The secluded minds of violent patients

In this paper, I will present two violent patients suffering from severe Personality Disorders, illustrating the changes that can arise during the course of several years' psychoanalytic treatment in high security hospital. Progress was monitored using the Operationalised Psychodynamic Diagnostics (OPD) system. The clinical presentations will indicate how secluded these patients' minds are to themselves and to those involved in their care. The psychoanalytic treatment, as one part of the overall treatment, is described to show how the secluded parts of the patients'' minds can be approached, including references to the regular regressions that arise, provoked by ‘getting better’.     

Catch 22: the inflammatory nature of insight

I will describe a man I saw in psychoanalytic psychotherapy with a history of serious drug abuse and violent psychotic episodes. At the start of therapy my patient had little capacity to tolerate the anxiety, depression or the inevitable frustrations involved in facing reality. Over time and with the support of the therapy he was able to increase his capacity for self observation noticing the way he withdrew from the world of shared reality into psychotic states of mind in order to avoid painful feelings of rage, humiliation and shame. In the book ‘Catch 22?, Joseph Heller described the paradox of pilots who wish to claim insanity in order to avoid fatal flying missions, while the authorities maintain that in claiming insanity to avoid suicidal missions the individual demonstrates a sane awareness of the insanity of the missions! This insight is deemed to be evidence of the individual’s sanity and consequently their plea of insanity is denied. In this paper, I will show how Mr. A’s developing capacity for reflective functioning lead to a ‘Catch 22’ as the insight he needed as part of the process of recovery threatened to overwhelm him with depressing realities about the extent of his illness.     

Can Psychoanalysis Become Empirically Supported?

The article discusses the application of the ideas of evidence-based medicine or empirically supported treatment to the field of psychoanalysis. The author argues that empirical support is gradual rather than categorical, and that the randomized clinical trial (RCT), which is commonly heralded as the appropriate method of support, confounds patient suitability factors with treatment 'as such'. As a consequence of the exclusive reliance on the RCT, empirical validation of psychological treatments has generally favoured cognitive-behavioural treatments, although there is ample evidence - albeit non-RCT - for the beneficial effects of short-term and long-term psychoanalytic treatment. The author argues for a suitability matching approach to empirical validation, where each treatment is tested, as powerfully as feasible, on samples based on selfselection (patient's choice, clinical assignment, suitability judgments etc.). The paper concludes by referring to two recent studies, indicating that there is reason to evaluate alleged empirical support with caution.     

Psychoanalysis in Austria after 1933-34

Our essay focuses on major developments of the history of psychoanalysis during the fascist and National Socialist years in Austria and sheds light on the re-establishment of psychoanalysis after World War II. With the consolidation of National Socialism in Germany in 1933 and Austro-fascism in 1934, any psychoanalytical reflection that was critical of political and cultural trends was extinguished. Vienna - once again - became the center of the psychoanalytical movement in Central Europe, taking over the role Berlin had played during the twenties. But, during the Austro-fascist system, psychoanalysis was isolated from an important part of its public. Psychoanalysts reacted by adopting an attitude of political abstinence, accompanied by self-censorship, they concentrated on training and clinical work, or they went into exile. Austria's Anschluß to the National Socialist Third Reich led to the final destruction of psychoanalysis. Nearly all Viennese analysts were affected by the anti-Jewish measures of the National Socialists and almost all of them fled the country. During the war years, a small group of people under the leadership of August Aichhorn tried to continue psychoanalytic training. Its members refounded the Viennese Psychoanalytical Society in early 1946. But, scientific traditions were broken and tendencies of anti-enlightenment, especially clerical and catholic prejudices, had continued from the time of Austrofascism and Nationalsocialism. The last chapter of our essay summarizes the research topics and the main historiographical studies done in the field.     

Psychoanalytic psychotherapy in paediatric liaison: a diagnostic and therapeutic tool

Paediatric liaison work requires an appreciation of the interweaving of the different factors involved when a child has physical symptoms. Psychoanalytic psychotherapy is usually viewed simply as a potential treatment option. This paper argues that its use is both therapeutic and diagnostic and that it should be valued for this breadth of contribution. The therapeutic process is conducted in a way that can promote an understanding of the child and their context and thus enhance the ability 9 to meet the child's needs by all involved in their care. This can be achieved without sacrificing the degree of privacy that the psychotherapist/patient relationship requires. Material is presented from the psychotherapy of a child who had an hereditary condition which moved unexpectedly into a terminal 2 phase after psychotherapy was started. Examples are given to illustrate the importance of the understanding gained from therapy and how, through an integrative process, it was used to assist the overall 4 care. The material also describes the potential diagnostic use of information from psychotherapy when this is formulated by consideration of conscious and unconscious mechanisms alongside mental state phenomenology. This has implications for the relationships between disciplines and for their training requirements.     

From Noosphere to Theosphere: Cyclotrons, Cyberspace, and Teilhard's Vision of Cosmic Love

Two theme–setting quotations introduce this essay—that of Yeats's falcon, deaf to the falconer's call, adrift in space above the blood–dimmed tide, counterpoised to Pierre Teilhard de Chardin's call to abandon old nationalistic prejudices and build the earth. With primary references to the thought of Teilhard, along with, among others, to Ewert Cousins, Andrew M. Greeley, Karl Jaspers, Marshall McLuhan, Ilya Prigogine, Karl Rahner, Leonard Swidler, David Tracy, and Alfred North Whitehead, I argue that the most crucial intellectual paradigm shift of the twenty–first century will challenge humanity to take the turn from uncritical attachment to rigid absolutism or atomistic fragmentation toward a sense of open–ended, off–centered centeredness and fluid connections—from a static to a dynamic model of reality. Central to my argument is the Teilhardian reinterpretation of the Christian metaphors of creation, fall, incarnation, salvation, and the eschaton in the evolutionary terms of the emergence of cosmic consciousness from the chrysalis of the world of the past—from chaos to order, from biosphere via noosphere to theosphere. Facilitated by the exponential growth of populations, collaborative research, science, technology, and global communication (most dramatically manifested by the Internet), this emergent understanding of what it means to be human can, first, foster the awareness that in humanity evolution has become conscious of itself, and then, gradually, precipitate the formation of “the global village” (the mystical body of Christ), as respectful dialogue replaces diatribe and the dualistic pugilism of Samuel Huntington's “Clash of Civilizations” is gradually transformed into a nonadversarial mentality that values shared humanity and a common purpose. Thus, eons hence, empowered by love–energy, the transmutation of the human into the ultra–human can take the ultimate quantum leap into a yet higher dimension where spirit/energy is no longer in need of flesh/mass, and Earth can be safely left behind.     

In search of the ‘Aha!’ experience: Elucidating the emotionality of insight problem‐solving

Although the experience of insight has long been noted, the essence of the ‘Aha!’ experience, reflecting a sudden change in the brain that accompanies an insight solution, remains largely unknown. This work aimed to uncover the mystery of the ‘Aha!’ experience through three studies. In Study 1, participants were required to solve a set of verbal insight problems and then subjectively report their affective experience when solving the problem. The participants were found to have experienced many types of emotions, with happiness the most frequently reported one. Multidimensional scaling was employed in Study 2 to simplify the dimensions of these reported emotions. The results showed that these different types of emotions could be clearly placed in two‐dimensional space and that components constituting the ‘Aha!’ experience mainly reflected positive emotion and approached cognition. To validate previous findings, in Study 3, participants were asked to select the most appropriate emotional item describing their feelings at the time the problem was solved. The results of this study replicated the multidimensional construct consisting of approached cognition and positive affect. These three studies provide the first direct evidence of the essence of the ‘Aha!’ experience. The potential significance of the findings was discussed.     

Treating Multidimensional Presenting Problems with a Mutually Integrative Approach Using the Genogram

The present article introduces a case study and describes a mutually integrative approach to treating a complex presenting problem. This article examines the specific issues surrounding integration when a supervisor and supervisee hold different theoretical perspectives. On occasion, such a relationship demands that the supervisee adhere to the model being taught by the supervisor. Examining integration in this format presents many advantages for both treatment and training. The key to the mutual integration is that two schools of psychotherapy can be combined in a way that creates a synergy; in that, together they are more powerful than either may be in isolation. A genogram with symbols from each model is incorporated to focus the treatment and create a format for the mutual integration.