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Dissociative identity disorder (DID) is life-long, childhood-onset, posttraumatic developmental disorder where chronic early-life maltreatment and attachment disturbances prevents the child's development of a continuous sense of self across emotional states, relationships, and social contexts. As development proceeds, these self-states acquire a sense of themselves, a capacity for information processing, memory, emotion, and behavior. Conceptualizing DID involves paradoxes and apparent contradictions. DID has been categorized as a severe mental illness with major psychiatric comorbidities. Studies show that DID individuals have a unique personality organization with repeated, often covert posttraumatic reactivity, especially in relationships (e.g., therapy). Paradoxically, research shows that, during development, DID individuals preserve psychological resiliencies consistent with responsivity to long-term, psychodynamically informed treatment. These include, when not stressed, capacities for therapeutic alliance, reality testing, and observing ego. [ABSTRACT FROM AUTHOR]

Anorexia nervosa is the psychiatric disorder with the highest mortality rate. Anorexic patients admitted to inpatient eating disorder units are often critically unwell in both their physical and mental health. Underpinning working with these patients is a real feeling that they are close to death. Staff, and particularly nurses, in eating disorder units may find working with anorexic patients extremely challenging. It has been documented that working with such patients can give rise to strong and difficult to process countertransference feelings and reactions. The authors of this paper introduced a Balint group for the staff on an eating disorder inpatient ward to provide a space for the team to reflect on the work. This paper reports on the experience of running this Balint group and describes the themes that gradually emerged. These are then discussed and related to the nature of the disorder and the particular challenges of working with this inpatient population. [ABSTRACT FROM AUTHOR]

Experiencing fear is a central feature of managing disturbed states of minds. In this paper, I will describe the experience of being terrified by a patient who was overtaken by extreme anxiety. Aetiologically, I will suggest that the lack of containment created terror in her mind. I will also describe my experience of leadership in a voluntary organisation. Using Hopper's concept of a fourth basic assumption, I will highlight the omnipresence of annihilatory anxiety in an example of organisational trauma. I will suggest that focusing on the issues of countertransference, working through experiences of being terrorised and paying attention to how you emotionally respond are crucial to lessening terror. [ABSTRACT FROM AUTHOR]

An NHS Mental Health Trust Medical Psychotherapy Consultation Service using psychoanalytic psychiatry to help the patient and professional is described. The Consultation Service established in 2000 is offered to secondary acute and community mental health teams and primary care. The service was evaluated as a basis for regional and national development. Between 2006 and 2013, 87 consultations from 210 were sampled to ascertain demographic and diagnostic profiles and outcomes of the consultation process. We conducted an online survey of local consultant psychiatrists' views about the service, and undertook a thematic analysis of the free text comments. We also conducted a survey of members of the Royal College of Psychiatrists' Medical Psychotherapy Faculty to ascertain whether similar consultation services existed elsewhere in the UK and had been evaluated. The Leeds model of psychoanalytic consultation – a 'consultation sandwich' – is described. From a psychoanalytic perspective, the work of consultation is seen as an extension of the dynamic field of the analytic situation. This paper develops the concept of a bastion – an omnipotent reserve in and between the patient and professional derived from adhesive identifications leading to stuck relationships. The adhesive identification in the patient and professional acts like a 'grievance glue' – a mutual manifestation in a last bastion of painful limitations not faced, losses not grieved. [ABSTRACT FROM AUTHOR]

Two seemingly unrelated characteristics of psychoanalytic couple psychotherapy may be better understood when juxtaposed. First, countertransference in psychoanalytic couple psychotherapy holds particularly strong intensity. Second, format decisions are central to couple psychotherapy. The use of conjoint and concurrent formats, or variations thereof, has been key in the historical development of couple psychotherapy and remains an area of much debate. Some couple psychotherapists use the format of couple psychotherapy flexibly, using variations of conjoint or concurrent couple psychotherapy, while others adhere strictly to working conjointly. Decisions regarding whether to undertake concurrent or conjoint therapy are not generally linked to countertransference; this article demonstrates that reading decisions regarding format through consideration of countertransference offers a needed perspective for the therapist. Case studies published by psychoanalytic couple therapists are analysed through this prism to demonstrate that changing the format may serve to dilute countertransference. One particular manifestation of countertransference, linked to oedipal dynamics, is explored: countertransferential intensity for couple psychotherapists potentially relates to being faced with their internal parental couple and their unresolved Oedipal strivings. Possible unconscious motivations to change the format of couple psychotherapy need to be carefully considered, as format changes may mask an avoidance of bearing the countertransference. [ABSTRACT FROM AUTHOR]

Although the treatment of suicidal adolescents is complex and may be daunting to many clinicians, it continues to play an important role in suicide prevention. In this paper, we use case material to address questions that arise in psychotherapy, including the contending priorities of understanding the suicidal act in order to prevent repetition, versus connecting emotionally with the patient in the therapeutic relationship; and the use of an evolving understanding of the complexity of suicide that develops over time as patient and therapist engage in a deepening relationship which fosters life-sustaining development and psychic change. We present a case description of a patient in later adolescence, who began intensive psychoanalytic psychotherapy after a suicide attempt and explore key components of therapeutic action. From this discussion we emphasise the relational aspects of the transference and countertransference that enables interpretation and increased therapeutic receptivity through collaborative interaction. We conclude that collaborative interaction is foundational for therapeutic action with suicidal adolescents. [ABSTRACT FROM PUBLISHER]

Although establishing an evidence base for psychoanalytic practice has become a matter of increasing practical and accountability concern, the establishment of an evidence base for psychoanalytic supervision has yet to be given any consideration. In establishing a more comprehensive evidence-informed approach to treatment and training, the corollary need to build an evidence base for psychoanalytic treatment supervision would accordingly seem an important next step to address. What research supports the use of psychoanalytically informed constructs in supervision? With that research base considered, is there any sort of an evidence base for psychoanalytic supervision practice itself? In this paper, I would like to examine those two questions, giving particular attention to two psychoanalytically derived variables of supervision import: the supervisory alliance and parallel process. Based on research review, data thus far provide a high degree of empirical support for the supervisory alliance as perhaps being the crucial fundamental and foundational variable in making supervision work or not. While comparatively far more limited and less robust in nature, data about parallel process offer a tentative degree of support for that construct's importance in supervision as well. While still only in its most formative period, we at least appear to have an informed and informing evidence base for psychoanalytic supervision beginning to take more substantial shape. [ABSTRACT FROM AUTHOR]

At a time of considerable organisational change within Probation Services, the authors describe a new initiative to offer psychoanalytically-informed clinical supervision to frontline probation officers, linked to the development of a care pathway for offenders with personality disorders. An analysis of feedback forms from supervisors during the first months of this project highlighted the typical countertransference challenges of probation work. In subsequent months, concerns about organisational change were increasingly evident in supervision, possibly amplifying existing concerns about risk, formulation and management of countertransference responses. The complexities of offering containment and supervision to probation officers, at a time when they were anxious about the security of their organisational ‘container’, are explored. [ABSTRACT FROM PUBLISHER]

In this paper, material is presented from supervision groups run for mental health professionals in different mental health settings. I will argue that a psychoanalytic framework, which puts the transference and counter-transference at the centre of clinical practice, offers an important model for thinking about psychosis and psychotic means of communication. When staff are able to 'tune in' to their patients' communications it can help to change a patient's monologue about his/her delusional world into a meaningful dialogue about their emotional world. [ABSTRACT FROM AUTHOR]