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Chapter Four: The Infrastructure of the Vertical Split

David Garfield Karnac Books ePub

As we saw in the case of Judith, disavowed action can be seen as the patient's way of trying to hold on to a threatened sense of self agency. Behaviors, actions and a variety of different split off states contain vital elements of an unintegrated self. For Judith, the mirroring selfobject experience, as it deepened, allowed for the reintegration of these various psychotic behavioral states. The key concept here is “threatened.” Given Judith's experience with her grandfather, her very psychological existence was at stake.

This chapter, through two clinical vignettes, explores in greater depth Kohut's (1971) concept of the vertical split. Interestingly, Sullivan's (1953) identification of “selective inattention” as a security operation within a self system can be seen to foreshadow Kohut's concept of the vertical split. Stern's (1985) research on the development of agency within the infant and the important role of caretaker attunement to the felt consequences of intended action add to the clinical understanding of disavowed motor acts. Here, faulty selfobject experiences result in the development of an in-depth sector of the psyche that remains conscious, yet disavowed. We clearly saw this in Judith's psychopathology.

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Chapter Three: Repair of the Self—Judith

David Garfield Karnac Books ePub

Forward and trailing edge transferences

As mentioned earlier, Marion Tolpin's groundbreaking (2002) elaboration of a transference continuum involved the idea that Kohut's mirroring, idealizing and twinship selfobject experiences lay at the forward edge of growth and development whereas the classic repetition compulsion transferences could be seen to be the re-enactment of the unconscious conflicts of childhood. The understanding of the emergence of symptoms in the course of an established treatment may point to the breakdown or shift in forward edge growth facilitative experiences. This then leads to classical transference phenomena.

After Judith's “delivery” of the dead four-year-old and her announcement of “integration” into “one” self, there followed a period of some six months of “regression.” Judith spent much of her waking hours in fantasies of nursing and sucking. At first it would be a bottle, then a nipple, then a whole breast. Gradually, there were images of penises, penises to suck on, penises to cut off, penises to bite off. These images were accompanied by great fear and apprehension.

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CHAPTER ONE: Introduction: The focal point

David Garfield Karnac Books ePub

Although Tony Potter's first encounter with psychosis occurred while he was in medical school, it came in a nonmedical way. He had, like countless others, noticed the old bag ladies and the scrawny young men near Washington Square Park who walked about mumbling to themselves. They all wore torn and dirty clothes that never seemed to fit. The elderly, short women in the park fiercely guarded their turf; no one should get too close to their garbage bins nor their shopping carts. One rather heavy old woman lay sprawled along the entire length of a bench. Though her head never moved, her eyes never closed. Tony could feel her gaze on him as he jogged through the park. These were the homeless mentally ill. New York absorbed them effortlessly. Like everyone else, Tony avoided them, steered around them, picked up his pace as he strode past them. But one afternoon on his regular running route, an odd thing happened. He had circled back through Soho and as he was passing the new “all-white” antique and kitchen store (white tables, white chairs, white coffeepots, etc.), he found that he was running alongside an athletic-looking man who appeared to be about 30 years old.

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CHAPTER EIGHT: Shame, pride, and paranoid psychoses

David Garfield Karnac Books ePub

Tony's work with Robert Meyer began in a fairly unremarkable way. Yet, it was an experience that was to imprint itself indelibly on the young psychiatrist's mind. Meyer had been admitted to Mount Sinai with a delusional disorder of a persecutory type. After his introduction to the subject through Jack Barnes, Tony was ready and interested to go to work. Psychotherapy with Robert was easy. This was an articulate, intelligent, 29-year-old married man who had worked in his father's lighting business.

Tony discovered that Robert had an invigorating and developmen-tally advanced childhood. He had been an active boy, played sports, had lots of friends, and revelled in his job as older brother to his two younger sisters. However, early in the therapy, Tony picked up that Robert's childhood had not been completely smooth. Robert had to defend his father from the jeering of neighbourhood children. The Meyer family was the least affluent on the block and Robertwould make up stories about how wealthy and powerful his dad was when other children would ask why their car was so old or why their house was so small. Robert simply told them that although his father was rich and well known, those things were not important in their family. Robert even remembered one or two fistfights around this issue.

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Chapter Nine: The Widening Scope of Psychoanalysis: Self Psychology and Psychosis

David Garfield Karnac Books ePub

We hope we have illustrated, the principles and practices of self psychology in the intensive psychotherapy of psychosis, providing a useful way to conceptualize and implement how we work with patients suffering from schizophrenia and related psychotic disturbances. All of the patients presented in depth in this book have had previous diagnoses of schizophrenia, yet all gradually worked through difficult and painful problems that underlay their delusional or hallucinatory experiences.

Concepts such as the vertical split, cross modal empathic attunement, fear of re-traumatization, the “forward edge,” disruption and repair all help the self psychology therapist address the various deficits patients have and need to work through during the course of psychoanalytic psychotherapy. The three sections of the book—mirroring, idealizing, and twinship, have, of course, framed the foundation of this approach. It is important to note that with these foundational understandings of self psychology, people who were previously viewed as hopelessly mired in a psychotic process have been able to recover and some have been able to eventually come off antipsychotic medication.

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