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National research studies report elevated suicide rates amongst gay men, particularly those under the age of 26. Much of the current health and psychiatric literature on suicide tends to focus on the external world impacting on the suicidal individual. Although valuable, it is not enough to understand the specific circumstances that could contribute to gay men's suicidality. This paper focuses on the relationship between the external and internal dynamics at play in the suicidality of gay men, with particular emphasis on the development, influences, and nature of a cruel and punishing superego. The author provides some contemporary psychoanalytic theories on same‐sex desire as a useful framework to understand minority sexuality. Some influential classic and contemporary psychoanalytic theories regarding suicidality and the development and character of a cruel and punishing superego are presented. The concept of internalized homophobia and the impact of heteronormative masculinity on the gay man's psyche are explored as drivers for suicidality. A composite case study from clinical experience with suicidal gay men in an NHS setting is presented to illuminate the discussion. This paper could add new perspectives and important dialogue for psychoanalytic psychotherapists working with this patient population. [ABSTRACT FROM AUTHOR]

Psychosis can be understood as, in part, a disorder of the self. The various factors that contribute to the development of psychosis and the consequences of psychotic symptoms potentially impede the development of the patient's subjectivity, and can lead to a complete breakdown of the patient's ability to accurately represent their subjective experiences. The development of paranoid delusions partially functions to compensate for the patient's inability to make sense of their subjective experiences in relation to an acknowledged other, in this case the psychotherapist. When the patient confronts the psychotherapist with their paranoid delusion and implicates the psychotherapist as a dangerous object, the psychotherapist is potentially exposed to a complex and disturbing dynamic where their own subjectivity may be drawn into question. This paper aims to explore the psychotherapist's experiences of this dynamic in a clinical setting by making use of a composite narrative of a psychotic patient with paranoid delusions that implicate the psychotherapist. The psychotherapist's experiences are discussed via the following three themes: constructing the patient's subjectivity; the psychotherapist's use of their own experiences; and holding the balance between opposing realities. [ABSTRACT FROM AUTHOR]

In a 2013 paper, Udo Hock (p. 942) attempted to give a balanced synthesis of the current state of a major French debate - with Laurence Kahn as one of the key participants - for an international audience. Since we are then all set to flounder in relativity, this, Kahn suspects, will be well suited to an approach in which the psychoanalyst and the patient are co-equals in a shared postmodern quest for meaning (p. 9). Kahn is not slow to indict this development as a betrayal of psychoanalysis as conceived by Freud, and applies herself to trace the various historical waves of rendering psychoanalysis more consonant with contemporary thinking styles. [Extracted from the article]

According to French psychoanalyst Jacques Lacan, psychosis is marked by a non‐separation of the object a. Consequently, transference in psychosis remains at the level of duality and appears to have an inverted form, where it is the Other that looks for something in the patient and not vice versa. This makes the handling of transference challenging since there is no triangular structure that can mediate between the patient and the Other. The patient cannot rely on the Other to deal with difficult experiences of jouissance (marked by excess and senselessness). In this paper, we discuss our work with a patient following the logic of melancholic psychosis. Specifically, we discuss three types of interventions that aim to provide a space where the clinician can ‘manoeuvre’ within the transference, thus avoiding a relation that becomes persecutory or erotomaniacal in nature and providing the possibility of finding solutions in dealing with psychic suffering. First, we describe interventions aimed at incarnating a limited other. Second, interpreting the mad Other is discussed. Finally, we outline how the clinical work involves having an interest in the patient's affinities. [ABSTRACT FROM AUTHOR]

This paper describes a condensed version of psychodynamic interpersonal therapy (PIT), Psychodynamic Interpersonal Empathy (PI‐E), which consists of the first level of competencies of the PIT model. The intention is to use basic psychodynamic principles and skills to enhance delivery of manualized, cognitive therapy based treatments. The intervention is designed to improve two common factors of therapy: the bond between client and therapist, and the ability of the therapist to create positive expectations through an explanation and understanding of the person's problems. Both of these so‐called common factors are consistently associated with clinical outcomes. Training has been developed specifically for low‐intensity therapists who are employed in the Improving Access to Psychological Treatment programme. Training focuses upon five basic components of PI: negotiation; picking up cues; using statements rather than questions; focusing on feelings; and understanding hypotheses. When used skilfully together, these simple components offer a powerful way of empathizing and deepening the collaborative work with the client. They all help the therapist to focus upon how the client is feeling ‘here and now’ in the session. Training in the model has the potential to improve outcomes and reduce dropout rates by enabling therapists to manage problem scenarios in an empathic way. [ABSTRACT FROM AUTHOR]

The Piggle, in its 40th anniversary year, was published after Winnicott's death. He treated this 2-year 4-month-old girl over two and a half years. Yet, until recently, The Piggle has been ambivalently reviewed and minimally studied, despite elegant posthumous papers, a recent introduction to Winnicott's collected works and an interview with the 'Piggle' in adulthood. We show that Winnicott's technique and interpretations fall into three categories: (1) early Kleinian 'deep' interpretations; (2) an Anna Freudian approach with developmental considerations, respect for defences, the analyst as a new developmental object; (3) a Winnicottian attitude and interpretations that hew close to the manifest material and emphasize the environment-individual relationship and full-bodied play. Winnicott's 'interpretations' include verbal interpretation, prosody, gesture, facial expression, body movements and contact. Winnicott details the child's reactions to the different interpretations. We close suggesting that Winnicott carried on dialogues, not only with the child, but also internal dialogues with former teachers (Klein/Riviere; Strachey as his first analyst and so connecting to the Freudians in the Institute of Psychoanalysis) and perhaps with Anna Freud as a colleague after her arrival in London in 1938. This is a manifestation of false versus true (analytic) selves. Understanding Winnicott's internal struggle with his former teachers/analysts, corrected by his responsiveness to the child's responses and suggestions, resulted in his bringing a truer self to this child's treatment and unravels The Piggle's enigmatic qualities. [ABSTRACT FROM AUTHOR]

Much as it is the prevailing paradigm within the NHS and the ideology underpinning the outcome measurement agenda, psychotherapy continues to question whether the evidence-based model represents a suitable methodology for complex psychological processes. Outcome measurement is antithesis to the psychotherapeutic project - or at least many within the discipline continue to argue this position. However, if providers of psychotherapy services are to survive in the 'real' world of evidence-based medicine, then the onus is upon them to side-step the 'paradigm wars' and find new ways of engaging with the mandate to measure. This paper proposes that psychotherapists can engage meaningfully with outcome measurement by asking two important questions of the time they spend with their patients: 'Is this treatment working for this individual presentation?' and, if not: 'What immediate action can be taken in order to remedy the situation?' The paper goes on to illustrate how the patient-reported outcome measure ( PROM), when incorporated into routine clinical practice can act as the mediator of this important self-evaluative process. [ABSTRACT FROM AUTHOR]

abstract This paper on regression during psychoanalytic psychotherapy is largely based on my experience of working with a patient who became profoundly regressed, going back into early infantile states of being. Due to concerns about confidentiality in a therapy which after several years is ongoing, I am only able to refer to the case in a general way; there will be a spectre at the centre of the paper. However, the impact of my experience has informed my thoughts and ideas about the phenomenon of severe regression, and has given birth to this paper. I will explore the dilemmas inherent in including confidential material in a published paper. I want to emphasize the importance of a thorough assessment of patients likely to regress, going on to consider the role of the therapeutic setting. I will talk about adjustments I have found it necessary to make in basic analytic technique in order to accommodate the extreme vulnerability of a regressed patient. I hope to contribute to the discussion among psychotherapists about the value and efficacy of a regressive experience, as well as its dangers, and, lastly, to consider the place that regressive phenomena hold in general psychoanalytic thinking. [ABSTRACT FROM AUTHOR]

abstract This paper was written in an effort to process rather extreme countertransference reactions to an 'absent' patient, i.e. one who attended her twice-weekly psychotherapy only sporadically. At times she did not come for up to several months and consequently a serious debt would accrue. However, it was not so much the amount owing but rather the constant cancellations, with seemingly 'rational' excuses about her non-attendance that would provoke an intense frustration accompanied, at times, by furious, almost sadistic countertransference feelings. The patient kept her therapist 'dangling in uncertainty' (), which the author considered to be a reflection of the patient's inner sado-masochistic object world. The author attempts to make sense of her countertransference in the light of the patient's early relationships and subsequently forms a hypothesis that the absences have been necessary to convey, very powerfully, experiences that may not have been communicated by regular attendance. Finally, the author offers her 'Afterthoughts' in the light of developments since the patient has read the paper and given her permission for publication. [ABSTRACT FROM AUTHOR]

This paper describes enactments in the countertransference -- spanning fantasies, actions, words and sexual responses to patients. It will explore the origins and reverberations of the analyst's enactments in an effort to understand whether they have obstructed progress or created special moments in the therapy where shifts in the patients' inner world, or further understanding on the part of the analyst could be created. Clinical vignettes will be used from work with several patients, although the analyst will focus mainly on work with patients who present with hysterical personality. The paper is an endeavour to tease out what, if any. differences there may be in working with hysterical patients, as opposed to patients with other personality types, in the nature of countertransference enactments. The author examines the role of rescue fantasies in the creation of an enactment. [ABSTRACT FROM AUTHOR]

The paper identifies some important areas of theoretical congruence between Jung and Bion in order to illuminate a central feature of analytic practice: analytic intuition. Jung and Bion suggest, in different yet surprisingly similar ways, that the therapist extends her reach towards unknown psychic reality through the exercise of analytic intuition. Both writers invite us to respect the symbolic and relational processes by which painful and disturbing emotional reality is intuited. Their particular formulations of unconscious process are used to arrive at a definition of analytic intuition and how it is experienced and used by analytic practitioners. The paper discusses Jung's and Bion's understanding of the dreaming process and also makes reference to Bion's 'reversible perspective' and Jung's 'synchronicity' as particular ways in which analytic intuition can be employed in analytic interpretation. The paper concludes by drawing a parallel between Jung's 'transcendent function' and Bion's 'binocular vision'. [ABSTRACT FROM AUTHOR]

This paper addresses a very familiar subject, with a particular focus on the psychotherapist's contribution to the transference-countertransference unconscious dynamic. It summarizes some of the many discussions on countertransference drawing from the vast literature on the subject. A case study is also given to illustrate the concept in clinical practice. The paper returns to the literature to trace the key elements that characterize it, and highlights the reiteration of different formulations of the same basic ideas. It then moves on to wonder about the reasons for this abundance of literature, proposing a parallel between the unravelling of countertransference in psychotherapy and the creative act, both based on the experience of personal discovery, where the production of an artefact does not require new subject matter but a fresh and personal reinterpretation. [ABSTRACT FROM AUTHOR]

In this paper, I explore the relational challenges of sexuality in the consulting room, as informed by developmental studies and 'moments' theory, and discuss the contentious issue of self-disclosure. I acknowledge that there has been a hiatus in recent decades in the discussion of psychosexuality in psychoanalysis, linked to a shift from Freud's drive theory to post- Freudian developmental theories, as well as to the change in the role of the therapist that this has entailed. While I also acknowledge that these changes have resulted in a certain de-eroticization and de-sexualization of psychoanalysis, I point to research showing that sexuality is, in fact, very much alive in the consulting room, but also to a gap in training on such issues, and to a concomitant lacuna in the literature discussing sexual attraction between therapist and patient. Before discussing the ethical and relational challenges of sexuality in the consulting room, I summarize the evolution of sexuality in psychoanalytic thinking and briefly discuss relevant developmental perspectives. I question the view that a developmental model is not suited to effectively working with sexual material. I illustrate theoretical points with a clinical case study, a development of previously published work ( Renn, 2012). [ABSTRACT FROM AUTHOR]

A comprehensive understanding of eating disorders should include engagement with the role of contemporary cultural trends. Feminists and critical social theorists have made significant contributions in this regard. Using two clinical cases, this paper contemplates the relationship between culture and psyche in eating disorder, proposing a psychoanalytic conceptualization underpinned by John Steiner's (1982, 1987, 1993, 2011) theory of pathological organizations and psychic retreats. Two conceptual terms will be introduced, namely 'the normalized body order' and 'the abject body object' to develop the argument. One of the clinical cases will be used to explore a particular kind of therapeutic impasse that can occur when therapist and patient are both female. In this particular case, the normalized body order emerged temporarily obstructing therapeutic progress; the impasse was understood to be an example of the so-called anti-analytic third (Straker, ). [ABSTRACT FROM AUTHOR]

abstract This paper argues that anorexia may be understood to be a particular kind of autistoid psychic retreat: a defensive withdrawal to a primitive enclosed part of the self that has been damaged by early infantile trauma, the result of a disruption to the mother-infant pair. This damage can be envisaged as an enclosed 'cyst' or 'tumour,' defensively 'sectioned off' from the rest of the individual's psychic life. When a patient takes refuge in an autistoid psychic retreat she is typically experienced as emotionally 'cut off' by others, including her psychotherapist, thereby making it difficult to establish and maintain a 'living' therapeutic alliance. The resulting countertransference, a crucial diagnostic tool for establishing the existence of an autistoid retreat, simultaneously challenges the therapist with a range of unsettling feelings that require processing in order to access the anorexic's inner world. The case of a female adolescent anorexic in psychodynamic psychotherapy will be presented. There were two distinct phases in this therapy, the second phase suggesting emergence from the autistoid retreat. This material will be used to illustrate autistoid dynamics and their implications for treating such patients. [ABSTRACT FROM AUTHOR]

The author comments on the paper by Abraham Brafman about the psychotherapy sessions given to a patient. He notices that Brafman wants the analyst to identify the problem with the routine practice of favoring four to five times-weekly treatment despite how fit the work is for the patient. He furthers that the author has touched at one level with the ethics of the psychoanalyst who might take advantage of a patient's dependency, greed, or naivety. He thinks that Brafman sees the performance of transference regression in less frequent treatment.

Personality disorders are an ill-defined group of psychopathological conditions that are increasingly seen as one of the main domains of NHS dynamic psychotherapy. The authors discuss some of the concepts that underlie the diagnosis though it can most easily be understood as severe non-psychotic pathology. Psychoanalytic theory has suggested several paradigms to understand and treat such conditions, and most of these rely on interpretation as the central therapeutic agent. The authors argue in this paper that therapists may need to consider the use of limit setting with patients with personality disorder where dangerous acting out may occur. This runs counter to the principles of therapeutic neutrality, and yet the limit setting may be a prerequisite to an effective therapeutic encounter. [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]

This paper suggests that the prohibition against 'taking the role of the good object' may inhibit therapists from an appropriate recognition of a loving relation between the patient and themselves. It is argued that the prohibition actually refers to a defensive attempt to get the analyst to take the role of the idealized object as a defence against the emergence of bad objects in the transference. This clinical scenario is contrasted with one where the patient needs to find in their therapist a real good object who genuinely cares for them. [ABSTRACT FROM AUTHOR]

This paper discusses three distinct countertransference-based interventions that took place at the Arbours Crisis Centre with a young man who had become verbally inarticulate and emotionally frozen. As we shall explain, each of the authors worked with this man at different points during the course of his finding his voice and discovering at least some of his feelings. [ABSTRACT FROM AUTHOR]

From the perspective of psychotherapists involved in working with young men, it is particularly interesting to consider ways in which boys may construct versions of their masculinities through an amalgam of social and personal discourses. Amongst the issues relating to young masculinities to arise systematically in research studies and in psychotherapeutic work, two are of particular interest for emerging understanding of the emotional consequences of new structures of masculine identities. These are the relationship boys have with their fathers, and the impact of social discourses on homosexuality. In this paper, material is presented from one boy who participated in an in-depth interview study of boys in London secondary schools. This boy reveals in unusual detail the ways in which dominant discourses on being 'gay' and on fathers govern the construction of contemporary young masculinities, even when boys themselves seek to resist these discourses. It is suggested that consideration of the operation of these discourses in young people's lives is a relevant concern for psychotherapists. [ABSTRACT FROM AUTHOR]

The systems theory concept of the closed system is suggested by Ronald Fairbairn as one metaphor both for internal object relationships, and their expression in transference. This paper considers how this metaphor may be helpful in analysing the patient-therapist relationship and, particularly, in deciding when aspects of it should be understood as transference. The argument is that one major challenge could be seen as lying in the complexity and subtlety of internal world systems, and a second in the many factors that conspire to lure the therapist to participate in rather than notice them. The systems metaphor seems useful both in bringing into focus some of the difficulties in analysing the therapist-patient relationship and also in offering a vehicle for thinking about them. [ABSTRACT FROM AUTHOR]

This paper explores crying in the clinical setting and offers a perspective on the nature of the emotional link which is formed with the crying narcissistic patient. Crying is an ordinary and familiar experience in the clinical setting which is generally characterized by the therapist feeling emotionally moved with a deepening of empathy. In contrast narcissistic crying can be associated with an absence or lack of emotional fit between the therapist and patient. The nature of this lack of fit throws an important light on the underlying difficulties of the patient which must be lived out in the therapeutic relationship and, more importantly, tolerated in the countertransference, before interpretation can be realized. [ABSTRACT FROM AUTHOR]

The author reflects on the Class and Psychoanalysis conference which was sponsored by the Site for Contemporary Psychoanalysis at University College London in London, England on October 25, 2009. She reveals that various papers were presented by experts at the conference which tackled shame among the working class, the impact of being a middle class psychoanalysts and influence of social class on the profession, among others. She notes that the conference forced her to assess the relationship between psychotherapists and patients.