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Chapter Three: Acting Out, the Repetition Compulsion, and Forensic Group Therapy

Williams, Andrew Karnac Books ePub

Andrew Williams

Working psychotherapeutically with patients who express their disturbance predominantly through action requires a careful consideration of the meaning behind behaviour. Understanding the significance of a particular form of sexualised or violent behaviour can provide a sense of relief to patients, offering meaning to a pattern of behaviour which might have previously been experienced by the individual as senseless, repetitive, and compulsive. For many patients starting in group treatment, starting to make links between their history, their current situation, and their particular form of acting out conveys a sense that behaviour can be understood, and, thus, some control gained: knowledge is, indeed, power.

Anna Freud, in her 1968 paper “Acting out”, differentiated between the acting out which occurs in neurotic patients and that which occurs in patients who tend to act out in their daily lives before coming into treatment (e.g., those suffering with perversions, psychosis, or addiction). She stated that for patients suffering with neurotic symptoms, the analytic setting provides a forum in which, through the use of free association and the analytic technique, the id pushes with increasing force against the ego. Acting out in this case represents an expression through action of a repressed memory, impulse, or wish, the therapeutic task being to develop an understanding of the repressed material as the acting out occurs within the transference relationship. In patients who act out before coming into treatment, however, the task is different. These patients tend to behave in more impulsive ways, whether in treatment or not, and action has long been used as a way of avoiding thinking. Thus, the aim is to enable the patient to move their form of acting out into the transference relationship so that it can be properly understood (Freud, A., 1968). For the perverse or violent patient, it is the movement of acting out into the forum of the group setting that presents an opportunity for understanding and lasting change.

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Medium 9780946439546

8. Psychotic moments, thinking and reasoning

Otto Weininger Karnac Books ePub

On this particular day Glen, the three-year-old boy described in chapter six, was tired and had not seen his mother, who had been away at a seminar for most of the day. At dinner he first said that he did not want anything, but when his mother offered him some food, he accepted it and began to eat. He ate heartily for about 20 minutes and then asked his mother to lift him out of his high-chair and put him on the floor. When someone else offered to do this, Glen made a sour face and grunted, ‘No.’ Only his mother was allowed to put him on the floor. As he went into another part of the kitchen, he noticed a spoon on the countertop and tried to get it. Finding it was out of his reach, he immediately began to scream and kick his feet on the floor. But it was the look on his face that struck me as the most arresting feature of Glen’s tantrum. Whereas previously he had been smiling or looking attentively, his face was now distorted, his eyes became slits, his lips were stretched across his teeth, his nose was wrinkled up, and his forehead was taut. He looked wild, in keeping with the anger he was expressing. Anyone other than his mother offering to help him was rejected with further exaggerations of his tantrum. If anyone, including his mother, spoke to him, he screamed loudly and put his hands to his ears as if the voices were hurting him.

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Medium 9781855750081

CHAPTER SIX: Counter transference

Christopher Dare Karnac Books ePub

In chapters three, four, and five we have discussed the treatment alliance and transference, concepts that have been used in connection with aspects of the relationship between the patient and therapist. These two clinical concepts originated within the psychoanalytic treatment situation, and we have indicated some possibilities of extension outside it. Both concepts emphasize processes occurring within the patient and tend to stress one side of the relationship only. Even the concept of treatment alliance, although nominally appearing to include the roles of both patient and therapist, has tended to be regarded from the point of view of processes and attitudes within the patient. However, there has been some change in this regard, particularly since the 1970s, in that the therapist’s attitudes, feelings, and professional stance have increasingly been taken into account.

Just as the term ‘transference’ is often used loosely as a synonym for the totality of the patient’s relation to his therapist, so the term ‘countertransference’ is often employed in a general sense (both within psychoanalysis and outside it) to describe all the therapist’s feelings and attitudes towards his patient, even to indicate facets of ordinary non-therapeutic relationships (Kemper, 1966). Such a usage is very different from what was originally intended, and, as a consequence, confusion has arisen about the precise meaning of the term which was first used by Freud (1910d) in discussing the future prospects of psychoanalysis. He said of the psychoanalyst: ‘We have become aware of the “counter-transference”, which arises in him as a result of the patient’s influence on his unconscious feelings, and we are almost inclined to insist that he shall recognize this counter-transference in himself and overcome it … no psychoanalyst goes further than his own complexes and internal resistances permit/

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Medium 9781780490823

Chapter Ten: Why read Fairbairn?

Graham S Clarke Karnac Books ePub

Thomas H. Ogden

I have found that Fairbairn develops a model of the mind that incorporates into its very structure a conceptualisation of early psychic development that is not found in the writing of any other major twentieth century analytic theorist.1 Fairbairn replaces Freud's (1923b) structural model/metaphor of the mind with a model/metaphor in which the mind is conceived of as an “inner world” (Fairbairn, 1943a, p. 67) in which split-off and repressed parts of the self enter into stable, yet potentially alterable, object relationships with one another. The “cast of characters” (i.e., sub-organisations of the personality) constituting Fairbairn's internal object world is larger than the triumvirate of Freud's structural model and provides what I find to be a richer set of metaphors with which to understand (1) certain types of human dilemmas, particularly those based on the fear that one's love is destructive; and (2) the central role played by feelings of resentment, contempt, disillusionment and addictive “love” in structuring the unconscious mind.

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Medium 9781780491271

8th May 1915 Brussels Russell

Lorraine Bateman Karnac Books ePub

Russell was interrupted midway through the morning by Hugh who, flustered, had rushed into the office.

“They've sunk the Lusitania. We might as well start to pack. We'll be in this war by the end of the month.”

“What, what do you mean? What's happened?” Russell asked.

“Torpedoed. She was on her way from America, had reached close to the coast of Ireland when she was sunk by a German submarine. There were hundreds on board, women and children too.”

“What a murderous thing to do. No doubt the Germans will have their defence ready. They'll say there were soldiers or munitions on board,” Russell said.

“Yes, it was always a risky endeavour to travel on her. Passengers had been warned, but I guess some just wouldn't be deterred. But I'm sure no one imagined this would happen. Over 100 people have been lost,” Hugh declared.

“What will we do? Was she under our flag?”

“Yes, and that's what we'll have to wait and see. The wires are buzzing.”

“But we've so much to do here, we can't up and leave.”

“Business as usual until we receive any instruction, and not a word about our potential departure, to anyone.” Hugh tapped the side of his nose twice, and he left the room.

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