13646 Chapters
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Medium 9781780491110

Chapter Five - The Frightened Couple

Karnac Books ePub

Stanley Ruszczynski

Working clinically with patients, individuals, couples, and families, who actually act out their difficulties through delinquent, violent, or sexually perverse behaviour, is probably the biggest challenge now facing contemporary psychoanalytic psychotherapy and psychoanalysis. Until recently it was thought that such patients could not benefit from in-depth psychoanalytic work. This view is now changing and increasingly such patients are seen in psychotherapeutic clinics for treatment, and not just for management and supervision.

In the clinical work with such patients it becomes clear that their actions are often driven by anger and hatred. Robert Stoller's description of perversion as “the erotic form of hatred” (1976) could be equally applied to much delinquency and criminality and more obviously to violence. These are all acts of violation and hatred against another. However, clinical experience also suggests that this external expression of destructiveness and hatred is often a desperate defence against overwhelming internal feelings of humiliation, vulnerability, and terror—a fear of becoming overwhelmed by unmanageable anxiety of annihilation. The histories of most of these patients show that they themselves were very often victims and were now in identification with the aggressor as a defence against further feared abuse and violence (Rosenfeld, 1975). In addition, they may also display what Mervyn Glasser refers to as “identification with the neglector” and through projective processes get themselves caught up in situations where they do not gain help, support and care but experience further neglect (Glasser, 1998; Ruszczynski, 2010).

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Medium 9781855750524

A constructivist position for family therapy

Hoffman, Lynn Karnac Books ePub

Copernicus … successfully abolished the egocentric notion that the little planet on which we live must be the center of the universe. We know that it was a difficult step to take and that resistance against it lasted longer than a century. It seems that now there is yet another, even more difficult step in that direction we shall have to make, namely, to give up the notion that the representations we construct from our experience should in any sense reflect a world as it might be without us.

von Glasersfeld (1987b, p. 143)

Periodically (though not many times in a lifetime) there comes a shift that is so radically different from one’s previous framework as to qualify as a shift in Gestalt, if not of paradigm. When I discovered family therapy in 1963, I experienced such a shift. I moved from the position that a symptom was a property of the individual to the idea that it had to be understood in the context of the family “system”. For twenty years thereafter, I studied families with an eye to discerning what interaction patterns or relationship structures were connected with the kind of problems a family therapist might be asked to treat.

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Medium 9781780490823

Chapter Twenty: Expanding Fairbairn's reach

Karnac Books ePub

David E. Scharff

Since Fairbairn first produced the basic outline of an object relations theory of mind and its applications to clinical work, his ideas have provided a sturdy framework for psychoanalysis and its applications that put relationships at the centre of development, and that place the therapeutic relationship at the heart of clinical work. This book is a testament to the depth and breadth these ideas have engendered. For me, his basic framework has continued to be the backbone of many theoretical additions that give ever more strength to an object relations approach. However, when I use the term “object relations”, I include the protean developments in analytic theory, in the allied fields of family and couple therapy, in studies of human development, and in the expansion of our ideas from science that increase our understanding and reach.

In this contribution, I will summarise some of the additions that have been especially useful in augmenting my own view of the analytic universe. Fairbairn's basic contribution is summarised in the 1996 paper by Ellinor Fairbairn Birtles and myself (reprinted in Chapter One), which also gives the historical context of his core ideas. Many of these foundational concepts are explored at length in other contributions in this volume. What follows uses that paper as its foundation.

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Medium 9781782200048

Chapter Seven - “I'm Staying There”

Molnar, Michael Karnac Books ePub

The first thing I noticed about the original print of this photograph is that it was fading into a beautiful golden sheen. Its subjects are dead, and now the supposedly preserved moment is following them into extinction. The natural world, or a bath of weak hypo, is having its revenge on art. The bleaching image is acting out its own doom.

In cinematography, fading or overexposure are often used to represent dreams or distant memories. Anyone acquainted with that technique is likely to read this image as unreal. Yet, in spite of chemical deterioration, the brown-tinged, century-old sunlight still picks out most of the details. In theory, the place and the children could be identifiable. That, at least, was my hope when I found the photograph among material bequeathed by Lucie Freud (née Brasch), the wife of Freud's youngest son, Ernst.

I assumed it related either to the Brasch or Freud families. However, there was no other external clue, no inscriptions or documentation. I guessed it must be around the turn of the century, give or take a decade, and the children's clothes indicate the Austrian or Bavarian countryside. It was not so much the cryptic activities of the children as the atmosphere that attracted me to the image. Certainly, I wanted to find evidence and understand what was going on, but no historical data could completely explain the effect of the picture.

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Medium 9781607059608

Spark 15. Doubt

Carrie Bloomston Stash Books ePub


“Doubt kills more dreams than failure ever will.”


Many of us hold on to doubt so we don’t allow ourselves to build a ladder with duct tape and backyard twigs to get us to the moon. But you can, you know. You can build that ladder with your own two hands, sheer excitement, and intention if you trust the process and take the first step.

One of the most important ways we can overcome self-doubt is to make peace with it. Befriend your doubt. Notice when it shows up. Gently honor it like an old friend. Maybe even nicely ask your doubt to leave. When we are busy trying to get rid of something, we expend a lot of energy and we are unwittingly feeding it.



We don’t have enough rituals in our modern culture, but our ancestors did. Use ritual to honor the transition into your creative activity. A ritual can be a simple thing we use as a tool to step into a more personal, internal space. It may be dark chocolate. It may be a moment of gratitude for the blessings of today. It may be a simple prayer in which you ask for strength and courage and that you work to your highest and best good. Maybe you say, “Today I will make a mess, play, and have fun.” I burn sage (smudge) before I work (a Native American ritual), to clear the energy and start fresh.

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Medium 9781855756441

11 Work discussion: implications for research and policy

Karnac Books ePub

Michael Rustin

The method of work discussion is highly particular—it depends on a single individual practitioner observing himself or herself while actively involved in a work situation and reflecting on the implications of what is being seen and experienced. A work discussion seminar supervises and reflects on each member’s observations and reports, and in that way there is a sharing of knowledge and understanding between practitioners whose work situations will usually have something in common. Nevertheless, it is the individual’s experience of a situation that is the focus of exploration according to this method.

Work discussion, since its inception, has had two major purposes. The first of these, which it shares with the method of infant observation, is educational and formative. It is intended, like infant observation from whose procedures it derives to a substantial degree, to enhance the psychoanalytic understanding and capacities of those who undertake it, outside or prior to their use by the learner/practitioner in a clinical context. Its usual participants are students engaged in work in educational, health, or care settings who are invited to conduct “participant observations” in their places of work and reflect on them in small seminars originally modelled on those that take place in infant observation programmes. The similarities lie in the method of presentation of detailed observational reports followed by supervisory and peer discussion, in the small scale of the activity (ideally five or so seminar members in a group, permitting two presentations per student in each term), and in its continuity of experience (with participant observations preferably continuing for a year or more). This method has been found to provide an opportunity to observe, reflect on, and learn about the emotional and unconscious aspects of work in these settings, which no other activity comparably provides. This has been a context in which some of the most valuable of contemporary psychoanalytic ideas could be learned in their use, and in their relation to experience, rather than merely “learned about” as abstract concepts. Such complex ideas as those of the relations of containment, the mechanisms of splitting and projective identification, “attacks on linking” (Bion, 1959) and on thought, and the varieties of defences against unconscious anxieties have, through this form of learning, become resources for understanding the dynamics of work-settings where human relationships are central. Just as with infant observation, it is found that a combination of the experience-based learning of work discussion, with some parallel learning of relevant psychoanalytic concepts and theories, enables students to find meaning in emotional and unconscious aspects of their experience and to achieve significant development in their capacity for thoughtful practice. In some educational programmes infant observation, and work discussion, and sometimes young child observation too have been undertaken in parallel, together with a course in psychoanalytic theory. The different balance between reflection and activity called for by these settings is often helpful to the learning process.1

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Medium 9781780490090

10: Some notes on maternal containment in “good enough” mothering

Bick, Esther; Harris, Martha Harris Meltzer Trust ePub


This paper expands Winnicott’s “quantitative” defnition of a “good enough” mother in qualitative directions, incorporating Bion’s concept of maternal reverie, Bick’s of the containing skin and the move from unintegrated to integrated states of being, and Meltzer’s of two-dimensional states. These concepts are illustrated through two infant observation cases and one analytic case of a mother with a new baby. All are concerned with the nature of “ft” between mother and baby, and with the baby-within-the-mother; with the way reawakened infantile feelings can interfere with reverie; with the complications of mourning (in two cases); with the baby’s struggle to introject the good breast whilst partly relying on second-skin support (in one case), and with the mystery of internalization in which (in another case) the thumb can take on the signifcance not of a mere plaything or transitional object, but rather, become the “agent of an internalized object in advance of the baby’s conscious control”.

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Medium 9781855755208

CHAPTER SEVEN: The power of the multi-generational psyche

Love, Janet C. Karnac Books ePub

Diary extract

Eighteen months have now passed since I last wrote in my journal. Time has simply disappeared into the spaces between the long-term project of my son’s aftercare recovery programme and the short-term, difficult, one-way-ticket project of looking after my mother’s deteriorating dementia and her inexorable march towards death itself. In the hours in between, I had continued working as a therapist, and also embarked on some new training as a systemic constellation therapist.

I had been suffering, for most of this time, a severe case of “theo-mania”. This was a word coined by Scott Peck, to describe “the illusion that we can be the scriptwriter in the drama of our lives” (Peck, 1993, p. 193). During this period, I was running and funding, single-handed, one private mental health hospital for depression and dementia, and an integrative aftercare recovery programme for psychosis, at different ends of the country. There seemed to be no respite from my storyline of living with mental illnesses. My general fatigue meant I became increasingly resentful of my script; worse than that, I found myself becoming frustrated and downrightangry with the scriptwriter(s). Where had all my training gone? I remembered my carefully thought through definition of the transpersonal in the foreword: “the transpersonal approach seeks to acknowledge, yet move beyond, the awareness of the individual‘self as a separate, isolated consciousness. It seeks to embrace a more interrelated, universal, complex sense of being which is in harmony with an unseen order of things and recognizes there exists beyond ourselves a powerful force that nurtures our growth and evolution”.

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Medium 9781782204015

Chapter Sixteen: Following the Trail of the Unconscious

Hickey, Catherine Karnac Books ePub

We continue with the sixteenth interview of the series. By now, the patient is quite familiar with the process. She has been interviewed in the Montreal closed circuit training programme multiple times. She has had multiple breakthroughs of murderous rage and intense guilt. The therapist has applied MUSC throughout the entire process. At this point in the journey we are beginning to see the start of structural change in her unconscious. Simply put, the various components of her unconscious—her defensive organisation, her anxiety, her resistance, and her emotion—are beginning to change.

For example, earlier on in the course of the therapy, she often had projection in relation to the therapist. She had unconscious anxiety in relating to him and this was for a variety of reasons, as reviewed. To summarise, she had unconscious anxiety generated by her murderous impulse. In addition, she had projective anxiety simply because she saw him as her grandmother; and this omnipotent, authoritative, and sometimes explosive figure frequently induced anxiety in her as a small child.

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Medium 9781780490038

8. Changing conversations

Karnac Books ePub

David Fourmy

When new territories of therapeutic conversation are being entered into, it can take considerable time to become familiar with such territories and to become proficient in the skills associated with these explorations. The key is practice, practice and more practice … the expressions of life that seem most spontaneous to us are those that we have had the most practice in.

Michael White (2007, p. 6)

This chapter focuses on the experience of a local multi-agency team established in anticipation of government legislation aimed at achieving better outcomes for children and young people by ensuring all organizations and practitioners providing services to children, such as schools, social workers, and health professionals, worked together in a more effective way. During the implementation and evaluation stages, the author was in the role of project coordinator. Hopefully what was learnt over the life of the project can be of value to practitioners working together in other settings.

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Medium 9781855756052

APPENDIX: Outline of concepts related to unethical behavior

Catlett, Joyce; Firestone, Robert W. Karnac Books ePub

I.   Causal factors:

1.   Genetic predisposition (difficult or impossible to alter)

2.   Childhood emotional pain (due to separation experiences, losses, and faulty parenting)

3.   Existential issues (aloneness, sickness and death)

II.   These factors lead to defense formation:

1.   The fantasy bond

The fantasy bond is a primary defense that is utilized in an attempt to cope with and allay emotional pain and stress, separation anxiety and death fears. The degree to which it is relied upon is proportional to the degree of frustration, emotional pain, and deprivation experienced during one's developmental years.

The fantasy bond is an illusion of connection to another person, persons or institutions—a merged identity with another individual, a family, a neighborhood, a nation, a political cause, a philosophy, or a religious belief. It supports a pseudoindependent attitude—an inward self-parenting process that precludes closeness or intimacy and fosters attitudes of superiority that lead to animosity and aggression toward other people, belief systems or entities that are different.

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Medium 9781855754546

Chapter Six - “Father” and son: Prince Hal and Falstaff

Jacobs, Michael Karnac Books ePub


“Father” and son: Prince Hal and Falstaff

While psychoanalytic writing has turned its attention many times to Shakespeare's plays, the history plays do not feature very obviously in the bibliographies of books, articles, and papers on characters and themes in the plays. The exceptions are Henry IV and the two Richards (II and III), although even in these instances the references are few. Perhaps that is because the history plays at first appear more a series tracing the dynastic struggles leading up to the Tudor monarchs.

The same relative paucity of interest applies also to the plays in performance. There are from time to time performances of the histories in sequence, and at one time Henry V attracted patriotic attention. But one of the more popular of the history plays remains Henry IV Part 1, perhaps for two reasons. The first is the inclusion in the cast of characters of Sir John Falstaff—a figure almost larger than life. Yet Sir John also appears in Henry IV Part 2, and in half the scenes. Nevertheless, Part 2 is performed less frequently and appears to have had less success even when it was written. The other ingredient that turns Part 1's dramatic history into a historical drama is the theme that runs through it of pretence, or of role-playing, even what the latest editor of the Arden edition calls “counterfeiting”. This is a reference in part to the motif of coinage that is a constant feature of the language of the play; but, even more so, counterfeiting refers to the fact that Henry IV has usurped the throne, that his son Prince Hal appears to deliberately associate with low life in order to appear all the grander when he becomes King and rises above it, as well as the pretence of Falstaff at the concluding battle of Shrewsbury.

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Medium 9781855754034

7. The new, the now and the nowhere in Kalsched's archetypal self-care system

Karnac Books ePub

M.D.A. Sinason and A.M. Cone-Farran

In this chapter the authors explore their experience of reading Donald Kalsched's book "The Inner World of Trauma: Archetypal Defenses of the Personal Spirit” (Kalsched, 1996) and also examine one of his subsequent papers "Archetypal affect, anxiety and defence in patients who have suffered early trauma” (Kalsched, 1998). In these works he describes an internal autonomous agency that can take over a patient's decision making and actions. This experience can be very disturbing and is often seen by the patient as damaging to self or others. However, Kalsched makes the case for it not being destructive in its aims. He considers its origins to arise from a reaction to severe childhood deprivation or trauma and to be aimed at survival. In the view of the authors, patients in other diagnostic groups can also experience the undermining of their own self agency. A different explanation of the experience will therefore be offered that addresses the much wider ramifications of it across the diagnostic spectrum.

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Medium 9781780491967

Chapter Six: Assisted Reproduction as Explored in the Kids are all Right

Karnac Books ePub

Katherine MacVicar

The Kids Are All Right is a well-received film that deals in a comedic way with many of the difficulties faced by families that have conceived children through assisted reproduction. In this case, the parents are lesbian and the children have been conceived by artificial insemination, each woman in the couple having used the same donor so that the children are half-siblings. The pregnancies have been routine; the children are not regarded as fragile or as miracle children, but everyone is aware of the special status of having two mothers and no father. The children, two attractive teenagers, refer to their parents as “the two mums”. There is a feeling in the film that the family is on display, and that the audience and the world are watching to see how the children fare. The mothers are eager to prove themselves, and do encourage the children to perform well, but it is moderated by the obvious loving commitment they have to them. The children have been informed, presumably in much earlier childhood, about the fact of a father, but have never met him. The audience is not told about male relatives or friends in the children's lives, but we presume that in this intelligent and sophisticated family, there have been some. What is portrayed is a normal caring family, but one that lacks a biological father. It is also one in which the parental couple has a sexuality that is given prominence in the film but that has complicated meanings to the children.

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Medium 9781904658344

Analysing Three-Card Combinations

Chapman, Catherine; Hughes-Barlow, Paul Aeon Books ePub


In the previous section we looked how the elements interacted when there were two cards, using Pairing. Now it is time to look at how the elements interact when there are three cards. With this knowledge we can analyse each card relative to its neighbours.


Fire and Water are enemies, so they fight and weaken each other.


Air and Earth are mutual enemies, like Fire and Water, but the effect is very different.

In the next two examples Synthesis triumphs as Thesis and Antithesis go to war.


These two elements are both active and friendly to each other, so the problems arise from the lack of basis (Earth) or feeling (Water), in which case there will be little comfort or security in the experience. While Air will provide intelligence to actions, there will be over-exuberance at the least, and obsessive behaviour at worst. The results will either be burn-out or some kind of confrontation. Since Air is such an antagonistic and divisive element, the differences between Thesis and Antithesis are heightened, even when they are friendly or of the same element. In some of the examples below, we see an unholy alliance developing.

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