Search

abstract Isabel Menzies Lyth's seminal paper on social systems as a defence against anxiety is so well known and frequently cited that it risks acquiring mythic or legendary status. But what explains its phenomenal influence? In this contribution I suggest that it is a model example of the psychoanalytic case study, deriving its power from a deep engagement with organizational particularities as a basis for general theorizing. Its continued influence depends upon the way in which it is used to conceptualize new organizational experiences. An example from an institutional observation undertaken as part of an advanced social work training at the Tavistock illustrates this. Institutional observation is one of a range of non-clinical psychoanalytically informed methods of training at the Tavistock, and in the final part of the paper I discuss new applications of Menzies Lyth's work that aim to illuminate the irrational forces shaping modern social policy. Death and anxieties about death emerge as a subtext of the present paper, perhaps reflecting the fact that it was prepared as part of a memorial conference to Menzies Lyth herself, and also that the paper taught us to think better about death as an aspect of organizational experience. [ABSTRACT FROM AUTHOR]

This paper considers education in the context of life‐threatening illness from a psychoanalytic perspective and is an edited and shortened version of a dissertation written for a Master's Degree in Psychoanalytic Observational Studies. Informed by the Work Discussion module, this paper uses observational material of a single case study during the author's time working as a learning mentor in a hospital school. The case study, with its participant observation method, considers the complexity of engaging a 4‐year‐old girl in learning while she undergoes treatment for cancer. The defences this child used against anxiety, such as a muscular rigidity as a form of protection against the trauma she was experiencing, will be explored. The author also suggests that with the consistent daily presence and available mind of the observer/mentor, who was able to think about Poppy's experience, the child began to let go of her 'second‐skin' defences and showed the beginnings of an interest in learning. The way in which the staff group struggle to manage the intense anxieties stirred up by their everyday work will also be discussed. [ABSTRACT FROM AUTHOR]

James Strachey published his seminal paper on the nature of therapeutic action in 1934 in which he introduced his ideas on the mutative interpretation. He saw interpretation as the cornerstone of the psychoanalytic method. Since then, there has been a great deal of work looking at the essential nature of the interpretation and how it can promote change. By the1960s, Loewald and others were discussing how interpretation needed to incorporate new psychoanalytic thinking, particularly in the area of object relations. As the intersubjectivity of the psychoanalytic encounter gained more prominence, the use of the structural interpretation decreased. The author suggests that there is still need for further work on how interpretation can promote change. Using theoretical ideas and clinical examples, the paper concludes that the mutative interpretation continues to offer something potentially transformative, but that the technique has to take account of relational aspects of the treatment and the developmental issues of the patient. However, the clinician's relationship with the ideas about a mutative interpretation can also affect the clinician's ability to use it to a therapeutic effect. [ABSTRACT FROM AUTHOR]

In this interview by email, Ann Scott, Editor‐in‐Chief of the British Journal of Psychotherapy from 2009 to 2022, is in conversation with Brett Kahr, responding to questions put to her by him and the Journal's Editorial Board. The interview focuses on Scott's background and its influence on her work; her early role at Free Association Books and her role as Deputy Editor of the BJP. She identifies papers from the Journal, on her watch as Editor‐in‐Chief, that have resonated particularly powerfully for her, commenting that all convey a sense of urgency and immediacy. She is asked to comment on the relationship between clinical and research approaches; current debates about informed consent; the Journal's title; the impact of online as well as print publication; whether published topics have changed over time; and the Journal's international standing. She describes the editorial principles that have governed her approach to the editorship, drawing on work by Britton, Turquet, Rey and Gabbard. She comments on some challenges she has faced as an editor, and shares the highlights of her tenure. Lastly, she is asked whether the editorship has impacted on her clinical practice, whether she has any regrets, and how she would like to be remembered in relation to her editorial work. [ABSTRACT FROM AUTHOR]

The importance of working with the parents in a collaborative way when undertaking a therapy with a young child is demonstrated. This paper illustrates the depth and the different quality of the work when both the child and the parents are helped simultaneously. The paper illustrates the movement in the parents' thinking from just reacting to the child's behaviour as 'being difficult' to being able to think about the behaviour in terms of it 'having meaning' in which the child is conveying a feeling through her behaviour. As well as showing the parents' psychological development, the clinical example describes the child's more age appropriate developmental progress. More specifically, it shows how the child was able to relinquish her omnipotent behaviours of 'always being in charge' in favour of relying on parents who were psychologically more available to her. Observations show how, as they realized their child's behaviour wasn't simply designed to persecute them, the parents were jointly able to create 'the cradle of concern' to care for her. As the therapy progressed there was a diminution of unhelpful transgenerational family patterns. [ABSTRACT FROM AUTHOR]

This paper describes the process of couple therapy with two couples that used blame as the currency of exchange in their relationship. Both couples struggled with managing three‐person relationships. The triangular setting of couple psychotherapy provoked and triggered primitive anxieties around exclusion, rejection and abandonment in both cases. I draw upon clinical work with two such couples to illustrate how one repeatedly collapsed the triangular space whereas the other gradually became more able to bear it. I refer to scientific evidence of the brain's ability to continue to change in response to new learning by forming fresh neural connections throughout life. I suggest that the repetitive occurrence of new experiences within couple psychotherapy can generate new neural pathways thereby biologically influencing new ways of how partners might respond to each other. I conclude by highlighting the therapeutic potential of the framework within which couple psychotherapy takes place, a triangular configuration which offers a developmental opportunity for navigating primitive anxieties related to triangular relationships. [ABSTRACT FROM AUTHOR]

Deciphering the way patients experience time provides an additional key to primitive mental areas which do not express themselves in the usual verbal or symbolic ways and can help us and our patients better understand these deep layers of the psyche. It is when the issue of time moves to the centre of experience as a separate and predominant aspect of existence, that there and then occurs a disturbance in our continuous and natural transition between various temporalities, one that often exposes an inner rupture, many times of a very early origin. The paper first focuses on a number of art works which portray attempts to deal with death anxiety by capturing the moment, or watching, controlling, organizing, cataloguing the movement of time as though such attempts could freeze time and make it endlessly prolongued. Second, theoretical aspects and clinical vignettes focus on understanding the experience of time as fractured and fragmented; on experiences of timelessness, and, on stereotypical, ritualistic, autistic-like relations to time, perceived as frozen still. In addition, conceptualizing the analyst/writer's experience of time in the presence of her patients provided a unique tool for expanding the understanding of the patients' internal world. [ABSTRACT FROM AUTHOR]

The paper describes and discusses some aspects of the countertransference in relation to two patients whose state of mind could be described as psychotic during treatment. The clinical work took place in the context of a private psychotherapy practice, but some aspects of the countertransference became evident in relation to external, but related figures connected with the treatment. It was not until the treatment with both patients had ended, and the author had done a considerable amount of work on her own processes, that she was able to acknowledge, think about, and eventually write about, the ways in which the two patients had impacted upon her own psyche. In order to achieve this aim of understanding, the author undertook a research degree at MA level as the frame in which to study psychotic processes in more depth, along with studying the transference and the countertransference. As she worked upon her degree thesis she became more aware of, and less embarrassed about, the countertransferential processes that taken place. The paper makes particular use of Stephen Purcell's contributions to identifying the countertransference and Harold Searles's work with psychotic patients. [ABSTRACT FROM AUTHOR]

abstract In this contribution I describe Isabel's approach to editing her papers for publication. I consider the 'unanxiety' that allowed for a constructive relationship to her work on her papers, and coexisted with her well-known dislike of writing. I go on to consider possible reasons for the dislike, including Isabel's longstanding preoccupation with the issue of how to translate the language of psychoanalysis into terms that could be meaningful to the organizations she was working with. I suggest that Isabel felt that the face-to-face encounter was needed to achieve this, and illustrate this with an example from a piece of consultancy at the Cassel Hospital that she undertook, which I observed. It is hoped that work on her literary archive, just beginning, will shed further light on these issues. [ABSTRACT FROM AUTHOR]

abstract In this paper the author describes two separate experiences of working with Isabel Menzies Lyth, first between 1987-1988 and then from 2002-2005. She recollects Isabel's seminal role as staff group facilitator on a long-term rehabilitation ward at Littlemore Hospital, the McKnight Unit, where the author worked as a nursing assistant. She describes how Isabel's insights and interpretations in that group introduced the staff to a new way of thinking, and shed light on complex ethical and clinical dilemmas. She discusses the powerful, sometimes surprising, impact of Isabel's psychoanalytic understanding of psychosis, and of the anxieties that the staff team faced in this work. She then describes the experience of fortnightly supervision with Isabel, some 15 years later, when the author had qualified as a clinical psychologist and was working in a forensic unit with mentally ill offender patients. The paper is a personal recollection of Isabel's enduring insights and a description of her keen intellect, sensitivity and compassion in practice. [ABSTRACT FROM AUTHOR]

Much demonology has grown up round the acronym IAPT. This paper considers the current state of its effect on the discipline in which we practise. The paper sets out the current landscape and begins to address the implications for those who are practising models of psychotherapy other than the cognitive–behavioural model. The outlook may not be a disaster but we need to heed the warnings and gather our thoughts so that we can ensure not only the continued existence of our model but its continued availability for those who need us. [ABSTRACT FROM AUTHOR]

The first half of this paper reconsiders the therapeutic work with a patient who had a troubled relationship with her older sister ( Coles 1998 ). In particular I explore the conflictual sibling transference and the countertransference anxieties I faced. In the second half of the paper I speculate about transgenerational conflicts between sisters and suggest that the patient's conflict with her sister, and her sense of lost identity when her sister died, may be linked to her mother's relationship with an older sister. I draw on literary sources which also illustrate the impact of sibling relationships. [ABSTRACT FROM AUTHOR]

In this paper the writer explores the work with a couple whom she came to think of psychically like Siamese twins, stuck together in order to survive and lacking separate psychic entities with intact coverings. Such a covering is something that we take for granted and which implies that each of us is a separate individual. However, this paper draws attention to the way that some individuals, who have not developed a robust enough sense of identity, might seek a desperate solution, by partnering with someone who shares their dilemma. Being ‘stuck’ together can help stave off intolerable anxieties but tends to raise claustrophobic anxieties. The paper investigates how the underlying anxieties are primitive and serious, and the terrors which are being defended against are often in the area of suicide or breakdown so that, although couple therapy can help to loosen this deadly structure, a more containing intensive individual treatment is likely to be necessary to support the process of individuation. [ABSTRACT FROM AUTHOR]

In Casale Monferrato, asbestos exposure has been a traumatic occurrence that has caused cancer and death among the town's inhabitants, resulting in the loss of trust and hope with regard to the future and the loss of healthy aspects of the self. This traumatic history has been denied for many years - part of an 'out of sight, out of mind' attitude that is often justified by financial interests. When traumatization is due to the careless behaviour of the owners of the major economic resources in a community, group identity is deeply affected. In such a situation, psychoanalytic group therapy seems to be the best means to historicize the event and create multiple narratives of somatopsychic suffering. In this paper, we present the experience of the first multifamily group in Casale Monferrato, focusing on the possibility of 'diluting' transference- and countertransference-related feelings of helplessness, thereby making them more bearable and thinkable. Sharing the meaning of the trauma also highlighted vital aspects in the functioning of the mind of the group, leading to a new and more mature way of facing illness and death. [ABSTRACT FROM AUTHOR]

In this paper the author considers the relationship between anxiety, symptoms and containment. She notes that the securest of us feel what we can call mature anxiety. Physically, it is different from immature, pathological anxiety where development of a part or parts of the self has been arrested. Immature, pathological anxiety, which is encountered and treated in the consulting room, brings with it the bodily upset that is seen in anxiety. In the author's experience what we struggle with nowadays is far more likely to be variants of what we have come rather vaguely to call personality disorder. In this situation the anxiety, though intense, is diffused through the self, finding its fateful and addictive manifestations in relationships and their failure, identity problems, inability to work and the sequelae of that, pathological indecision, rage and a general, miserable dissatisfaction with life and what it offers. But anxiety remains central all the time. To provide a frame for some of these thoughts, the author considers Dickens's A Tale of Two Cities. The character of Dr Manette provides an example of the symptomatic personality, and the character of Sidney Carton of the much more modern, personality-disordered individual. [ABSTRACT FROM AUTHOR]

abstract This paper examines ethical dilemmas confronting the analytic practitioner working in student counselling in higher education. The author explores the institutional ambivalence that a university counselling service may evoke, especially at times of reduced resources and survival anxiety. Challenging aspects of the practitioner's work include the difficulty of responding to increased levels of psychological disturbance amongst students in the face of a reduction of time resources. The impact of time constraints is illustrated in a number of harrowing case examples, showing how expectations of psychological help for vulnerable students may not be possible to meet. The ethical basis for raising such expectations is brought into question. [ABSTRACT FROM AUTHOR]

abstract Disclosures about the extent of sexual abuse within the church context and the gradual revealing of the way that the institution has responded in the past indicate underlying anxiety and associated defensive processes. It is suggested in this paper that these processes have led to secrecy and deception. Similarities between the behaviour of perpetrators and the response by the church are explored alongside current preoccupations within the church. Psychoanalytic ideas and theories of organizational dynamics are used to explore and reflect on the fantasies and explicit and implicit assumptions within the institution. It is suggested that the church has displayed institutional narcissism in its response to disclosures. Ideas are illustrated by generic situations. [ABSTRACT FROM AUTHOR]

abstract The Labour government's response to the ) report was to implement the 'Improving Access to Psychological Therapies' (IAPT) programme within Primary Care Trusts in the NHS. In this paper, I argue that the IAPT programme's explicit commitment to 'well-being work' risks distorting the unconscious anxiety-containing function that society traditionally allocates to mental health practitioners. Drawing on the social defence paradigm of ) and later work by ), I use an organizational case example to explore some of the unconscious dynamics within an IAPT service and explore how mechanisms such as defensive splitting and projective identification within the multidisciplinary team result in psychotherapists coming to represent an unwanted, vulnerable and expendable aspect of the service. I contend that psychotherapists may serve an important function as unconscious ambassadors of a split-off affective aspect of IAPT primary care mental health services, and that as such they will urgently need to ensure they do not succumb to burnout or unhelpful ways of working and relating within the team. [ABSTRACT FROM AUTHOR]

abstract This paper argues, with examples which include the nuclear arms race and climate change, that the most valuable psychoanalytic insights into political questions are likely to be counter-intuitive, since they will draw attention to unconscious states of mind which resist recognition. [ABSTRACT FROM AUTHOR]

In this paper the author describes clinical work with forensic and anti-social personality disordered patients where the clinician is placed in a countertransference situation where, in the course of what is good therapeutic work, he experiences an overwhelming sense of having failed the patient. The author utilizes Glasser's idea of ‘identification with the neglector’ and Hinshelwood's writings on patients with disordered relations to care, to examine this experience, and he differentiates it from the concept of ‘identification with the aggressor’. Two clinical illustrations are used to highlight the issues discussed and show how with this patient group much of the clinical work is done in the countertransference. [ABSTRACT FROM AUTHOR]

This paper highlights three important combined subjects in Estela Welldon's theory: perversion and depression, perversion and anxiety and perversion and motherhood. The underlying argument is that annihilation anxiety is central for the pervert and not castration anxiety. This annihilation anxiety goes back to a particular relationship between mother and child, which explains at the same time the ever-present threat of depression. [ABSTRACT FROM AUTHOR]

The absence of frameworks for discussion of social class issues within psychotherapy is one concern of this exploratory paper. Another is to raise questions about how we might think psychoanalytically about the far-reaching impact of class. A small exploratory qualitative research study is described in which experienced psychoanalytic psychotherapists were interviewed about class issues. The interviews mainly concerned their perceptions and understandings of class issues within psychotherapeutic relationships, but were framed by biographical and professional experiences relating to class. The reports from pairings of differently classed therapists and patients raised many questions about the ways in which class and class differences can be experienced and understood within the transference/countertransference matrix, as well as the surrounding anxieties and projections. [ABSTRACT FROM AUTHOR]

The paper explores two literary texts - Dostoevsky's novel Crime and Punishment and Euripides' play Bacchae - from the point of view of immature masculinity and the catastrophe that can follow if the boy fails to achieve a genuine separation from the maternal object. The author examines the masculine anxieties and defences that arise when the boy fails to work through the Oedipus complex and instead retreats to a dyadic relation with mother which excludes the father. This retreat involves a denial of reality and the creation of a paranoid world in which his own wishes to take possession of mother can be experienced by him as an intrusion by the mother into his own masculine identity and ultimately as castration by the mother. Attempts to resolve this threat to masculinity include the use of anal defences and tyrannical states of mind in the creation of a pseudo-masculinity. [ABSTRACT FROM AUTHOR]

The term transvestism is mistakenly applied to describe all categories of cross-dressing. This leads to theoretical and clinical confusion, as men who cross dress share some common features but differ greatly in regards to their aims and intentions. The aim of this paper is to provide an understanding of the formation and development of transvestism that extends beyond the classical psychoanalytic explanation of castration anxiety. Today, more emphasis is placed on anxieties emanating from the early symbiotic relationship with the mother, the formation of the sense of self and unresolved separation anxiety. Insights gained from clinical work with transvestites can enhance our understanding of the construction of masculinity and the male's greater gender conflicts and sexual insecurities. Also, the study of the homosexual fantasies or intense homophobia experienced by some fetishistic cross-dressers relate more to gender issues and conflicts than sexual orientation. [ABSTRACT FROM AUTHOR]

Prompted by the surprising reaction of a young man with a borderline personality to an interpretation of castration anxiety, this paper sets out to explore some of the unconscious determinants of tattooing and piercing. Recognizing that such acts can have an initiatory function, sociological, anthropological and psychoanalytic views of initiation and the role of the father in masculine development are examined. In some boys oedipal development is forestalled and castration anxiety is not experienced. A bifocal approach using object relations theories based on regression and Lacanian perspectives that highlight reactions to an oedipal impasse is used to understand these processes. Symbolic body modifications are differentiated from those that are non-symbolic. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various topics within the paper "Anxiety, Symptoms and Containment," by Bernardine Bishop published in the journal.