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A slow match is a very slow-burning fuse presenting only a small glowing tip whereas a quick match is one, which once ignited, burns at top speed. In this paper, I will present a number of clinical vignettes to illustrate situations when the therapist realised there was a sudden unexpected rise in 'temperature' of a patient's mind and why this may have occurred. A fuse was lit but was it a slow or a quick one? I will relate this ignition to the possibility of premature interpretations, or a failure to notice how anxious the patient was in the presence of the terrifying object-therapist and also, patients' unexpected responses to external interferences during a session. Descriptions of how these situations unfolded during sessions are given, and how, upon reflection, these could have been diffused differently. The emphasis will be on how best to maintain a psychoanalytic stance but also how to clinically judge when a session must be terminated in order to protect patient and therapist from exploding 'bombs' inadvertently ignited by patient or therapist. The importance of supervision and consultation with colleagues will be stressed. [ABSTRACT FROM AUTHOR]

Is our foundational story of sexual identity still relevant and valid for today, or is it wrong? Oedipus has been used in the past as a cautionary tale for the consequences of transgressive sexuality, as well as an exemplar of hetero-normative development. Perhaps most influentially he has been used recently to illustrate a mechanism that underpins the concept of a pathological organization of personality, a perverse turning of a blind eye to the truth. But is this reading mistaken? In this article I return to the crossroads with Oedipus to try to give him back – for the first time – his sexual identity. By offering a re-reading of the myth in light of how we understand the impact of internalized stigma on the formation of sexual identity today I hope to show that our psychoanalytic imagination can use the Oedipus myth to encompass a range of different developmental possibilities. [ABSTRACT FROM AUTHOR]

Prof. Richard Layard's influential advocacy for greater provision of ‘evidence-based’ psychological therapies, based in part on an economic rationale, has lead to greatly increased provision of cognitive behavioural therapy (CBT) and short-term therapies for depression, through the Increasing Access to Psychological Therapies (IAPT) initiative, whilst longer-term psychodynamic treatments are under threat, criticised as lacking an evidence base. This paper argues for the continuing provision of intensive thrice-weekly psychoanalytic psychotherapy treatments, time-limited to two years. It does so by describing such a treatment within an NHS psychotherapy department with a patient with a long history of severe personality pathology, including significant levels of perversity. The paper describes the patient's difficulties and his movement through the treatment, focussing on his difficulties making genuine emotional contact, his destructiveness of such contact, his acting out in the treatment, his perversity and the vital working through of the ending. The shifts the patient made are described, and follow-up information on the patient is given. The paper discusses the unique benefits of time-limited treatment and intensive psychoanalytic treatments for this ‘hard-to-help’ group of patients, and the economic rationale that can be made for such treatments. [ABSTRACT FROM PUBLISHER]

The author explores the development of female violence and its typical expression in acts of aggression directed towards the woman's own body and those of her children. She explores the societal resistance to confronting the disturbing reality of maternal abuse in the light of commonly held, cherished beliefs about femininity in general and motherhood in particular. The hidden nature of female violence, so often enacted in the private, domestic realm, is evident in the clinical case material presented. The author presents a model of the psychology of female violence described as ‘crimes against the body’. [ABSTRACT FROM PUBLISHER]

In this paper, I draw on Freudian and Lacanian psychoanalytic theory to consider the notion of perversion and fetishisation within the context of contemporary UK public mental health services which have been subject to New Public Management restructuring. Offering an organisational case example based on clinical experience within an expanded NHS mental health service, I explore how services that are subject to neo-liberal regulatory and performance management systems sponsor a perverse organisational solution to the anxieties and difficulties of dealing with psychologically distressed patients. I conclude that theorising the unconscious dynamics of perversion and fetishism may provide an opportunity to rethink governmentality, offering a potentially fruitful means of addressing recent political concerns about the negative impact of a ‘target culture’ on public sector health services. [ABSTRACT FROM PUBLISHER]

Increasing numbers of patients presenting problems with internet pornography have led to changes in the culture and practice of group analytic therapy at the Portman Clinic. The addictive element of this new form of artificial, sexual stimulation has to be recognised as part of the harm it produces. Group members spontaneously develop some of the principles and practice of established methods of addiction treatment, especially the 12-step programme, by helping each other manage their compulsion. This self-help function of the group coexists alongside the psychodynamic perspective, in which the meaning of harmful sexual behaviour is explored and understood. Certain individuals are more vulnerable to excessive use of pornography because of early developmental problems and current difficulties in their sexual relationships, resulting from internal conflicts about their sexuality. The group provides intimacy without sexualisation, primarily through a sibling transference. The therapist embodies an ability to think about the complexity of the sexual abuse that the pornography portrays. He or she works towards a truer perception of reality for group members, in which the false solutions of compulsive sexual behaviour are seen to be what they are: impediments to healthy development. [ABSTRACT FROM AUTHOR]

Various indices of use of Internet pornography have drawn attention to the extent of adult sexual interest in children; clinical experience and now research evidence are accumulating to suggest that the Internet is not simply drawing attention to those with existing paedophilic interests, but is contributing to the crystallisation of those interests in people with no explicit prior sexual interest in children. Drawing on clinical experience in a specialist NHS outpatient psychotherapy service, the author argues that a dichotomous notion of paedophilia is no longer tenable, and any model of paedophilia needs to take account of eruptions of a sexual interest in children in those who appear not to be consistently paedophilic and who have had adult-to-adult sexual relationships. This phenomenon is analysed in two ways: first, by considering how it is that the adult sexual adaptation might ‘unravel’ under the influence of Internet sex to reveal underlying paedophilic currents and second, by revisiting general and psychoanalytic theories of paedophilia and by considering how predisposing factors to paedophilia might be amplified through access to Internet pornography. [ABSTRACT FROM PUBLISHER]

The author describes psychotherapeutic treatment with a woman who uses severe forms of self-harm to express her hope that she can find real understanding and an environment that can respond to her. She discusses the significance of the earliest experiences of maternal care and the particular importance of the skin; she describes how traumatic breakdowns in early care are unconsciously re-created in later assaults on the body, which serve to communicate distress, anger, protest and the hope that a real attempt will be made to relate to the person who self-harms. Self-harm is viewed not as a suicidal gesture, but rather, as an attempt to preserve life, and to represent and contain unbearable states of minds. The author outlines ways in which self-harm can create a narrative and embody unbearable feelings and unspoken thoughts. It is seen as a form of self-expression and communication, both conscious and unconscious, which is not wholly destructive but has important hopeful and self-preservative aims. [ABSTRACT FROM AUTHOR]