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CHAPTER ELEVEN: Reconstruction in psychoanalysis: Ms. C., the “Slow Scientist”

Aleksandrowicz, Dov R.; Aleksandrowicz, Malca Karnac Books ePub

Freud, working with Breuer (Breuer & Freud, 1893–1895), made the historic discovery of the relationship between the symptoms of psychoneurosis and early childhood life events, including the early relationship with parents and other close family members. Since then, reconstruction of those events and relationships has become a cornerstone of the therapeutic process, as has the analysis of defences and of the transference. The primary aim of the latter is, as a matter of fact, to open the way to the reconstruction, which maintains its status as a mainstay of psychoanalysis and psychoanalytic psychotherapy (Blum, 2005). All methods of psychotherapy based on psychoanalytic theory (and not only psychoanalysis proper) include a measure of exploration of childhood life events and relationships and their relevance to a patient's present difficulties. The task of reconstruction is not merely to uncover repressed infantile wishes and traumatic events of childhood, but also to integrate them with the adult personality: a man's or a woman's loves and hatreds, his or her values, fears, and hopes.

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CHAPTER TWO: Early development and the developmental matrix

Aleksandrowicz, Dov R.; Aleksandrowicz, Malca Karnac Books ePub

The twentieth century, heralded as “the century of the child” (Key, 1911), lived up to that name. The past decades have witnessed a growing interest in the study of children in general and infants in particular, reflected in an expansion of developmental studies. Volumes have been written on child development, and prestigious journals devoted to the subject are being published. The exponential growth of scientific data necessitates a re-assessment of psychoanalytic theory of emotional development. The early developmental theories formulated by Freud (1905, 1915) and his students, as well as those of most later psychoanalytical writers, were, by and large, inferred from reconstruction arrived at during the process of psychoanalysis of adults or older children. Mahler, Pine, and Bergman (1975) were the first psychoanalysts to conduct systematic observations of infants and toddlers. Studies conducted more recently by psychoanalysts such as Stern (1977, 1985) and Shuttleworth (1989) attempt to integrate data from systematic observations of infants and toddlers with data derived from adult or child analysis and are, therefore, more valid empirically than earlier studies. Even so, the subjective experience of the preverbal infant eludes our investigative tools, and theories of early emotionaldevelopment are based, at best, on extrapolation and conjecture, and at worst on fantasies and projections of the adult patient or of the investigator. In spite of these limitations, systematic observations of the infant's behaviour, of his emotional expressions, and of his response to his caregivers provide us with valuable data that have greatly modified our early views on emotional development.

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CHAPTER FIFTEEN: Mastery, aggression, and narcissism

Aleksandrowicz, Dov R.; Aleksandrowicz, Malca Karnac Books ePub

“[The will to power …] is the primeval tendency of the protoplasm.”

—(Nietzsche, 1901)

“There's gold, and it's haunting and haunting; it's luring me on as of old;

Yet it isn't the gold that I am wanting, so much as just finding the gold.”

—(Service, 2001)

Ori, a two-and-a-half-year-old toddler, tries very hard to join some pieces of Lego in a manner known only to himself. He is visibly frustrated by the difficulty and angrily rejects offers of help, saying, “Not that!” Finally he succeeds in putting together a sort of a landing platform, which he raises in a triumphal gesture, his face beaming with pleasure, and announces proudly: “My Auntie Ettie 'teached' me!”

What is the motivational force driving Ori's efforts? What drive release provides the source of his joy? These seemingly simplequestions pose a challenge to the psychoanalytic theory of drives. Exploratory behaviour, manipulation of the physical as well as the social environment, practicing skills for their own sake: all these seem to form a life-long continuum of an urge to master one's own body as well as the environment. Like Ori, we all invest occasionally considerable effort into these activities and derive joy or frustration from success or failure.

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CHAPTER EIGHT: Diagnosis of developmental deviations

Aleksandrowicz, Dov R.; Aleksandrowicz, Malca Karnac Books ePub

The diagnosis of a developmental deviation may be obvious, as in the case of a hyperactive child, or it may be subtle, as in impairment of working memory in an adult. The problem may be apparent to the patient, his parents, or even a casual observer, or its identification may require professional expertise and specialized instruments. The age of the subject and his developmental stage determine the diagnostic procedure. In most cases, a detailed history is indispensable; a family history may often be helpful, since genetic factors may play a role, as we have already mentioned.

We will examine the diagnostic procedures according to age: infancy and toddlerhood, childhood, and adulthood.

We will first discuss the subject of risk factors for developmental irregularity. Such risk factors are the domain of obstetrics and of neonatology and are much too numerous to review here; we will mention only a few common ones, some of which we have encountered ourselves. As a rule, any condition that can adversely influence the pregnancy may represent a risk factor for the development of thechild. Such conditions include maternal diabetes (a very common unfavourable influence on the developing foetus), malnutrition, infections, especially viral infections, exposure to radiation, many prescription drugs, heavy smoking, and most substances of abuse, especially alcohol and opiates. Paternal exposure to alcohol or ionizing radiation is also likely to have an adverse effect (Abel, 2004; Morgan, 2003). Foetal factors comprise anything that can adversely influence the development or maturation of the foetal brain, including inborn errors of metabolism (e.g., hypothyroidism or phenylke-tonuria), cardiovascular malformations interfering with brain blood supply, neonatal prematurity, a small-for-age neonate, heavy medication during labour, foetal anoxia, and neonatal jaundice.

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CHAPTER TEN: Psychotherapy of a girl with minimal ADHD: Giselle, the “Girl who Tamed Dinosaurs”

Aleksandrowicz, Dov R.; Aleksandrowicz, Malca Karnac Books ePub

Giselle was nine years old at the time of referral for consultation. She was described by her mother as “irritated and irritating”, and the main complaints were difficulties in relationship with her parents and her younger brother, two years her junior, with whom she fought most of the time. She was friendly toward her youngest brother, who was twenty months old at that time, and she willingly participated in taking care of him. Giselle's parents reported that she often refused to comply with reasonable requests, overreacted to minor frustrations, and was occasionally physically aggressive toward her seven-year-old brother, whom they described as a friendly and lovable child. When the parents attempted to discipline her by sending her to her room, she would slam the door and kick it or throw things around to the point of causing damage.

Her school performance was satisfactory though uneven: when motivated she achieved high grades, but not infrequently she would neglect or forget her assignments and sometimes did poorly on tests. There were no behaviour problems at school. Her social life, however, was fraught with difficulties: she had no girl friends, engaged occasionally in some games with a few boys from the school, but was close to no one. Attempts by the parents to engageher in extracurricular activities were short-lived, in spite of Giselle's initial enthusiasm.

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