13558 Chapters
  Title Author Publisher Format Buy Remix
Medium 9781855757806


Karnac Books ePub

Mary Kay O’Neil

Courage involves belief and action. The courageous person acts on strongly held and intensely felt beliefs. Is couragealso a feeling? Certainly emotions underlie and evoke courage. Courage—the Latin cor is the root of the word—is traditionally connected with the heart, which was once thought to be the centre of the emotions. Courage allows a person to better manage the threatening passions of life: love, hate, and anger are prime motivators; fear in the face of danger and anxiety in the face of risk must be overcome. Courage involves conviction, determination, risk, and uncertainty. Courage expresses, often, the realization of ideals central to a person’s sense of self. Yet, whether based on a belief, an unconscious ideal or an emotion, whether expressed in thought, word, or action, courage is universally considered an admirable quality, a “good feeling”.

Courage, as Susan Levine elucidates, has yet to be integrated into psychoanalysis. This she attempts to do. She links “courage”, as positive, self-preservation, with “masochism”, as negative and self-destructive. The author tries to make this “good feeling” a psychoanalytic concept. Her observation that a patient’s experience of the psychoanalytic relationship can be both courageous and masochistic allows for exploration of both conscious beliefs and unconscious fantasies and of assumptions in the transference and countertransference. Further, she allows that even sadomachosism can be a courageous defensive attempt to resolve conflicts and trauma. Drawing on the scarce analytic contributions in this area and her clinical experience, Levine does indeed bring courage, this commonly valued human attribute, into a psychoanalytic way of thinking and working.

See All Chapters
Medium 9781855755635

CHAPTER ONE: Relational thinking: from culture to couch and couch to culture

Karnac Books ePub

Lynne Layton

Introduction: history and key assumptions of relational analytic theory

At one point in my personal analysis, my analyst, whom I had chosen in part because the self psychology and object relations books on her shelf suggested that she was someone who would not bludgeon me with predictable oedipal and penis envy interpretations, told me that the reason she had forgotten to call me at the agreed upon time during her three-month maternity leave was that I appear self-sufficient and give the impression of having no needs. This touched a very sore spot in me and I went off to seek consultation—having parents whose mantra when they did something hurtful was always “You're too sensitive,” the last thing I needed was an analyst who made a big blunder and blamed it on something about me. We worked it out. But I begin with this vignette because I think that it is my sensitivity to this issue that drew me to what has come to be known as relational psychoanalysis. Of the many schools of psychoanalysis, none besides relational analysis, so far as I know, holds as a central ethical principle not just awareness, but acknowledgement, of the analyst's complicity in the inevitable re-enactments that are at the heart of any treatment.

See All Chapters
Medium 9781574411904

Chapter 21: Tracy—Multiple Sclerosis

Naomi Scott University of North Texas Press PDF

Chapter Twenty-One

Tracy—Multiple Sclerosis

“If I miss my ride, the next week I walk into the arena using my cane. When I finish riding and dismount, I walk away and forget the cane. I don’t need it anymore,” Tracy Roberson said, reaching down to pat her horse’s neck. “It’s completely amazing.”

After agreeing to tell me her story later, she said “Walk on,” and from only the pressure of her legs squeezing his sides, her big buckskin mount began walking, then trotting in a figure eight, with no signal at all from the reins.

Ten years earlier, Tracy got out of bed one morning and fell flat on her face. She pulled herself up, sat on the bed a minute, then stood.

Again, she fell flat on her face.

Lying on the floor she wondered, did I take something last night to possibly cause this—aspirin maybe? No, that was not the case.

The twenty-seven-year-old hadn’t been feeling well for quite a while before this happened. “I was tired all the time but thought it must be just the lazy housewife syndrome.” She recalled she didn’t want to make the beds, do laundry, dishes, or get her child’s clothes ready.

See All Chapters
Medium 9781855753495

CHAPTER ELEVEN Psychoanalytically-informed CAT: a first treatment for problems of sexual relationships

Karnac Books ePub

Heather Wood


Among the caseload of psychotherapy, psychological therapy or counselling services there will be a small proportion of patients whose principal difficulties are enacted within sexual relationships and often expressed through their sexual behaviours. They may be referred initially because of relationship difficulties or with a “ticket of entry” to the service such as depression or anxiety but at assessment it may become clear that compulsive or destructive behaviours or fantasies in sexual relationships are central to their difficulties.

Psychotherapy can play a useful part in the treatment of patients with disorders of sexual arousal, desire, or response where the problem is psychogenic, but this is not the group that I will focus on here. The group of patients I am concerned with are those who present loosely with what DSM IV (American Psychiatric Association, 1997) refers to as “paraphilias” or ICD 10 (World Health Organization, 1992) refers to as “disorders of sexual preference”— what psychoanalysts have traditionally thought of as perversions. I use the term “loosely” because DSM IV and ICD 10 use strict diagnostic criteria to describe fixed, repetitive, often ritualized behaviours. Many patients seen in practice might not have problems that meet these criteria, yet they present with compulsive sexual behaviours or behaviours enacted within sexual relationships that assume a sexual charge or excitement (such as sadomasochistic modes of relating) that are a source of distress to them and often also to their partners.

See All Chapters
Medium 9781780490823

Chapter Twelve: Fairbairn: Oedipus reconfigured by trauma

Karnac Books ePub

Eleanore M. Armstrong-Perlman


In The Structure of Scientific Revolutions (1962), Thomas Kuhn emphasises how the prevailing paradigm influences scientific endeavour. Data is structured, processed, and given relevance within the framework of the prevailing model. When the paradigm begins to be faced with new data that confront the model, there is a phase of accommodation. The basic theory is stretched to contain the new data in an attempt to preserve the basic structure by various modifications. At this stage, there is resistance to alternative paradigms. It is safer and more comforting to readjust the existing conceptual edifice. But such readjustments create strains and tensions which can lead to the breakdown of the resistance to new paradigms. The proliferation of the epicycles needed to cope with the data within the Ptolemaic system led to the Copernican revolution in astronomy.

I believe that the recent upsurge of interest in the work of Fairbairn is arising from the current tensions and strains facing the Freudian paradigm to accommodate and adjust to new data. In this chapter I hope to clarify how Fairbairn's concept of our fundamental nature is affected by cumulative trauma arising from too misattuned maternal responsiveness. This gives rise to defensive structures necessary for psychological survival, and these are formed in the state of absolute infantile dependence. This is prior to the resolution of the Oedipus complex in the name of preserving the “affectionate current” (Freud, 1910h), with the mother before the advent of the father.

See All Chapters
Medium 9781782200888

CHAPTER ONE Chomsky with Joyce

Laurent, Eric Karnac Books PDF


Chomsky with Joyce

The following lecture was delivered at the École de la Cause freudienne on 11 April

2005. Under Serge Cottet’s chairmanship, Jacques Aubert and Éric Laurent were invited to present the recently published Book of Lacan’s Seminar, Le Sinthome.


hen you look at Jacques Lacan’s admirable Seminar XXIII in the form it has now found,1 with its superb and serene knots, matched up with Lacan’s 1975 lecture, with the surprising

“Reading notes” by Jacques Aubert, and finally with Jacques-Alain

Miller’s “Note threaded stitch by stitch”, one can scarcely imagine our dread back then as we sat in the audience of Lacan’s Seminar.

In November 1975, we could but take measure of our unfathomable ignorance.

First of all, there was Joyce, whom we thought we had read when we were younger. We knew that this was just a first entry into reading

Joyce, but we did think we had crossed the threshold. Now all of a sudden we found ourselves back on the outside. We simply weren’t on the right page. We would have to start from scratch. It was “all hands on deck” to try to get hold of a copy of the Viking Press edition of Finnegans

See All Chapters
Medium 9781855753266

7. Second experiment: is empathic attunement interactive?

McCluskey, Una Karnac Books ePub


As explained in the last chapter I wanted to test the hypothesis that in comparison with the students the experts had paid greater attention to the interaction between therapist and client. If so, this would provide a reason for seeing empathic attunement as goal-corrected and requiring close attention to how each responds to the other. One would also expect that if the students were given training in attending to interaction they would improve their level of agreement with the experts.


My hypothesis was:

Students who are given instructions to pay attention to the interaction between therapist and client will produce more accurate ratings of empathic attunement than those who are not given such instructions.

Overview of experiment

The design of the experiment involved creating two matched groups. The groups were matched on three grounds:

(i) Whether they had rated the material previously

(ii) Gender

(iii) Whether they were in year one or year two of training

Each group rated the same videoed clips of clinical practice. Both groups were given written definitions of affect attunement. One group, in addition to the definitions, was given written instructions on what to pay attention to while viewing the extracts. Each of the participants attended a de-briefing session where they were asked to respond to two questions. The de-briefing session was tape recorded.

See All Chapters
Medium 9781855753884

CHAPTER FIVE. Ego Development in Therapy with Adults

Clark, Margaret Karnac Books ePub

‘The biblical fall of man presents the dawn of consciousness
as a curse. And as a matter of fact it is in this light
that we first look upon every problem that
forces us to greater consciousness’

(Jung, 1930, p. 388)

In this chapter, we see how for some adults the unfolding of the self through de-integration, and the gradual enlargement and strengthening of the ego through the process of re-integrating whatever the experience was found to be, has not progressed well enough in childhood. Through clinical examples, we consider different degrees of damage and different types of defence, and how these can be worked with in therapy.

Assessment of ego-strength

We need to try to assess before beginning therapy that the patient’s ego is strong enough to sustain what they may experience as assaults upon it – or to know that the therapy will be, at least at first, to strengthen the ego. But since that very strengthening depends on the ego integrating previously unconscious aspects of the psyche, this is a very difficult assessment to make. In therapy, it is always ‘as if one were digging an artesian well and ran the risk of stumbling on a volcano’ (Jung, 1917, p. 114).

See All Chapters
Medium 9781855751965

1. The Winter’s Tale: marriage and re-marriage

Fisher, James Karnac Books ePub

Let’s begin with a tale, a tale of hateful jealousy and suspicion, as well as, one might say, a tale of remarriage. But why begin there? Not all of the couples who seek therapy by any means suffer the kind of jealousy and doubts that plague Leontes in Shakespeare’s The Winter’s Tale. Nor would I suggest that the experience of couples in therapy can always be described as a process of “emerging from narcissism towards marriage”, to reiterate the subtitle of this book. Juxtaposing these states, narcissism and marriage, in polar opposition may seem puzzling. And yet that is just what I mean to do throughout this book, to set in opposition narcissism and marriage, in ways perhaps familiar and unfamiliar. Adapting Bion’s notation, we could then picture “narcissism ↔ marriage” as a fundamental human tension.

By marriage, I mean to emphasize the passion for and dependence on the intimate other. By narcissism, on the other hand, I do not mean a preoccupation with the self, a kind of self-love. Rather, I mean to point to a kind of object relating in which there is an intolerance for the reality, the independent existence of the other. Narcissism in this sense is in fact a longing for an other, but a longing for an other who is perfectly attuned and responsive, and thus not a genuine other at all.

See All Chapters
Medium 9781780490397

CHAPTER FOUR: Integration of consciousness with deep psyche

Mulhern, Alan Karnac Books ePub

Previous chapters have outlined a four-stage structure of psychotherapy within which healing takes place: comprehension/containment, analysis of character, synthesis (alignment to the deep psyche), and integration of consciousness with the deep psyche. All stages are necessary for the complete journey. For instance, no matter how powerful the experience of stage three (the meeting with the deep psyche) all can be lost without the integrative processes of character reform and a realignment of the ego characterising stage four. Jung, stressing the importance of using phantasy material in order to access the unconscious, writes:

The meaning and value of these fantasies are revealed only through their integration into the personality as a whole—that is to say, at the moment one is confronted not only with what they mean but also with their moral demands.

(CW, Vol. 8, p. 68)

By moral demands Jung meant requirements from the Self that the ego/personality should readjust. He finishes The Transcendent Function stressing the importance and difficulty of this integration process:

See All Chapters
Medium 9781855758506

Chapter Twelve: Psychotic phenomena in large groups

Karnac Books ePub

Caroline Garland

In this chapter I give two examples of instances in the wider world in which the group-as-a-whole functioned in the grip of a psychotic process. In the first brief instance, in which little therapeutic work was possible, the events took place in a girls’ secondary school. The second involved much of London in the immediate aftermath of 9/11 and is an attempt to show something of the way in which a traumatized group can begin to gather itself up to think and act coherently once more. Both instances concern an attack upon an existing belief-system: one from within the same system, which was unsuccessful, and one from an alternative system, which was devastatingly effective in the shorter term.

During a training as a child psychologist many years ago, I was asked to see an 11-year-old at an inner-city comprehensive school. The school was a devout Church of England establishment for girls only. The pupils wore a sober uniform, at odds with the lively gear sported by many other comprehensive schools of the day. The school lived within the shadow of the large parish church to which it was attached, and there were frequent and intimate contacts between the two establishments: morning prayers, for example, were held within the church. Many of the staff were members of the Christian Union and attended meetings regularly.

See All Chapters
Medium 9781912567362

22. The Child Psychotherapist and the Patient's Family (1968)

Bick, Esther; Harris, Martha Harris Meltzer Trust ePub

Martha Harris

Practical matters of setting and communication are first considered, then attention is paid to underlying unconscious communications between family and therapist, clarifying the role of therapy as something that supports rather than interfering with the child's relationship with his parents. The process of transferring anxieties and working in the transference is described by means of two clinical cases (a ten-year-old boy and a sixteen-year-old girl), followed by one example of consultation with parents and child in which the therapist's role is specifically “to help the parents use the unrivalled experience they have of their own child.”

Those of us who work with children are more dependent on the co-operation of the patient's family than is the adult therapist as a rule. If the patient is a young child it is usually the mother, sometimes the father, who has to bring the child to treatment; the older child or adolescent still needs parental backing and encouragement at times to continue during difficult periods.

See All Chapters
Medium 9781855753006

10. Psychological Development and the Changing Organization of the Brain

Levin, Fred M. Karnac Books ePub

A description of the optimal psychoanalytic model should contain sufficient information to explain how the model itself came into being, since the model is of the mind, an “organ” that is in many ways selfreplicating. The brain is the kind of selfreplicating “machine” that John von Neumann dreamed about and wrote mathematical descriptions of But few of our developmental models of mind map out the manner in which new mental structure function comes into being and becomes assimilated into the model itself Rather, even the best merely describe the series of steps that a particular type of development traverses. Two shifts within science may result in our scientific, psychoanalytic world changing substantially over the next several decades. First, the high-speed digital computer has begun to extend into so-called supercomputer realms, where computers can be used to model behavior of systems of ultracomplexity: the weather, the flow of heat within the mantel of the earth, and the complex activity within the central nervous system (note well, the metabolic activity within the brain is thinking). Second, we have the combined insights of a large number of sources, which seem themselves to be growing more or less exponentially: economics (decision-making theory), artificial intelligence, learning disabilities science, neuropsychology, neuropsychiatry, psycholinguistics, neurolinguistics, anthropology, archaeology, linguistics-semiotics, psychiatry, psychoanalysis, social work, communications science, human engineering, robotics, anatomy, physiology, chemistry, neuropsychopharmacology, neuroendocrinology, genetics, neural net research, dream and sleep research, molecular biology, neuroimmunology, theoretical physics (which is getting closer to a “theory of everything”), and ethology. This list is of course partial; the space of this entire book would barely contain a complete list of all such disciplines! In the nejct 20 years all knowledge relating to the human brain will be programmable into the most sophisticated computer models man has ever seen, which will then be well on their way to learning how to digest, analyze, and comprehend new patterns, and the results will begin to document and validate the small number of remaining viable psychological theories of the brain and demolish those that are outmoded.

See All Chapters
Medium 9781855751873

9. Bion’s “transformations in ‘O’“ and the concept of the “transcendent position”

Karnac Books ePub

James Grotstein

In the title of this chapter, I suggest that Bion’s concept of O transcends Klein’s concept of the paranoid-schizoid and depressive positions as well as preceding and succeeding them. I could also have said that it goes beyond not only Freud’s pleasure principle but also his and Klein’s notions of the death instinct, each of which my thesis renders as signifying mediators of O, thereby making O the ultimate, though unknowable, signified. From another perspective one can think of O as analogous to the “dark matter”, that amorphous mass that is hidden in our universe, which thoroughly perfuses it (Tucker & Tucker, 1988). It also summons concepts of pure ontology for psychoanalysis, especially the idea of Ananke1 (Greek: “Necessity” or “Fate”; Ricoeur, 1970), Lacan’s (1966) concept of the Register of the Real, and Peirce’s (1931) concept of “brute reality”. I believe that the concept of O transforms all existing psychoanalytic theories (e.g. the pleasure principle, the death instinct, and the paranoid-schizoid and depressive positions) into veritable psychoanalytic manic defences against the unknown, unknowable, ineffable, inscrutable, ontologi-cal experience of ultimate being, what Bion terms “Absolute Truth, Ultimate Reality”. It is beyond words, beyond contemplation, beyond knowing, and it always remains “beyond” in dimensions forever unreachable by man.

See All Chapters
Medium 9781855753884

CHAPTER EIGHT. Individuation: Relating to Other People

Clark, Margaret Karnac Books ePub

‘We meet ourselves time and again in a
thousand disguises on the path of life’

(Jung, 1946, p. 318)

Self-knowledge and relationships

Jung has often been accused that his ‘myth’ of individuation is too introspective, insufficiently related to other people or to the needs of society. It is certainly true that his emphasis is more on our inner development. But, as we have seen repeatedly in the clinical illustrations throughout this book, a change in someone’s internal world leads inevitably to changes in their external circumstances. In Jung’s words:

relationship to the self is at once relationship to our fellow man, and no one can be related to the latter until he is related to himself … Individuation has two principal aspects: in the first place it is an internal and subjective process of integration, and in the second it is an equally indispensable process of objective relationship. Neither can exist without the other. (Jung, 1946, p. 234)

He is saying that as we withdraw the psychic contents we have projected onto our neighbour, we simultaneously both acknowledge these feelings as our own and also thereby see our neighbour more accurately as himself.

See All Chapters

Load more