Childhood trauma from a patient and a psychoanalyst perspective: linking chronic depression to relational multiple trauma

The relationship between multiple childhood trauma, as well as adversity, and chronic depression has been reported repeatedly. However, there is a lack of clinical differentiations of these findings. We complemented patient self-ratings, using the Childhood Trauma Questionnaire (CTQ), with psychoanalysts’ perspectives in order to provide finer grained clinical differentiations of the trauma behind chronic depression. These differentiations connect the trauma scales with early relational experiences. We developed a bespoke instrument derived from psychoanalytic trauma concepts. A subsample of 52 cases of chronically depressed patients alongside their 24 psychoanalysts was taken from the LAC depression study, in order to complement patient and psychoanalyst ratings. Our results confirm the connection between multiple childhood trauma and chronic depression. Besides relational trauma, the psychoanalysts’ perspective found separation trauma and transgenerational transmission of trauma to be significant. These traumatic relationships seem to precede and accompany adverse life events and/or traumatic experiences. They may even prevent adequate coping and/or processing of such experiences. Patient interview material from study intake and five-year follow-up further provides an insight into the changes the trauma narratives undergo throughout time. These changes emerged due to a joint reconstruction of the meaning of traumatic experiences throughout the course of the psychoanalytic process.     

Characters on the Stage. Ibsen's “Life-Lie” Revisited

The authors inquire as to how far psychoanalysis uses its inherent capabilities to decipher the inner structure of subjectivity in present-day psychoanalytic practice and thinking. They maintain that in psychoanalytic practice, the analyst's unresolved neurotic conflicts cause him to create conscious mystifications of his own unconscious situation, thus distorting his understanding of the patient's unconscious in a systematic manner.     

Words that touch2

In this paper the author examines her own use of language as a psychoanalyst and asks: what is the best way to help analysands to find the words to express not only what they are thinking but also what they are feeling and experiencing? In common with other psychoanalysts, the author has observed that each of us simultaneously utilises both advanced psychic mechanisms that are accessible to symbolism and more archaic ones, which are less so. However, she draws a distinction between people who are able to tolerate the perception of their own heterogeneity, even if it is sometimes a source of suffering, and those whom she terms ‘heterogeneous patients’. Patients in the latter category, whose lack of internal cohesion causes them anxiety, are afraid of losing their sense of identity. The author asks how we can understand their language and how we should speak to them. She uses several clinical examples to demonstrate that ‘heterogeneous patients’ need to be touched with a language that does not confine itself to imparting thoughts verbally but also conveys feelings and the sensations that accompany those feelings. It is also an ‘incarnated’ language because the words pronounced by the analyst can awaken, or reawaken, bodily fantasies in the patient. These words may enable him to find an emotional meaning in forgotten sensory or bodily experiences, which may then become a starting point for his work of thinking and of symbolisation.     

The Balint movement worldwide: present state and future outlook: a brief history of Balint around the world

Michael and Enid Balint began running seminars for GPs (family physicians) in London in the late 1950s. Balint groups were soon started in other countries leading to the formation of the International Balint Federation. This paper describes the activities of the Federation and surveys the health and strength of the Balint movement in different parts of the world. While formal Balint training seems unlikely to become part of the official curriculum in more than a few countries, Balint's ideas will continue to be influential.