier und Jetzt der psychoanalytischen Situation einer Kindheits Verführung als sexuellem Trauma. Wir entwerfen den relationalen Ansatz theoretisch und klinisch in Bezug auf die Analyse des Inzest Traumas. Das Konzept der Reinszenierung hilft uns das Auftauchen des Inzest Traumas als ein Anzeichen einer früheren Kindheitserfahrung in der psychoanalytischen Situation zu verstehen. Es werden drei klinische Beispiele diskutiert, die die Wege illustrieren, die Hypothese innerhalb des analytischen Prozesses anzuwenden. Die klinischen Beispiele zeigen den Wert von (Re-) Inszenierungen, die in der unbewußten Kommunikaton enthalten sind, welche die erotische Übertragung repräsentieren.

Rachman A WM et. al. El rol de la seducción sexual infantil en el desarrollo de una transferencia erótica: perversión en la situación analítica.

Basado en la teoría del trauma de la confusión de lenguas de Ferenczi, proponemos la siguiente hipótesis: una transferencia erótica es un enactment en el aquí y el ahora de la situación analítica del trauma de la seducción sexual infantil. Trazamos la aproximación relacional del análisis del trauma del incesto. El concepto de enactment nos ayuda a entender la emergencia del trauma del incesto en la situación psicoanalitica, como indicación de una experiencia infantil temprana.

Se presentan tres ejemplos clínicos que ilustran formas de uso de la hipótesis desde el proceso analítico. Estos ejemplos clínicos demuestran el valor de los enactments contenidos en la comunicación inconsciente que representa la transferencia erótica.     

Social trauma: The pathogenic effects of untoward social conditions

Abstract

Psychoanalysis has traditionally overlooked the fact that unsuitable and damaging life conditions, originating in the social milieu, play a part in the pathogenesis of emotional suffering and mental disorders. Nonetheless, the self establishes an object relation with the social system, as well as with the non-human environment. This is expected to act as a container–contained relationship. Whenever the community and its institutions fail to act as a container for individuals and groups, this generates a trauma, which can be compared with the baby's experience of a failure in mothering. Such failures can be classified in several categories. The first is when the social system fails to contain, nurture, care for, and protect individuals, as in the case of the lack of assistance and compassion towards the victims of poverty, disease, natural catastrophe, social turmoil, economic crisis, violence, or war. The second category occurs when there is a blatant attack, on the part of the authorities or privileged social groups, on minorities, or even on the bulk of the population, as in the case of social repression, war—both internal and external—racism, genocide, or persecution. The third is when there is a perversion of the social system, which feigns to uphold current social values and laws while actually breaking them, as in the case of corruption, chicanery, and mendacity on the part of the authorities. One recent example of this is the impeachment process against the Chief of Government of Mexico City. The author approaches this problem by exploring the consequences of such experiences for the development and functioning of personality structure and personal relations, as well as their repercussions for individuals living together in the community and for the necessary relation between them and the authorities.     

A controversy between Freud and Ferenczi and beyond

Abstract

With the aid of passages of Ferenczi's paper on elasticity, and of the correspondence between Freud and Ferenczi, the author points out the conceptual difference between Freud and Ferenczi, evokes the historical roots of this difference, and highlights its continuing importance in present-day psychoanalysis.     

Childhood Sexual Assault,Quality of Life,and Psychiatric Comorbidity in Veterans With Military and Civilian Sexual Trauma

Veterans with military sexual trauma (MST) are at risk for a variety of psychiatric conditions, including posttraumatic stress disorder (PTSD) and depression. Survivors of MST are also likely to experience diminished quality of life (QoL). Individuals with higher lifetime incidence of sexual trauma may also be at increased risk for poorer outcomes in QoL and psychiatric symptomatology. The differences in psychological sequelae among those who have experienced sexual trauma as children, and those whose sexual trauma exposure is limited to adulthood are relatively understudied. The majority of sexual trauma literature has focused primarily on civilian trauma, and comparatively few studies have specifically examined psychosocial sequelae (e.g., QoL) in veterans with MST. This study examined how childhood sexual abuse (CSA) affects overall QoL as well as severity of PTSD and depressive symptoms. Veterans who reported CSA had significantly greater depression symptom severity than veterans who did not. No significant differences in PTSD symptom severity or QoL were found between veterans who did and did not report CSA. Results highlight the need for further examination of the relationship between CSA and depression in veterans with MST-related PTSD who also report CSA.