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CHAPTER FOUR Speak no evil: the role of creative therapies in working with severe disability

Corbett, Alan Karnac Books PDF


Speak no evil: the role of creative therapies in working with severe disability


he sexual abuse of others is the enactment of pathological depressions and anxieties that the perpetrator has been unable to put into language. Forensic psychotherapy is concerned with putting speakable words to unspeakable actions, to allow patients relief from inflicting the agonising narrative of their life onto others. While we tend to think of psychotherapy as primarily a talking treatment, there is a growing evidence base for its more creative methodologies in the forensic world, including art therapies (Smeijsters & Cleven, 2006).

Most people with intellectual disabilities, even at the mild or moderate end of the spectrum, encounter difficulties with verbal communication

(Iacono & Johnson, 2004), including speech that is hard to understand, problems in understanding what is said, and difficulties in expressing themselves because of limited vocabulary and sentence formulation skills. How much should this matter in the consulting room, given the traditional privileging of psychotherapy as the “talking cure”?

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12. To know or not to know—or how do we know that we know?

Karnac Books ePub

Vigdis Wie Torsteinsson

T3he paraphrase, in the chapter title, of one of the most famous quotations in world literature is a living example of the fact that this is not only a “modern” problem. Throughout the entire drama, Hamlet is preoccupied, even engrossed, in the question of how one can have true and certain knowledge about others. In one of the scenes we meet the king and the queen, Hamlet’s stepfather and mother, who are worried because Hamlet is still grieving over the loss of his father. The queen asks:

If it be, Why seems it so particular with thee?

Hamlet: Seems, madam! Nay, it is; I know not “seems.”
Tis not alone my inky cloak, good mother,
Nor customary suits of solemn black,
Nor windy suspiration of forc’d breath,
No, nor the fruitful river in the eye,
Nor the dejected liaviour of the visage,
Together with all forms, moods, shapes of grief,
That can denote me truly. These, indeed, seem,
For they are actions that a man might play

[Act I, ii: 74-84]

This short passage can be read as a comment on one of the constantly recurring questions about the nature of knowledge. Is it sufficient to observe the exterior characteristics of a person’s conduct, the observable dimensions that are accessible to all, or must we take into account something that can be called “an interior”, something that is only accessible from the “inside” of a person’s consciousness or body? Hamlet expresses here his understanding of what is needed to have a true and certain knowledge of others— for him, the inner, subjectively experienced world is the only reality. And tliis is a position easily recognized by therapists.

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Chapter Nine - Crossing the Border Within: Migration, Transience, and Analytic Identity

Karnac Books ePub

Gabriel Ruiz

Then—in my childhood—in the dawn/Of a most stormy life—was drawn/
From ev'ry depth of good and ill/The mystery which binds me still—

—Edgar Allan Poe, Alone

Becoming a psychoanalyst brings forth an ongoing elaboration in one's developing identity. This expansion of one's internal dimensions inevitably includes aspects of culture (Akhtar, 1999). Yet when our inscape is met with the amalgamation of two or more distinct cultures, one's analytic identity stretches the boundaries of this transformation to compelling depths (Akhtar, 2006). Throughout my analytic training I often wondered how my Mexican is weaved into my American as a psychoanalyst? My own analysis and training, as was most of my supervision, were conducted in English, my second language. Where does the migrant farm experience of mine reside? Where does this childhood experience of going from farm to farm, US to Mexico and back migrations resound?

It is not only in the “Mexico” or “US” experience that my analytic identity develops from. I find it arises out of my internalized experience of traveling between the two countries. Actual and internal experiences of transitioning between “Mexican” and “American” culture grounds my ongoing analytic understanding of my patients. In essence, this “to and fro,” is the deepest signifier of my ongoing self-definition as an analyst.

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1. Seduction

Smith, David L. Karnac Books ePub

Science does not rest upon solid bedrock. The bold structure of its theories rises, as it were, above a swamp.


Although the communicative approach is a relatively recent development within psychoanalysis, important stands of communicative theory were prefigured in some of Freud’s earliest work on unconscious mental processes. This aspect of Freud’s early work is not widely known. It was not incorporated into Freud’s later psychoanalytic theorizing. Indeed, there is no reference to this aspect of his work in any of Freud’s accounts of the origins of psychoanalysis in spite of the fact that it played a major role in his self-analysis and played an important role in Freud’s thinking during the late 1890s.

Between the years 1896 and 1899 Freud wrestled with fundamental theoretical issues which were to determine the substance and subsequent course of development of classical psychoanalysis and its offshoots. After his initial collaboration with Breuer, Freud had gone on to advance, in 1896, his highly unpopular seduction theory of psycho-neurosis. This theory stated that hysterical symptoms were caused by unconscious memories of childhood sexual traumas - ‘seductions’ by adults or older children. Little more than a year later, in September 1897, Freud began seriously to question the validity of this proposition, and during the closing years of the nineteenth century he gradually came to replace the seduction,theory with the idea that hysterical symptoms were caused by repressed infantile sexual phantasies rather than memories of real experiences. The theory based on the purported causal role of wishful infantile phantasies became a cornerstone of psychoanalytic theory.

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6. The Role of Unmentalized Experience in the Etiology and Treatment of Psychosomatic Asthma

Judith L. Mitrani Karnac Books ePub

The psyche and the soma are not to be distinguished except according to the direction from which one is looking.

[D. W. Winnicott, Through Paediatrics to Psychoanalysis]

The creation of modern psychosomatic medicine as an integrated discipline dealing with the psychological concomitants of physical maladies, the study of psychological reactions subsequent to organic illness, and the interaction between psyche and soma in the production of disease is historically bound to psychoanalysis. Early on in his formulation of the libido theory, Freud appeared cognizant of the profound effects of the soma upon the psyche. He proposed that the life force itself was derived from bodily functions and demonstrated their significant impact upon mental life (1895b,c). Freud’s contribution of the two models of the pathogenesis of bodily symptoms (those seen in conversion hysteria and the “actual” neuroses) was significant in the early development of psychosomatic theory and has remained both the basis for and the problem of psychosomatic research for over half a century.

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