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Chapter Five - Inspiration of the Clinical Psychoanalytical Practice by the Dialogue with the Neurosciences and Embodied Cognitive Science: Some Examples

Leuzinger-Bohleber, Marianne Karnac Books ePub

Facing the pain in psychoanalyses with severely traumatised chronically depressed analysands—new ways in conceptualisation and treatment*


Night after night Mr P wakes up bathed in sweat and in shock from a nightmare following a mere few hours of sleep: for the last twenty-five years he has been suffering from severe depressions accompanied by extreme sleeping disorders, unbearable, chronic widespread pain, suicidal thoughts, panic attacks, and a series of psychosomatic symptoms, among others, acute neurodermatitis.

Mr P is one among many suffering from severe depression. As already mentioned in Chapter Three: according to the World Health Organization (WHO), today over 300 million people suffer from major depression, which, according to the organisation's prognosis, is destined to become the second most frequent illness worldwide by 2020. This enormous increase in severely depressive sicknesses is the object of interesting historical, sociological, and economic analyses, which I am unfortunately unable to address in present context (cf., Chapter Three; Bahrke, 2010; Ehrenberg, 1998; Gammelgaard, 2010; Haubl, 2013; Illouz, 2006; Sennett, 1998). In keeping with psychoanalytic concept research, I will instead be focusing on clinical and extra-clinical results relating to the intimate and frequently unrecognised link between trauma and depression. Mr P's nightmares also point to this connection. Thus, for instance, following six months of psychoanalysis, he reports the following dream:

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Medium 9781782205159

Chapter Seven - The Institution: Doctrine and Ideology

Imbasciati, Antonio Karnac Books ePub

The holy theory

Clinical psychoanalysis today has changed enormously and a process of integration with respect to the other psychological sciences (in particular developmental, neonatal, and infant psychology, attachment theory) and the neurosciences (Fonagy, 1999, 2001, 2005; Fonagy & Target, 1997; Stern & BCPSG, 2008; Siegel, 1999, 2012; Schore, 2003a, 2003b; Kandel, 2005; Damasio, 1999; Imbasciati, 2005b, 2012a, 2012c, 2013b) is under way. However, an adequate theoretical reformulation (Imbasciati, 2013a, 2013b, 2013c, 2013d) has not corresponded to this change. Psychoanalysis is a clinical science: “clinical” does not mean “to treat” (cf. Chapter Three) but to investigate the mind using a clinical method. The scientific nature of the “clinical method” requires investigating not simply on the single case and on any single result of treatment, but on how to extract from all the cases “treated”, or better modified, a general theory of the functioning of the system on which work has been done. This is the difference that distinguishes the scientist from the craftsman. Therefore, general theories have to be inferred from the clinical practice: if it is a science and not craftsmanship, and if the clinical practice progresses and changes, this means that underlying these there are new and different theories which it should therefore be possible to extract and formulate. Psychoanalysis is not only a technique of therapy, but, as Freud underlined (1923a), an investigation of the functioning of the mind: his On Metapsychology (Freud, 1915) was an attempt, one hundred years ago, to explain the mind and in particular the unconscious mind, with the help of the sciences of the time (Imbasciati, 2011a). The part that definitely is explanatory is made up of the first two articles: it is here that Freud outlines a theory that explains the general functioning of the mind and it is this that people today still identify as “Freud's theory”. In this synthetic expression at the level of popular culture, a part is identified as the whole, a metonymy, as the part that is formulated at explanatory level (the Energy-drive Theory), to which Freud refers throughout his work, is taken as representative of every other description and also as a single and partial explanation; and it is thus assumed precisely as it is an “explanation”.

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CHAPTER SIX: Nos in group analysis

Ormay, A.P. Tom Karnac Books ePub

Foulkes (1964) wrote, in Therapeutic Group Analysis,

In a recent article on man’s place in nature, Sir Julian Huxley has stated that Charles Darwin’s Law of Natural Selection holds good and can now be studied scientifically, can be seen in action. This constitutes the biological inheritance of man. The particular feature of the species man is the evolution of improved brains. This has led to a development which, to quote Huxley, gave man ‘the capacity for conceptual (rational and imaginative) thought and for true speech, with words and symbols denoting things and ideas instead of merely sounds and gestures expressing feelings and emotional attitudes. This enables him to do something radically new in the history of our planet — to transmit experience and awareness cumulatively, from generation to generation’ . By this capacity a second mechanism of heredity, cultural inheritance, has been introduced and this latter has made man the latest dominant group on earth. Man is a new and unique kind of organism. His evolution, Huxley says, is no longer purely biological but also cultural.

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CHAPTER FOUR: Splitting of psychic bisexuality in autistic children

Karnac Books ePub

Didier Houzel

The meticulous application of psychoanalytic technique, together with an outstanding “capacity for reverie”, enabled Frances Tustin to discover the nature of the unconscious fantasy that lies at the heart of autistic functioning and organization: that of an unbridgeable discontinuity between self and object, represented by the “broken button” of her young patient John and by the persecutory feelings of being ripped apart that practically all autistic children express in the course of their psychotherapy. Tustin summarized her findings in her description of the mouth-tongue-nipple-breast discontinuity and the concept of “premature psychological birth”—in other words, the necessity for the child to process an awareness of physical separation from the object, the maternal breast, even though, at that point in development, he or she does not yet possess the mental capacity to symbolize it.

I would like to dedicate this chapter to Frances Tustin. I know that she personally had to face up to terrible anxieties that had to be overcome in order for her to throw light on that fundamental level of human experience at which the Self, emerging from its confusion with the Object, begins to establish its basic identity. In a very moving interview I did with her, she talked of certain crucial moments in her own life, her analysis with Bion, and her discovery of the fantasy that lies at the heart of autistic spectrum disorder. The convergence of these three components was in itself striking, and from it a new light seemed to shine forth. As with any discovery in psychoanalysis, hers was made thanks to an alternating movement between her own personal analysis and her work as psychotherapist. To my mind, it is mainly thanks to that approach, which she carried out courageously and in relative isolation, that we now have a deeper understanding of autism and of the way psychotherapy can help children who suffer from it.

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CHAPTER TWENTY-TWO: Last Visit to the 3-Point Therapist

Davies, Hilary A. Karnac Books ePub

The trainee walked very slowly towards the 3-Point Therapist's door. She knew she wanted to delay the moment of arrival and thus of departure for as long as she could.

For the trainee it had been an amazing and difficult journey since she had first knocked on this door a long while ago. Now both she and the therapist had agreed that it was time for her to move on and for their meetings to end.

As she approached the door, the trainee reflected that she had learnt so very much.

“You need to know that I can teach you only 3 Points” she remembered the therapist informing her at their first meeting. She recalled her own slightly sinking feeling at hearing these words and her assumption that she had little to learn here and may not even return!

Things had worked out so very differently. After that first visit she had in fact waited eagerly for her visits to the 3-Point Therapist and came away each time feeling inspired and refreshed, if a little daunted by what she had heard.

In essence, she may have learnt only 3 Points, but what 3 Points! These Points had changed everythingabout the way she practised and what she viewed as the priorities in her work with her clients and the families. The 3 Points had changed her and the way she thought and felt about people and relationships. They had changed her view of the difficulties that people face and how they can best be supported with these.

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