The analytic setting today: using the couch or the chair?

This paper re‐visits Murray Jackson's 1961 paper in the Journal of Analytical Psychology, ‘Chair, couch and countertransference’, with the aim of exploring the role of the couch for Jungian analysts in clinical practice today. Within the Society of Analytical Psychology (SAP) and some other London‐based societies, there has been an evolution of practice from face‐to‐face sessions with the patient in the chair, as was Jung's preference, to a mode of practice where patients use the couch with the analyst sitting to the side rather than behind, as has been the tradition in psychoanalysis. Fordham was the founding member of the SAP and it was because of his liaison with psychoanalysis and psychoanalysts that this cultural shift came about. Using clinical examples, the author explores the couch/chair question in terms of her own practice and the internal setting as a structure in her mind. With reference to Bleger's (2013) paper ‘Psychoanalysis of the psychoanalytic setting’, the author discusses how the analytic setting, including use of the couch or the chair, can act as a silent container for the most primitive aspects of the patient's psyche which will only emerge in analysis when the setting changes or is breached.     

Moved to tears: Technical considerations and dilemmas encountered in working with a 13-year-old boy with acquired quadriplegia 1

This paper is about therapeutic work with David, a 13-year-old boy who, at the age of 5, was the victim of a hit-and-run road traffic accident resulting in quadriplegia. The circumstances leading to the accident and its sequelae reveal a particularly complex picture, which combines early emotional deprivation and trauma. Although cognitively intact and able to speak, David could not move. Yet he created movement in others through a desperate necessity, by communicating via the employment of extreme projective forces. The highly complex presentation of emotional, psychic and bodily damage in the child, and in particular, David's physical paralysis, has had a profound impact upon what I have come to think of as the ‘mindbody’ of the therapist. Winnicott has talked of the infant's ‘psyche/soma’. Here I want to extend the notion and consider the bodily impact of projections in particular and how these have a powerful emotional and physical resonance on the ‘mindbody’ of the therapist, especially in therapy with a young person whose body is damaged. In this paper, I consider technical challenges and dilemmas encountered in the work, including the complex interplay of transference/countertransference phenomena. This unusual presentation of a boy in extraordinary circumstances led to considerations of psychoanalytic method and interpretative activity, which may be viewed as being inspired by ‘emotional truthfulness’.2 2 Alex Dubinskey (Chair ACP conference 2004) commenting on aspects of this work used the term ‘emotional truthfulness’.

Dans cet article, l'auteur raconte son travail thérapeutique auprès de David, âgé de 13 ans, qui à l'âge de 5 ans fut victime d'un accident de la circulation avec délit de fuite, accident qui le laissa tétraplégique. Les circonstances qui aboutirent à l'accident et à ses séquelles forment un tableau particulièrement complexe mettant en jeu des carences affectives précoces et des traumatismes. Bien que ses capacités cognitives ne fussent nullement atteintes et qu'il fut capable de parler, David ne pouvait pas bouger. Par l'urgence désespérée de son discours, transmise grâce à des projections extrêmement puissantes, il réussissait à susciter du mouvement chez ses interlocuteurs. La présence conjointe et extrêmement complexe de dommages affectifs, psychiques et corporels chez cet enfant – et notamment sa paralysie physique – eut un impact profond sur ce que l'auteur en vient à appeler l'“ esprit-corps ” du psychothérapeute. D. W. Winnicott a parlé du “ psyché-soma ” du jeune enfant. Dans son texte, l'auteur élargit cette notion, notamment pour prendre en considération l'impact corporel des projections, ainsi que leur résonance émotionnelle et physique massive sur l'“ esprit-corps ” du thérapeute, surtout lorsque son patient est une personne jeune dont le corps est endommagé. L'auteur explore les défis et dilemmes techniques rencontrés au cours de son travail, y compris le jeu complexe de phénomènes transférentiels et contre-transférentiels. Ce traitement, inhabituel, avec un garçon dans des circonstances sortant de l'extraordinaire soulève des questions concernant la méthodologie psychanalytique et l'activité interprétative, questions qui peuvent être considérées comme étant inspirées par la “ véracité émotionnelle ”.

Dieser Artikel ist über die therapeutische Arbeit mit David, einem 13-jährigen Jungen, der im Alter von 5 Jahren das Opfer eines Unfalls mit Fahrerflucht war, der zu einer Querschnittslähmung führte. Die Umstände, die zu dem Unfall führten und seine Folgen legen ein besonders komplexes Bild dar, das frühe Vernachlässigung und Trauma kombiniert. Obwohl David kognitiv intakt war und sprechen konnte, konnte er sich nicht bewegen. Doch schaffte er Bewegung aus verzweifelter Notwendigkeit in anderen, indem er mit mithilfe der Benutzung von extremen projektiven Kräften kommunizierte. Die höchst komplexe Präsentation von emotionalem, psychischem und körpelichem Schaden in dem Kind und insbesondere Davids körperliche Lähmung, hatte eine tiefe Auswirkung auf das, was ich nun den ‘mindbody’ (Gemütskörper) des Therapeuten nenne. Winnicott sprach vom Psyche/Soma des Babies. Hier möchte ich diesen Begriff ausweiten und besonders die köperliche Auswirkung der Projektionen betrachten und wie diese eine starke emotionale und physische Resonanz auf den ‘mindbody’ des Therapeutens haben, insbesondere in der Therapie mit einer jungen Person, deren Körper beschädigt ist. In diesem Artikel betrachte ich technische Herausforderungen und Dilemmas, denen man in dieser Arbeit begegnet, einschliesslich der komplexen Wechselwirkung von Übertragungs/ Gegenübertragungsphänomenen. Diese ungewöhnliche Behandlung mit einem Jungen in aussergewöhnlichen Umständen führten zu Überlegungen zur psychoanalytischen Methode undzur Deutungsaktivität, die von ‘emotionaler Wahrheit’ inspiriert wird

Riassunto: In questo articolo si parla del lavoro terapeutico con David, un bambino di 13 anni che, all'età di 5 anni, fu vittima di un incidente stradale che portò alla quadriplegia. Le circostanze che portarono all'incidente e la sua sequela rivelano un quadro particolarmente complesso, nel quale emerge un misto di deprivazione emotiva precoce e trauma. Sebbene David fosse abile cognitivamente e potesse parlare, egli non poteva muoversi. Eppure il bambino generava movimento negli altri attraverso una disperata necessità, comunicando con l'uso di estreme forze proiettive. Il presentarsi di un danno nel bambino altamente complesso nella sua dimensione emotiva, psichica e corporea, ed in particolare, la paralisi fisica di David, hanno avuto un profondo impatto su ciò che ho iniziato a pensare come il ‘corpomente’ del terapeuta. Winnicott ha parlato dello ‘psiche/soma’ del neonato. L'autrice vuole nell'articolo estendere la nozione e considerare l'impatto corporeo delle proiezioni e come queste abbiano una risonanza emotiva e fisica molto forte sul ‘corpomente’ del terapeuta, soprattutto nella terapia con un ragazzo giovane il cui corpo è stato danneggiato. Nell'articolo considero le sfide tecniche e i dilemmi incontrati nel lavoro, compreso il gioco complesso dei fenomeni transferali e controtransferali. Il trattamento insolito con questo bambino in circostanze molto particolari ha portato a considerazioni riguardo al metodo psicoanalitico e all'attività interpretativa, che si possono considerare come ispirati da ‘verità emotiva'¹     

The Unreal Child1

Unrepresented mental states lead to an impaired ability to feel emotions and trust in oneself, one’s history and in the world. The article explores the question of how representations of oneself and the relevant other, the mother, become possible in the course of therapy when dissociative processes previously made this impossible, and what role unconscious communication plays in the analytic realm. This question will be explored by examining the theories of André Green, Philip Bromberg, and Howard Levine.     

Toward a Confucian Notion of Human Dignity

This essay discusses the possibility of conceptualizing a Confucian notion of human dignity. Previous discussions on this topic have been either historical or reconstructive, the former discussing mainly how Confucianism considers dignity and the latter exploring the possibility of conceptualizing a Confucian human dignity as an alternative to Kant’s Menschenwürde. This essay focuses on mainly the latter effort. Specifically, I critically evaluate professor Ni Peimin’s celebrated attempt at reconstructing Confucian dignity in the context of Kant’s Menschenwürde, arguing that Ni’s work offers us novel and original insights on human dignity but fails to be coherent in several senses. On the other hand, Kant’s Menschenwürde may well lack motivation in particular circumstances, and gives no credit to moral efforts. Building upon this criticism, I further Ni’s discussion of the “four hearts” and propose a revised version of Confucian dignity.     

The day the clock stopped. Primitive states of unintegration,multidimensional working through and the birth of the analytical subject

This paper is based on one idea and built around one clinical experience that helped me to broaden my comprehension of it. The idea, underlying the work of several authors, is that when the analytic field is saturated with primitive and unintegrated mental contents, the analyst’s somatic countertransference is a precious indicator of a deep, dissociated form of communication. The clinical experience concerns the difficult elaboration of a complex, multifaceted countertransference that took place during the early stages of the analysis of a sensitive patient who used to communicate in a very dissociated way and that I found hard to contain. This experience, closely described in the article, led me to formulate the clinical idea that the transference field may be made of distinct layers (psychoid, affective, verbal), and that each one of them may potentially convey dissociated, even contrasting bits of information. The corollary of this is that the analyst should be ready to accept contrasting sensations, feelings and thoughts at the same time, as they might be the basic ingredients of a complex reverie. The analyst could find himself/herself in front of his/her own internal unelaborated multiplicity before a symbolic image may emerge to link the scattered pieces of the experience. Nevertheless, the heart of this paper is not about suggesting an idea, but in the sharing of a complex working through, which fostered the birth of a new, more human relational perspective: the capacity of being together in time, in a transitional space where there is neither total separation nor fusion.     

The seventh penis: towards effective psychoanalytic work with pre‐surgical transsexuals

The author reflects on his contrasting analytic work with two transsexual patients. He uses three previous psychoanalytic studies (Stoller, Morel and Lemma) to explore whether effective analytic work with the issues driving a person's determined wish for sex reassignment surgery (SRS) is possible. Particular consideration is given to how such work might navigate a path between traumatizing and pathologizing the patient on the one hand and avoiding important analytic material out of fear of so doing on the other. The author proceeds to ask whether it is possible to tell in advance, with any degree of reliability, who is and who is not likely to benefit from surgery. He considers certain diagnostic issues in relation to these questions. Illustrations are given of how, in practice, countertransference anxieties about psychopathologizing transsexual patients can contribute to significant difficulties in working clinically with them. It is argued that the understanding and containment of such anxieties could eventually lead to more effective analytic work, and that such work might be further facilitated by considering the contribution of mind‐body dissociation to transsexualism.     

Sandplay therapy with couples within the framework of analytical psychology

Sandplay therapy with couples is discussed within an analytical framework. Guidelines are proposed as a means of developing this relatively new area within sandplay therapy, and as a platform to open a wider discussion to bring together sandplay therapy and couple therapy. Examples of sand trays created during couple therapy are also presented to illustrate the transformations during the therapeutic process.     

‘You were not born here,so you are classless,you are free!’ Social class and cultural complex in analysis

The unconscious impact of differences in culture and social class is discussed from the perspective of an analyst practising in London whose ‘foreign accent’ prevents patients from placing her within the social stratifications by which they feel confined. Because she is seen by them as an analyst from both ‘inside’ and ‘outside’ the British psycho‐social fabric and cultural complex, this opens a space in the transference that enables fuller exploration of the impact of the British social class system on patients’ experience of themselves and their world. The paper considers this impact as a trans‐generational trauma of living in a society of sharp socio‐economic divisions based on material property. This is illustrated with the example of a patient who, at the point of moving towards the career to which he aspired, was unable to separate a sense of personal identity from the social class he so desperately wanted to leave behind and walk the long avenue of individuation. The dearth of literature on the subject of class is considered, and the paper concludes that not enough attention is given to class identification in training.     

The image schema and innate archetypes: theoretical and clinical implications

Based in contemporary neuroscience, Jean Knox's 2004 JAP paper ‘From archetypes to reflective function’ honed her position on image schemas, thereby introducing a model for archetypes which sees them as ‘reliably repeated early developmental achievements’ and not as genetically inherited, innate psychic structures. The image schema model is used to illustrate how the analyst worked with a patient who began life as an unwanted pregnancy, was adopted at birth and as an adult experienced profound synchronicities, paranormal/telepathic phenomena and visions. The classical approach to such phenomena would see the intense affectivity arising out of a ruptured symbiotic mother‐infant relationship constellating certain archetypes which set up the patient's visions. This view is contrasted with Knox's model which sees the archetype an sich as a developmentally produced image schema underpinning the emergence of later imagery. The patient's visions can then be understood to arise from his psychoid body memory related to his traumatic conception and birth. The contemporary neuroscience which supports this view is outlined and a subsequent image schema explanation is presented. Clinically, the case material suggests that a pre‐birth perspective needs to be explored in all analytic work. Other implications of Knox's image schema model are summarized.     

Binding legacies: ancestor,archetype and Other

This article discusses the multicultural interconnection between Jungian analysts’ training and Africanist training candidates. The importance of ancestral lineage and archetypal influences in the clinical setting are explored for better understanding of issues related to the transference and therapeutic interventions. A discussion of racial relations and racism is addressed as a frequently missing element in the psychoanalytical training of future Jungian analysts.