19 Chapters
Medium 9781855758520

CHAPTER SIXTEEN: The enactive phase: sessions 252 to 255

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Norbert Freedman and Rhonda Ward

Almost immediately following the nodal moments of the desymbolizing phase, there appeared a sequence of sessions which we could not classify as either A or Z, and were, thus, neither predominately symbolizing nor desymbolizing sessions. Even more striking was another “objective fact”, alerting us to a potentially informative event: during these sessions, the analyst's scans increased in length. This could mean that the patient had more to say and/or that the analyst was more engaged, but whatever the interpretation, there was a veritable surge of analyst's comments at this point. During the desymbolizing phase, the length of the analyst's scan (expressed in words spoken) was for session 245, 247, and 249, 555, 719, and 452 words, respectively. For sessions 252, 253, 254, and 255, the word output was 823, 1010, 1003, and 709, respectively. Noteworthy is that the scan for session 257, an unambiguous A session and the last of this specimen, had a word count of 1475. From the vantage point of referential activity, there also appeared to be an upward trend: the RA score for session 252 was 0.449 and for session 255, 0.467. It seemed we had entered a new phase in the analytic process, be it patient activity or analyst engagement. Perhaps we were, to use Palombo's memorable metaphor, “[At] the edge of chaos when a small change in input from the environment can lead to a reorganization of the system's structure at a level of increased complexity” (1999, p. 175). Perhaps the upward slope involves a process of differentiation occurring only “at the phase transition between frozen ice and chaotic fluid states” (ibid., p. 176).

See All Chapters
Medium 9781855758520

CHAPTER FIVE: Reminiscing and recollecting

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Jamieson Webster and Norbert Freedman

Let us revisit the Effectiveness Study where we encountered ten patients who elected to speak to Dr V, an analyst, about their earlier experience in treatment. The group had been divided in half with respect to their scores on the Effectiveness Questionnaire: five patients experienced the treatment as satisfactory and the other half reported a sense of dissatisfaction. Once more, we ask the question: what is meant by effective treatment?

In further studies of these patients and their recall narratives with Dr V, the division five and five holds over a number of telling categories with satisfaction correlating with measures of reflective functioning (Fonagy, 1995), secure attachment (Roy, 2007), absence of annihilation anxiety (Hurvich, 2002), and high referential activity, as measured by the referential process (Bucci &Maskit, 2007). One might conclude that satisfaction with therapy is a good quantitative indicator of the success of a treatment with all the concomitant benefits: more secure attachment to the therapist, decrease in anxiety, a widening of one's self-reflective capacities, and so on and so forth.

See All Chapters
Medium 9781855758520

CHAPTER THREE: The RTD Coding System and its clinical application: a new approach to studying patients' representations of the Therapeutic Dialogue

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Jesse D. Geller, Donna S. Bender, Norbert Freedman, Joan Hoffenberg, Denise Kagan, Carrie Schaffer, and Neal Vorus

The Schedule of Therapy Remembered (STR) produced a rich narrative of people's recollections of their therapy experiences. How to use this information to get a measure of patients’ judgments about what was and what was not accomplished during a course of therapy now became the question to be answered.

The primary aim of Chapters Three and Four is to demonstrate the potential of the Representation of the Therapeutic Dialogue Coding System (RTDCS), as well as its operational definitions, scoring principles, and instructions. This will be followed by a presentation of the ways in which RTD scores can be analysed to be specifically responsive to the need for normative information about patients’ retrospective reconstructions of the verbal and nonverbal aspects of the therapeutic dialogue. Included are the first steps in analyses of RTDCS data sets used on a case by case basis to arrive at highly particularized outcome criteria and to try to test the hypothesis that the likelihood of benefiting from a course of treatment is increased if a patient avails himself/herself of the opportunity to construct, remember, use, and identify with benignly influential representations of the therapeutic dialogue in the physical absence of the therapist.

See All Chapters
Medium 9781855758520

CHAPTER NINE: Termination crisis and a panic attack: sessions 41 and 42

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Norbert Freedman, Marvin Hurvich, and Alexandra Petrou

About a year and a half after the phase of Mohamed's early treatment engagement, the psychotherapy came to an abrupt halt. The analyst described how the earlier sessions reflected a process of rapprochement in the phase of the working alliance, next a middle phase of depression and hopelessness, and then a final phase which necessitated a return to his home country. The anticipated departure was a subtext that defined the last two recorded sessions (see Chapter Seven). It is in anticipation of despair that our final observations of the recurrence of Annihilatory Anxiety and its transformation will begin.

Throughout this year of treatment the themes of past torture, torture remembered, and torture relived permeated these sessions: the torture in camp, undernourishment, having been sentenced to death, and recounting what prison guards had done to others. Once more, however, a reading of the clinical material (as well as the therapist's comments) suggested that the impact of trauma progressively permeated the patient's state of consciousness, and led us to consider sessions 41 and 42 to reflect a process of cumulative trauma. When these memories were revived in therapy, they peaked once again in the anticipation of panic, and this concern was activated in session 41. But then, through the coincidence of a fire alarm, the total spectrum of terror was activated and relived during the therapeutic hour. That becomes the central theme of session 42. It is for this reason that we designated session 41 to be anticipatory of the panic attack, and then session 42 became the panic attack proper session. Once more we will offer the highlights of each session scene by scene.

See All Chapters
Medium 9781855758520

CHAPTER FIFTEEN: The emergence of nodal moments during the desymbolizing phase: sessions 245 to 249

Freedman, Norbert; Geller, Jesse D.; Hoffenberg, Joan; Hurvich, Marvin; Ward, Rhonda Karnac Books ePub

Norbert Freedman and Rhonda Ward

While in church after communion, connecting within her heart to God, holding her baby on her lap and feeling love for her, Ms Y encountered a moment of a coming together of meaning, of uniting disparate parts within herself, be they a linking of hallucinatory wishes to reality, subjective self-awareness with objective self-awareness, or the splits arising from triangular conflict. This scene from the end of session 243 (Chapter Fourteen) was a nodal moment preceded by a transference regression. It was a moment of unification, marked by a surge of libido, a crucial ingredient of ego synthesis. When such a nodal moment occurs during a regression, it is a first step in the direction of the upward slope and of Progressive Symbolization.

Nodal moments highlight paradoxical transformations at work. These crucial events are preceded by episodes of desymbolization, where the underlying meaning is implicit and unformulated. But when the nodal moment appears, meaning becomes explicit, formulated, symbolized. It is in the transformation from the unformulated to the formulated that the paradox can be discovered, processed, and confronted.

See All Chapters

See All Chapters