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Medium 9781855758780

CHAPTER TWENTY-NINE: For Nina Coltart: in memoriam, or calling the thing by its name

Karnac Books ePub

Anthony Molino

In a note dated 3 July 1997 and appended to the introduction of my Freely Associated: Encounters in Psychoanalysis with Christopher Bollas, Joyce McDougall, Michael Eigen, Adam Phillips, and Nina Coltart (1997), I cited my withdrawal from the manuscript of the original “sketch” of my encounter with Dr Coltart written prior to her death by suicide on Tuesday, 24 June 1997. In the aftermath of that sudden and sad event, “reflections of a different sort”, I noted, “now seem in order”. If my memory serves me well, only three people had read that sketch submitted for publication with the rest of the manuscript. One of them was Nina Coltart herself who, in a handwritten letter to me dated 28 January 1997, gave her unequivocal stamp of approval both to the final version of our interview as well as to my highly idiosyncratic and potentially shocking impressions of our time together. Convinced, as I remain, that Nina had intended our interview to serve and survive her as a final testament of sorts, and entrusted, as I was, with the dissemination of its contents, the invitation to contribute to this commemorative volume occasions that I herewith make public, for the first time, those paragraphs originally penned for Freely Associated.

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Medium 9781910444160

CAPÍTULO 11 - Creación de un tiempo especial para los pediatras que observan infantes

Jeanne Magagna Ediciones Karnac ePub

Liliana Berta y Mónica Cardenal


El objetivo de este trabajo es señalar las principales contribuciones del método de observación de bebés a la pediatría y, en consecuencia, a la salud mental infantil. La enseñanza del método dentro de un hospital facilita la participación de profesionales de todas las especialidades, entre ellos pediatras, quizá los más reticentes a ser convocados fuera de su ámbito para un entrenamiento de este estilo. Nuestra experiencia se centra en la realización de un seminario de observación en consulta pediátrica del niño sano, en los consultorios externos del hospital. Esta innovación del método de Esther Bick fue creada por Kamala Di Tella junto con el doctor Horacio Lejarraga en 1980. El curso es de un año de duración, y se divide en dos módulos: 1) Observación, 2) Discusión Clínica.

El primer módulo se dedica a las observaciones directas de lactantes sanos durante la consulta pediátrica, y al estudio y discusión de material bibliográfico sobre las diferentes etapas a lo largo del primer año de vida, incluyendo el embarazo y el parto. El marco teórico integra la concepción psicoanalítica con las teorías del desarrollo, tanto tradicionales como vigentes.

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Medium 9781855753396

2. Rome, 9 July 1977

Bion, Wilfred R. Karnac Books ePub

Q: Before yesterday’s seminar, I was curious to know what Dr Bion thought about music. I’d been reflecting on an analytic experience of mine when I felt that a woman patient preferred music to analysis and was trying— and had begun—to find music in analysis too, for certain reasons: music banished visual experiences, especially terrifying ones associated with the phobic space. She was able to dissolve the terrifying experiences of sounds by putting them together in a melody and using only certain sounds or certain limited pitches. If the music was broken down, the sounds took on a terrifying quality reminiscent of the terror of the visual, almost bodily, three-dimensional images of a claustrophobic space. But I had attributed this possibility of seeing terrifying images to her phantasy of a Cyclopean eye—the third mental eye that psychologists talk about—which she seems to see graphically before her.

An experience with another analysand puts me in mind of Ulysses, who turned himself into “Nobody” so as not to be seen and eaten by Polyphemus. So I wondered if Dr Bion feels we can also invoke a Cyclopean perception that has to do with music and analysis, as some psychologists have demonstrated. Does Dr Bion think there is any connection between all this and the problem of musicians who play without reading the notes and others who can only play if they have a score in front of them?

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Medium 9781782201632

CHAPTER FIVE The disability transference: transference and countertransference issues

Corbett, Alan Karnac Books PDF


The disability transference: transference and countertransference issues


he narrative of forensic disability psychotherapy is largely constructed in the “here and now” experience of the countertransference relationship. Through an intersubjective exchange of feelings, thoughts, and memories a jointly authored narrative emerges that is guided as much by affect as cognition. The countertransference becomes the repository for those elements of the patient’s unconscious he cannot bear to keep hold of, providing the therapist with projected aspects of the forensic patient’s self and allowing an insight into those aspects of their perversion that can rarely be put into words. Through this process the countertransference becomes an invaluable tool with which the patient’s internal landscape can be mapped and navigated. In this chapter I wish to examine various theoretical concepts relating to transference and countertransference in forensic disability therapy. Through examining some clinical vignettes in which failures to work through problematic transference issues have resulted in breakdowns in therapeutic functioning, I will outline the notion of the disability transference, a way of conceptualising the various countertransference implications of working with patients with disabilities.

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Medium 9781782202714

Chapter Six: Thinking with Bion on Thinking

Miller, Ian Karnac Books ePub


The clarity of Bion's blueprint in “The Psycho-Analytical Study of Thinking” integrates his reading of Freud, Klein, and Kant, in light of clinical emergence. Each of the three thinkers in Bion's conception is given credit: Freud for his 1911 paper on primary and secondary process; Klein for her depiction of object relations; and Kant, drafted into Bion's service in elaboration of Klein, for his idea of the “empty thought”, the philosophical precursor of the Bionian dynamic binary, container-contained, graphically represented by Bion, as if in an ideogram of the mind in his creative “mathematical” extension of the Kleinian process P/S<>D (Klein, 1946), by twinned biological symbols, male and female. Here, Bion's idea of mathematical elements emerges from the same thinking process he outlines in this paper: citing Aristotle, he suggests that the idea of a mathematical element is analogous to his “conception”, itself the product of the thinker's weathering the storm of frustration attendant upon the clash of preconception and realisation.

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Medium 9781855751835

9. Gender identity development and eating disorders

Di Ceglie, Domenico Karnac Books ePub

Gianna Williams & Richard Graham

In this chapter we would like to present some ideas and clinical material on the relationship between eating disorders and gender identity development. The relationship between eating disorders and sexual development has been previously reported in the psychiatric literature, most notably by Crisp (1967). The emphasis has perhaps been that of the eating disorder (anorexia nervosa) controlling or reducing the feminine aspects of a developing female adolescent. As this issue has been widely addressed elsewhere, we do not focus on it within this chapter. Similarly, we do not address the research on the incidence of eating disorders in those who are either homosexual or have problems with gender identity.

It is our intention here to address the matter from a different perspective—that is, through consideration of case material in which issues of both gender development and an eating disorder were very prominent. Our perspective is to consider the link between these two areas using psychoanalytic ideas, and our clinical material is taken from psychoanalytic psychotherapy with individuals and families. Consequently, our ideas are underpinned by the concepts developed by Sigmund Freud, and the further developments of his work by Melanie Klein. In order to assist the reader’s understanding of the case material, some of the relevant psychoanalytic concepts are described briefly below.

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Medium 9781780491813

CHAPTER ELEVEN A sister is being murdered

Karnac Books PDF


A sister is being murdered

Sarah Mandow and Alison Knight-Evans

n his seminal paper, “Mourning and melancholia”, Freud (1917e) mapped out the terrain of the already disturbed or fragile mind when it is confronted with an experience of overwhelming loss.

He clearly distinguishes this internal state of affairs that he calls melancholia from the process of mourning, a painful, energy-consuming, but ultimately life-orientated task. In melancholia, the response becomes inward looking, an attack on the ego that weakens rather than develops psychic functioning. Klein (1955) contributed the concept of projective identification, which can explain the way in which a fragile ego cannot face the damage done by the attacks to itself and its objects, splits off the bad feelings, and experiences them not as loss of a good object, but as the presence of something malign.

This terrifying, unwanted part of the ego is projected into the other and controlled and defended against as if it were a completely separate entity.

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Medium 9781855758780

CHAPTER NINETEEN: That sense of awe

Karnac Books ePub

Jane Reid

Ifirst knew Nina when I arrived at Sherborne School, aged twelve, in 1945 and she was an awesome eighteen and head of my house, more grown up than the grown-ups, more distant than the staff. Soon, she departed for Oxford to read—languages was it?—and I, in due course, followed her there.

Later, I got to know her quite well and had great delight in her company. We met at her sister Gill’s house only every five years or so, but nevertheless we were friends. We had wonderful conversations, picking up topics from the last time, exploring every kind of subject from every kind of angle. It was always stimulating, always fun. But I never quite lost that sense of awe. As a young woman, in the conformist climate of the 1950s, Nina had the strength and determination to be different, to go back to O-levels to qualify for medical school after finishing her Arts BA, and to undertake the long years of study and practice that brought her to the pinnacle of a profession chosen, perhaps, because through it she could help people deal with the trauma in their lives. I admired her for her humour and her humanity, her integrity and her wisdom, but perhaps most of all for her courageous and high-minded pursuit of distinction.

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Medium 9781855753631

11 physical and emotional difficulties

Thomson-Salo, Frances Karnac Books ePub

The majority of babies experience minor illnesses and procedures in the first year. Most babies who have heel pricks and injections in their first year tolerate this well, and some use these experiences of invasive procedures to make a developmental move forward. Other babies seem so sensitive that having an invasive procedure feels as though it should not have happened, that it is too much to cope with, and they regress temporarily. If parents are able to think about the effect an intervention is having, despite any distress they themselves may feel, their babies usually can too, without it being traumatic.

A simple cold may have a considerable effect on babies in the first few months, resulting in regression and in expressing their feelings less vigorously. Such regression as a response to illness allows a baby a rest from the demands of life, even if occasionally it may look as though the baby does not regain the ground lost for quite some time.

We can only begin to imagine what the experience of being seriously unwell or suffering a disability feels like. Even a newborn baby can respond to a threat to survival with enormous anxiety. Some parents feel that when invasive procedures are done to their baby, they would like to be there for support. Others cannot bear to see their babies hurt, or they fear that their babies may associate them with the hurting. There is no single right or correct way. If parents could feel that what matters is to find what works best for them and their baby— and realize that they usually know their baby better than anyone—this would guide them in providing the support their baby needs. Their baby’s personality and past history, as well as those of their parents*, would then point to what the babies would find most supportive. For some babies, if at all possible the parents need to be present so that the baby can keep his gaze locked on them. Other babies manage better if they have their transitional object during the procedure and their parents are there to greet them in a less frazzled state after it is completed.

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Medium 9781782201502

CHAPTER FOUR Haunting and parricide

Shengold, Leonard Karnac Books PDF


Haunting and parricide


oewald (1980, p. 248) reminds us that the indestructibility of unconscious mental acts is compared by Freud to that of the ghosts in the underworld of the Odyssey, ghosts which awake to new life as soon as they taste blood. He refers to “transference neurosis”. This is the formation in the course of a psychoanalysis that brings the emotional relationships of the past into a focus centring on the analyst in the present, so that he or she comes to life as a parent figure for the patient. Loewald writes,

Transference neurosis, in the technical sense of the establishment and resolution of it in the analytic process, is due to the blood of recognition, which the patient’s unconscious is given to taste so that the old [early parental] ghosts may reawaken to life. Those who know ghosts tell us that they long to be released from their ghost life and laid to rest with their ancestors. As ghosts they haunt the present generation with their shadow life. Transference is pathological insofar as the unconscious is crowded with ghosts, haunting the patient in the dark of his defenses and his symptoms,

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Medium 9781855753709

CHAPTER THIRTEEN: Can there be a monopoly on psychoanalysis?

Karnac Books ePub

Darian Leader


This chapter explores the history of the question of the ownership of psychoanalysis and the attempts to define the nature and parameters of psychoanalytic treatment. It shows how psychoanalysis has evolved into a plurality of practices with their own traditions and that hence it is not possible to provide a single model of psychoanalytic theory or practice today. Recent attempts to claim a monopoly on psychoanalytic training are discussed and the conclusion reached that there are no serious arguments to support this, only appeals to an imagined authority. All forms of therapy, in contrast, ought to have as one of their goals a questioning of appeals to irrational forms of authority.

There are many questions that only make sense at a particular time and place. When the historian and philosopher of science Thomas Kuhn was describing the genesis of his celebrated theory of paradigm shifts, he singled out the importance of what he saw as the conditions of possibility of posing questions. What mattered, he thought, was less to see how a particular scientific theory answered a question than to explain how that question could have been asked in the first place (Kuhn, 1977).

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Medium 9781855754003

CHAPTER EIGHT: The relativity of the vertex. From the point of view of a binocular vision

Lopez-Corvo, Rafael E. Karnac Books ePub


In his work on transformation (1965) Bion presents arguments to explain situations where patients could alter their position in relation to outside objects by changing their view-point as a result of splitting of time and space dimensions. Bion refers to this mechanism as “reversible perspective”, where the patient’s time and space operates in a different dimension to that of the analyst, similar to Rubin’s vase, where you can see either a vase or two faces looking at each other, depending upon what you choose as a figure and what as its background.

Bion also refers to a “binocular vision”, such as, for instance, the capacity to consider the breast and its absence as two different spaces, an attitude possible only when there exists the capacity to symbolize the absent object; because, after all, to observe the absence of the object and to name it at the same time is precisely the result of a binocular vision. Such form of vision is absent in psychotic patients (or, following Bion, in the psychotic part of the personality) because thinking is then dominated by a blind void that Segal (1957) has referred to as the “symbolic equation”. It is also indispensable for the analyst to keep a binocular vision about the session, in relation to transference for instance, with its twofold time component about what has occurred in the past and what is happening now in the session; or in similar terms, between unconscious and consciousness, or between phantasy and reality.

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Medium 9780946439119

11. The Final Goal of Psycho-analytic Treatment (1934)

Balint, Michael Karnac Books ePub

ONE can confidently describe psycho-analytic treatment as a natural process of development in the patient. If, then, I inquire into the final goal of our therapy, I do not mean by this a prescribed final state, which, deduced from some philosophical, religious, moral, sociological, or even biological premise, requires that everyone should ‘get well’, according to its particular model. I ask rather: is our clinical experience sufficient to define the final goal, or at least the final direction of this natural development?

There are special cases particularly suitable for this inquiry. I am thinking of those people who—like Freud‘s famous Wolf-man—break off the analysis with only partial results, and then, after an interval of years, continue the treatment, possibly with another analyst. The resumed work offers a very favourable opportunity for a fresh investigation of the former non-adjusted obstacles, and a cure in such a case supplies the proof that it was precisely those obstacles that had previously blocked the way to recovery.2

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Medium 9780946439157


Guntrip, Harry Karnac Books ePub


Since, under the stimulus of day-to-day clincial work in which patients are constantly presenting fresh and unexpected sidelights on familiar problems, it is impossible for one's theoretical position to remain static, I welcome this opportunity of reviewing and bringing up to date the theoretical standpoint that I presented in 1961 in Personality Structure and Human Interaction1 and further developed over the intervening years, in the manuscript prepared for Schizoid Problemsy Object-Relations and the Self.2 Since that manuscript was completed early in 1967, I realized that already, in some respects, further clarifications of basic ideas had taken place, and that I would benefit by a further attempt at a condensed statement of the essentials of present-day psychodynamic theory as I see it.

I shall, therefore, at the outset, outline my over-all plan, Perhaps the most important thing I wish to emphasize is that I shall present the” Object-Relations Theory, “not as a British School of Psychoanalysis but as a far more fundamental phenomenon. It is true that in The American Handbook of Psychiatry, I had the opportunity to present the views of W. R. D. Fairbairn under that heading, and in the broad context of that most comprehensive standard work, there was justification for so doing.3 Nevertheless, I wish now to place Fairbairn in his true context, as part of a long-standing and ongoing movement of thought in the psychodynamic exploration of human nature, I shall thus describe object-relations theory as the struggle for predominance of one of the two different types of thinking mixed and confused together in psychoanalysis from its earliest beginnings in the work of Freud. Object-relations theory, or to use the American version,” Interpersonal-Relations Theory, “is the emancipation of Freud's psychodynamic personal thinking from its bondage to his natural-science, impersonal, intellectual heritage. We must, therefore, look again at the clash of neurophysiology, psychobiology, and psychodynamics in the arena of Freud's restlessly original and exploratory mind. There has never been a stage of psychoanalytic theorizing when both lines of thought have not been visible, but gradually research into the ego and personal relationships has more and more occupied the center of the stage.

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Medium 9781855759060

7. An Elegy, a Love Song and a Lullaby

Ogden, Thomas Karnac Books ePub

Prose states; poetry merely suggests. Poetry suggests because what it suggests cannot be stated. So it is to poetry that I turn, in this and several of the other chapters of this volume, in an effort to glean for myself and the reader a sense—and no more than a sense—of essences of important human experiences. The sense of an essence that we glean from a poem, if the poem is a good one, is not already there (“inside” the reader or “inside” the poem) waiting to be illuminated; it is newly created each time, not only in the medium of words, but just as important, in the medium of someone else’s words. And that experience of being spoken by another person as one speaks him is a very large part of what is extraordinary and surprising and disturbing about poetry. We are known as we had not known ourselves because, up to that point, we had not been ourselves as fully as we are becoming in experiencing the poem and as the poem experiences us. Similarly in the analytic relationship, patient and analyst as individuals each read and are read by the unconscious of the other. As a result, when the analysis is going well each participant is being known as he has not known himself—because he has not been as fully himself before.

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