Reflections on the role of the analytic setting in the light of COVID-19

There have been many reflections, both individual and collective within our Institutes, on the effects on our work with patients caused by COVID-19 and the requirement to move suddenly from the setting of our own consulting rooms to working with patients online (see also, the previous issue of this Journal). This paper focuses on what we have learned from these experiences that can add to our knowledge about the role of the setting in analytic work. Drawing on Bleger’s (1967) seminal paper highlighting the usual setting as a mute projection carrier for primitive wishes and affects, the paper explores how different patients have reacted to the loss of the analyst as the guardian of the setting and in particular as an embodied presence. Some key questions and challenges for both patients and analysts during the pandemic, when ‘the setting begins to weep’, are explored.     

Occasion setting is specific to the CS-US association

In Experiment 1, rats were trained on a discrimination in which one occasion setter, A, signaled that one cue (conditioned stimulus, CS), x, would be followed by one outcome, p (unconditioned stimulus, US), and a second CS, y, by a different outcome, q (x → p and y → q); a second occasion setter, B signalled the reverse CS-outcome relations (x → q and y → p). In a subsequent stage, the animals were divided into two groups, and trained as before, except that both A and B were presented in compound with a novel occasion setter, C. For Group S (same) the CS-outcome relations following A and B were identical to those in the pretraining stage, whereas in Group D (different) they were reversed. In a subsequent test, stimulus C was shown to be a more effective occasion setter in Group D than in Group S. In Experiment 2, rats were trained on a negative occasion-setting discrimination in which CS x signaled outcome p, and y outcome q; when x and y were signaled by the occasion setter A then no outcome followed (x → p, y → q, A:x-, and A:y-). In a subsequent stage, A was now trained as a positive occasion setter, signaling reinforcement of x and y. In Group S, x and y signaled the same outcomes as in the prior training stage (x-, y-, A:x → p, and A:y → q), whereas in Group D they signaled the opposite outcomes (x, y, A:x → q, and A:y → p); more efficient test performance was seen in the latter group. These results suggest that the each occasion setter conveyed information about the specific combination of CS and US paired in its presence (i.e., x → p and y → q, or x → no p and y → no q). These results are consistent with the suggestion that occasion setters operate, at least in part, on a specific CS-US association.     

Some Questions Raised by the Practice of Online Analysis1

In this paper the author explores some of the issues raised by the practice of online analysis. In particular, he emphasizes the difference between the setting and the frame and proposes a theoretical approach of the latter as emerging within the transferential dynamic.     

Die Behandlung von Borderline-Persönlichkeitsstörungen

Zusammenfassung Bereits 1681 beklagte sich ein englischer Arzt in einem Brief über Patienten, die ohne jedes Ma? jene lieben, die sie alsbald ohne jeden Grund hassen würden. Weiterhin seien pl?tzliche Ausbrüche von Wut, Schmerz, Angst oder ?hnlichen Emotionen zu beobachten. Mit dieser frühen Beschreibung typischer Borderline-Symptome wird die Darstellung der Entwicklung der Theorie der Borderline-St?rung von den Anf?ngen bis heute eingeleitet. Vor diesem Hintergrund werden der Stand der Diagnostik und die derzeit wichtigen Behandlungskonzepte umrissen, und zwar die psychodynamischen, verhaltenstherapeutischen und klientenzentrierten Ans?tze. Es wird dargelegt, welche Antworten es auf die Frage gibt, was das angemessene therapeutische Setting ist, insbesondere mit Blick auf station?re Behandlungskonzepte. Die vorliegenden empirischen Studien best?tigen die Wirksamkeit von Psychotherapie bei Borderline-St?rungen. Die geringe Zahl der Studien belegt aber auch die Schwierigkeit der empirischen Forschung in diesem Bereich. Der abschlie?ende Ausblick in die Zukunft der Psychotherapie der Borderline-Pers?nlichkeitsst?rungen prognostiziert eine weitere Zunahme von Pers?nlichkeitsst?rungen im Spektrum psychiatrischer Erkrankungen und eine zunehmende Differenzierung des Behandlungsangebots bzw. Spezialisierung der Behandler.      

On the Distinction Between the Motivating Operation and Setting Event Concepts

In recent decades, behavior analysts have generally used two different concepts to speak about motivational influences on operant contingencies: setting event and motivating operation. Although both concepts still appear in the contemporary behavior-analytic literature and were designed to address the same antecedent phenomena, the concepts are quite different. The purpose of the present article is to describe and distinguish the concepts and to illustrate their current usage.