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CHAPTER THREE: Psychosis in Freud's papers before and after his Schreber text

Thomas Dalzell Karnac Books ePub


This chapter will situate Freud's Schreber text in the evolution of his thought by studying his papers on psychosis before and after 1911. While Macalpine and Hunter have argued that Freud originally made no distinction between neurosis and psychosis, it will be seen that although Freud initially regarded repression (Verdrängung) as a defence mechanism common to both, he already understood the rejection (Verwerfung) responsible for the more serious and psychotic illness, amentia, as a more energetic and successful defence. We will also find that, in his earliest thinking on paranoia, Freud was already trying to work out the difference between paranoia, as a psychotic illness, on the one hand, and obsessional neurosis on the other. And where his 1911 text understands Schreber's repression not simply in terms of a defence against something intolerable, but as a libidinal withdrawal and regression to infantile narcism, we will see how his libido theory developed afterwards. Why Freud could later refer to the homosexual element of his aetiology in a number of papers without mentioning the libidinal fixation will also be addressed, and we will ask if this was because of developments in his drive-theory or because of the nature of the illness being discussed. Finally, we will consider the significance of Freud's second topology, and its leading him to speak of a disavowal (Verleugnung) in psychosis rather than repression, and ask whether he gave up his earlier understanding of disposition in terms of libidinal fixations. The relevance of this will become clear in Chapters Eight and Nine when we find that Melanie Klein and Ronald Fairbairn have understood Schreber in terms of Freud's later theories, whereas Lacan represents a return to Freud's 1911 text.

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Medium 9781782205623

2 - Negative Hallucinations, Dreams, and Hallucinations: The Framing Structure and its Representation in the Analytic Setting

Gregorio Kohon Karnac Books ePub

Rosine Jozef Perelberg

The framing structure

Green states that when holding her infant, the mother leaves the impression of her arms on the child, and this constitutes a framing structure that, in her absence, contains the loss of the perception of the maternal object and a negative hallucination of it. The framing structure is the outcome of the internalisation of the maternal environment created by maternal care. It is the “primordial matrix of the cathexis to come” (Green, 1986b, p. 166). The capacity for the negative hallucination of the mother lies at the origins of representation; it is against the background of negativity that future representations of the object are inscribed. This is the role of the negative in its structuring function (Green, 2005a, p. 161;1 2005b). From this perspective, negative hallucination precedes all theory of representation. The negative hallucination creates a potential space for the representation and investment of new objects and the conditions in which the activities of thinking and symbolisation can take place.2 In marking the role of the absent other in the constitution of the psyche, Green is following the traditions of both Winnicott and Bion. This is an absence as “an intermediary situation between presence…and loss” (Urribarri, 2005, p. 205). This leads to Green's statement that “the Psyche is the relationship between two bodies in which one is absent” (1995, pp. 69–76).3

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Medium 9781855752757

19. M(l93l)

Glen O Gabbard Karnac Books ePub


The premonitory character of Fritz Lang’s M {Morder unter uns} and its connection with the rise of Nazism has been indicated more than once. I would like to demonstrate the essential ambiguity in this linkage.

It is said that a masterpiece allows interpretations at multiple levels. According to Lang himself (though should we ever believe auteurs?), he just wanted to make a ‘documentary* about a criminal and the process of police investigation. He tells us that he was inspired by The Threepenny Opera and by a news report about Berlin’s organised crime mob searching for an unknown killer to get rid of the insistent presence of the police. To Lang then, the film is the hunt for a criminal and his subsequent judgement by the mob.

The Nazis themselves, already powerful enough in 1931 to dictate the law, forced Lang to change the original title of the film Morder unter uns (Murderer^ among us) to Mf probably because they felt he was alluding to them! Rarely is a translated title better than the original, but the alliteration in MkMaudit (M the cursed)2 makes this more stirring than the original German title.

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Medium 9781855758759

Chapter Eight: Interprofessional collaboration: Achieving integrated care in mental health services

Sarah Benamer Karnac Books ePub

Tony Leiba

Interprofessional collaboration and working between psychotherapy and the statutory services in mental health is essential if service users and their carers are to receive a seamless service. Interprofessional collaboration and working is a highly complex activity. Some of the challenges for the statutory services in mental health and psychotherapists in working together are evident in ideological differences, power and status relationships, differing organizational cultures, and disparity of professional language.

This chapter will present some introductory thoughts on interprofessional collaboration, along with some discussion of the relevant advantages and challenges. The stimulus for this paper grew out of The Bowlby Centre Conference (2008), “Telling Stories? Attachment-based Approaches to the Treatment of Psychosis”. During the discussion sessions at the conference, it became clear that the health professionals from the statutory services for people deemed to be undergoing a psychotic experience, and psychotherapists involved in the care of these individuals, often struggled to find a common paradigm and language to enable service users to receive effective care.

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Medium 9781780491578

8 Dolly: A Depressed Neurotic Suppliant Personality Disorder

Arnold Rothstein Karnac Books PDF


Dolly: A Depressed Neurotic

Suppliant Personality Disorder

Darya Aleksandrovna, Dolly, is a typical example of the kind of feminine integration of narcissism that Women's Liberation abhors. For Dolly, her husband Stiva and her children are narcissistically invested possessions (objects). She narcissistically invests the ego functions associated with her identity as a beautiful woman, housewife, and mother. The smiling admiration she receives for her beauty and possessions and for her performance of activities associated with her identity represent the substance of her narcissistic integration. In these smiles she momentarily recaptures a sense of narcissistic perfection for her self-representation.

Stiva's infidelity shatters her system. She longs for her husband's love, or for the love of another adult male. She stays with

Stiva after he has hurt her because she is afraid and weak.

She should leave him, but she was conscious that this was impossible; it was impossible because she could not get out of the habit of regarding him as her hus-

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Medium 9781855754386

CHAPTER 7: Emotions and the primal brain

Antonella Sansone Karnac Books ePub

There is no such thing as an infant…without maternal care there would be no infant. (Winnicott, 1960b, p. 39)

Neurobiological studies show that healthy brains depend on healthy bonding relationships with the primary caregivers and effcient connections of neurons in the brain. All these connections make the brain of a two-year-old four times heavier than the newborn's. Early events determine which circuits in the brain will be reinforced and maintained. It is the emotional environment in particular that reinforces this wiring system and determines the density and complexity of connections among the neurons. Neurobiologists show us that the wiring is related to the quality of the parent-infant relationship, the way the baby is cared for, and the quality of the baby's attachment to the parents and others.

Development is about incorporating experience into the developing brain, thus producing new connections and reinforcing them. The capacity of the brain to modify its own structure in response to the environment is called neuroplasticity. Perry, Pollard, Brakely, Baker, &Vigilante have stated (1995): “The single most signifcant distinguishing feature of all nervous tissue–of neurons–is that they are designed to change in response to external signals. Those molecular changes permit the storage of information by neurons and neural systems.”

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Medium 9781855757462

CHAPTER TWENTY: A Specific Painting in a Specific Way

Hilary A. Davies Karnac Books ePub

The trainee was by now getting quite used to the therapist's unconventional ways.

She headed for Trafalgar Square a week later in search of the specific painting she was to view in a specific way.

It was difficult.

In some ways she was, in her mind, trying to link this task to the conversation she had had with the therapist at their last meeting, on the simplicity yet complexity of the therapy process; on the importance and specific role and position of theory in the therapy task; on the crucial issues of expertise and power in the therapy; on the critical importance of the therapist's task of supporting and never undermining the families’ competence and expertise.

She tried to think ahead, preparing to allow herself simply to enjoy and take in the painting. Her head was somewhat full of worries about getting it right. She wanted to be the good student. She could not help wondering what it was all about.

On arriving at the National Gallery, the trainee made her way to the new Sainsbury Wing, where she located the painting.She was pleased to find that the room where it was displayed was not crowded. It was a weekday and mid-afternoon. She thought that she would have a good view from all angles. She knew the painting already, and was intrigued by her mission and what she would learn that was new.

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Medium 9781855754973

CHAPTER FIVE: Supervising trainees: teaching the values and techniques of psychoanalytic psychotherapy

Ann Petts Karnac Books ePub

Jean Arundale

When I was asked to talk about supervision technique, for the BAP course on Developing supervision skills , my initial response was I m not sure what the technique is, but I can think about what I do and maybe find out. Thinking of supervision as having a technique with a set of skills to be learned seems a natural approach in our technical culture, so I accepted the invitation. However, I soon had second thoughts about the notion of technique. Is supervision a matter of laying out procedures of good practice to be followed, or something deeper? I have now come to believe that the concept of technique in supervision is somewhat artificial, a view of the surface, and that it is much more a matter of values internalized from the experience and study of psychoanalysis that counts.

So I begin with some questions that are perhaps heretical in view of current trends towards training in supervision. Is it possible to teach the job of supervision, as such? Is supervision a group of skills or a process that can be transmitted in a training course? Is it necessary to provide training for the position of supervisor? Is training a necessary requirement for the job?

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Medium 9781782203193

Chapter Seven: Reflections and Conclusions

Lorraine Price Karnac Books ePub


Winterson (2011, p. 144) quotes Hartley's (1953, p. 5) beliefs about the past.

“The past is a foreign country: they do things differently there.” But she considers that revisiting the past has benefits too, “Yes, the past is another country, but one that we can visit, and once there we can bring back the things we need.” In therapeutically revisiting the past (in regression to dependence) we are given a second chance to develop and take back the things we need as part of developing emotional maturity.

In writing this book I have sometimes used my personal stories, seeing them as an intrinsic part of my work. Reflexivity in psychotherapy is important, even more so when working with the type of client addressed in this book, and the use of myself is a significant aspect of my way of being, requiring self examination and self analysis throughout the therapeutic process. Reflexivity has also been an integral part of my process throughout this book and my research.

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Medium 9781782205579

Chapter Four - The Moments to Conclude

Luis Izcovich Karnac Books ePub

Moment or moments?

You will have noticed that the question of time concerns the whole of the analytic experience, but of special importance is the idea analysts have of how analyses end. There is on the one hand the evidence of experience, that is to say, the observable facts, and on the other hand what analysts say about how and when an analysis should end. It is clear that Lacan established this moment of concluding as singular. He used the sophism of the three prisoners to suggest a process that follows a precise sequence: the instant of seeing, the time for understanding, and the moment to conclude. This is unambiguous in a text published after the introduction in 1967 of his proposition on the pass. So, in “L'acte psychanalytique, compte-rendu du séminaire 1967–1968” (2001 [1969]), Lacan refers to an elective moment, that of the act, to mark the passage from analysand to analyst. It concerns a specific moment that is logical and distinct.

Lacan invented a specific instrument to assess this moment. This is the instrument of the pass. Its objective was not to create a rule for the formation of the analyst but to make an offer to those who wish to testify to this moment of the passage to the analyst. Lacan created the term “passand” for those who offer to make such a testimony and proposed the term “jury” for those assigned to assess the testimony. This term “jury” was then replaced by that of “cartel” in the schools where the pass functions, thereby emphasising the dimension of epistemic elaboration instead of the candidate's assessment. Between the passand and the jury, Lacan introduced the term “passer” for the one who gathers the testimony of the passand to transmit to the jury. The experience of the pass, which is that of each passand, is deposited as knowledge for the cartel on condition that there has been a working through (élaboration) on the part of the passand, an accurate testimony on the part of the passer, and a working through afterwards by the cartel.

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Medium 9781855759220

CHAPTER TEN: No Sex couples, catastrophic change, and the primal scene

Francis Grier Karnac Books ePub

Francis Grier


Acommon presenting problem to the marital psychotherapist is that of No Sex. Sometimes a couple names this as their principal problem at a first interview. Often, however, they will be too embarrassed to be so frank, but it will soon become apparent that there is this crucial absence in their relationship. In this chapter I propose to attempt to make some inroads into understanding this situation. I want to concentrate, in particular, on how such difficulties often arise when the partners share a history of inadequate working through of certain aspects of the oedipus complex.

I will use three clinical illustrations, which represent variations on a theme. The variations are, I suspect, quite commonplace, although the particular version that any couple develops is their own. The underlying theme consists of the dynamic relationships between the child and the parents in intercourse in the primal scene. The three variations represent typical defence systems erected by couples against the psychic pain evoked in attempting to accept the reality of the primal scene. The variation of my first couple, the Flints, consists of their not being able to bear the fact that it is the parents who couple. They insist on a version in which the child and one of the parents come together, the other parent becoming the excluded one. The Grays, my second couple, did not dispute that it was the parents who were intimate, but they could only conceive of the excluded child being cruelly deprived. This justified their complaining about this forever and ever. The variation or solution of my third couple, the Forsyths, was to eliminate the child in the triangle and hence to construct a non-procreative version of adult intercourse. There was to be no problem or pain, because no demanding child would eventuate from the intercourse. For all three couples, their coming to therapy was evidence that they knew something was seriously wrong and that they needed to change. However, when confronted with the reality of the demands made by psychic development, they reacted as if faced with a catastrophe.1

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Medium 9781855751392

16. Psychotherapy and religion

Neville Symington Karnac Books ePub

I believe that the psychotherapy movement is experiencing a period of severe crisis, a crisis that is similar to and with the same roots as the crisis that is evident in organized religion throughout the Western world. I wish therefore in this chapter to start by presenting the view that the contemporary psychotherapy movement (i.e. the movement that has developed since the days of Freud) developed as a reaction to the dominant attitudes within organized religion. From there I want to go on to examine what I call traditional religion and its categories. I then go on a brief excursus into the symbolic nature of the sexual and, from there, to an examination of conscience and its formative role in mental health. This leads naturally to an examination of the great religious teachers as illuminators of conscience, and then to my view that the crisis in the psychotherapy movement lies in the philosophical nominalism that underpins it. I shall end by trying to adumbrate the hazy outline of a solution—a solution that lies in the development of a concept of the Good within the sphere of human intimacy. I should add that the reader may notice certain similarities between this chapter and the previous one in viewpoints argued and concepts presented. However, the excision of such overlap in either chapter would have resulted in a dilution of what I am trying to say.

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Medium 9781855759336

CHAPTER FIVE: Assessment

Fiona Ross Karnac Books ePub

In psychotherapy it is not always possible to think of assessment as a separate part of the therapeutic process as every session is likely to have some qualities of assessment. This is particularly so when perversion is a prominent feature of the patient’s pathology as secrecy, evasion and deceit will be characteristics of the patient’s initial communications with the therapist. Perversity as a psychic defence is likely to emerge very slowly in the therapeutic relationship.When looking at the origins of perverse sexuality in early trauma, we are looking back at the parent-child relationship. Emotional, sexual and physical abuse are most often experienced within the family, generally perpetrated by the parent or a close parental fi gure on the child. It is therefore most important, as with all assessments for psychotherapy that the assessor listens to the patient’s account of their infancy and childhood. This would include both that which the patient presents as factual information and the surrounding fantasy material.

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Medium 9781855757882

CHAPTER NINE: Conclusions and future directions

David A Lane Karnac Books ePub

Manfusa Shams

With increasing competition in the global economy market, a business set up within a family context appears to be the most desirable option for getting optimum levels of achievement in the economic sector around the world. The statistical evidence of 65–80% of all businesses in the world being family business (Nation, 2004), with 80% of family businesses from the USA and Europe (Flintoff, 2002) is in support of this accessible option for economy growth. The present estimate of 75% of all businesses in the UK (Jackson &Shams, 2006) being family businesses is supporting this trend.

Family business has been characterized as a unique economic organization for the pattern of ownership, governance, management, and succession, influencing the organization’s goals, strategies, structure, and the functional strategies designed to transfer succession to the next generation (Chua, Chrisman, &Sharma, 1999).

Family businesses function around families; families, in turn, determine the nature and extent of business. With diverse family systems in different cultures, we must discuss the implications of diverse coaching approaches for family businesses within and beyond a particular cultural context.

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Medium 9781855757349

CHAPTER THREE: Group-as-a-whole: A self psychological perspective

Walter N. Stone Karnac Books ePub

Walter N. Stone

Abstract: As Self-psychology has evolved from exclusively dyadic treatment, it has illuminated transference configurations that are applicable to group treatment. Selfobject transferences not only are directed to individuals and to the whole group. In addition the concept of the group-self, refers to members’ deeply felt inner experience of the group ideals and goals.

Individual's experience of whole group interpretations often stirs a basic ambivalence between group membership and self-expression. Self psychologically informed interventions, understanding and explaining, focus on therapists tasks of empathically understanding individuals prior to explaining (interpreting) the group-as-a-whole. Examples will illustrate transference and coun-tertransference aspects of the treatment process.

Key words: Selfobject; group-self; empathy; interpretative understanding; interpretative explaining.

Emerging from the ferment of interest in group phenomenon, Kurt Lewin (1951) conceptualized a group as a system, different from the sum of its parts. Groups were understood to have unique properties that were embedded in a hierarchy of systems and containing subsystems within their boundaries. Clinicians were thereby provided a conceptual tool with which to understand the interactions (verbal and behavioural) of a dynamic system frequently referred to as the group-as-a-whole. Systems’ views encompass group dynamic perspectives, including goals, boundaries, norms, roles and values.

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