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Robert Waelder and W.R. Bion share an interest in articulating elemental landmarks within the psychotherapeutic terrain wherein primitive ideation may become transformed into a reclaimed reality orientation. The present paper extends their interest through clinical and literary example. It surfaces an aspect of Bion’s therapeutic calculus, implicit but unstated, in the temporal arrival at multiple and continuously changing “d” structures within the ongoing process of therapy. By recognizing the joint contribution of therapist and patient within these creations in time of arrival at approximations to the depressive position, the authors illustrate the weaving of “white hole” matrices, affording temporary relief from the dread of annihilative anxiety that reclaim the patient’s capacity for non-psychotic self-orientation. [ABSTRACT FROM AUTHOR]

Every psychotherapist working in the challenging field of the addictions is familiar with patients who yo-yo between extended periods of abstinence from substances, or other compulsive and non-substance-based addictive behaviours, and who then lapse or relapse to compressed periods of excessive substance misuse, the so-called binge episode. In this paper we reverse the lens of theoretical focus somewhat, from its more traditional position within the clinical field of addiction. We suggest that periods of abstinence from substance misuse, or other compulsive behaviours, may also represent a type of binge-like behaviour which satisfies, for a time, core needs though which may also invariably be non-sustainable if the underlying psychodynamic processes underscoring such repetitive abstinence binges are not explored and translated, in work with the patient. Linkage will also be made between poles of experience that addicted and substance abusing patients evince, which are here termed black holes (Sweet, ) and white holes (Miller, personal communication, 2015). These proposed intra-psychic structures are, it is asserted, intimately related to the ability, or not, of the individual to bear psychological pain and distress, tolerate separation from objects at both an inter-personal and intra-psychic level and to delay gratification of instinctually grounded desires and wishes. The authors reference Hopper's () previous description of both black holes and white holes in the addictions, and Glasser's () conception of the black hole in relation to perversion and his description of the 'core complex', drawing out both similarities and differences in the viewpoints presented. Key ideas in the paper are illuminated and contextualized through the presentation of a number of illustrative clinical examples. [ABSTRACT FROM AUTHOR]

This paper explores the idea that electronic computer-based media, also referred to as the new technologies, may act as receptacles for and transmitters of projected aspects of the self. These aspects of the self then enter into relations with a new and emerging range of technologically generated objects, which may critically influence aspects of the therapeutic relationship. In the virtual worlds that evolve in relation to the new technologies, obsessional thinking and compulsive behaviours may be stimulated, precisely because split off aspects of the self must be constantly monitored as stored images, interacting with signifiers in the technological chain, often felt to be under threat from a range of potentially persecutory and bizarre objects [Bion, 1962. A theory of thinking. International Journal of Psychoanalysis. 43]. It is suggested that an intra-psychic representation of the self, the mediated self, may evolve based on a blurring of the lines of demarcation between projected/introjected elements of the self and its objects. Drawing upon clinical case material, where appropriate, the author also discusses some similarities and differences between various forms of substance addiction, computer compulsions and, more broadly, the idea of the fetishistic object relation. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to suggest that the emergence of substituted cathinones or M-cat drugs (notably mephedrone and methylone) and their rapid proliferation of use, amongst drug users in the UK from 2009 onwards, signals changes in the habits, preferences and lifestyle choices made by certain drug users, whilst also indicating a pronounced increase in the levels of co-morbid mental health conditions experienced by another, yet often distinct, group of users. Design/methodology/approach – This latter group of users, it is suggested, tend to initiate use of psychoactive substances (including tobacco and alcohol) at a younger age. In addition, it is suggested, they often present to treatment and criminal justice services with a history of chronic childhood relational trauma, as a background against which severe patterns of drug abuse has evolved. In this light the lack of significant supplies of social capital, as a protective factor against the development of chronic drug use, is further considered in the paper that follows though a brief literature review and qualitative clinical case reports. Findings – Novel psychoactive substances ( Newcombe, 2013) appear so seductive, for a certain group of users, because they seem to provide a temporary form of cognitive and emotional anaesthesia, enabling users to self-medicate, often against experiences of profound psychological trauma and contemporary lives that are typically experienced as boring, hopeless and pointless. The euphoric effects of psycho-stimulants such as mephedrone are particularly appealing to individuals attempting to escape a subjective sense of daily dysphoria and may on this basis lead to, rather than recreational use, more persistent patterns of drug use. However, in contradistinction to this group of users, another recreational – mainly weekend leisure – group of users continues to evidence a voracious appetite for psycho-stimulant substances. Originality/value – It is suggested that this second group of users has been particularly influential in substitute displacement towards the emergence of legal highs, due to the poor quality and illegal status of street drugs such as cocaine, amphetamine sulphate and MDMA (ecstasy). [ABSTRACT FROM AUTHOR]

In clinical theory and practice we rarely find an isomorphic fit between early patterns of attachment and discrete clinical disorders or syndromes. Although a linear equivalence is not implied here the author draws out parallels between early disorganized attachment patterns, the internal world of the substance abuser and the ways in which such psychodynamic processes invariably shape and influence the therapeutic encounter. Exploring further Main and Hesse's (1990) assertion that the essence of disorganized attachment can be summed up as fright without solution, the author develops the idea that active and repeated drug use represents attempts to anaesthetically freeze the self, and in so doing to disable and paralyse internal object imagos that induce feelings of panic, terror and dread. In addition the ingestion of drugs, as other writers on the subject have observed ( Rosenfeld, 1965), often provides a type of internal inflation of the fragile self, leading to a sense of omnipotent and omniscient superiority on behalf of the substance abusing patient. [ABSTRACT FROM AUTHOR]

In this paper, the author explores the internal world of a patient who had suffered exposure to an acute and life threatening trauma and who subsequently developed a dependence on alcohol. It is suggested that a detailed exploration of internal object and self-representations, as these emerged through both acting out and in the transference/counter-transference dynamics of the therapeutic relationship, enabled a greater understanding of structural dissociation, splitting and the move to mourning and the recovery of objects previously lost through projective identification. Some thoughts are also offered by the author on primitive super-ego states, trauma and addiction. [ABSTRACT FROM AUTHOR]

abstract This paper explores some aspects of psychotherapeutic technique in work with a range of presenting individuals who appeared to evidence various levels of personality integration. Consideration is given to a continuum of personality organization, based on psychotic, borderline and neurotic self-structures. The central contention advanced in the paper is that a very careful and detailed analysis of the presenting patient's level of structuralization is required before a decision on the suitability of psychotherapeutic intervention can be made. I have suggested that prospective diagnosis, by recourse to symptomatology or subset symptomatology, is an inadequate means by which to gain an accurate understanding of an individual's particular needs. Recognition of the predominant mode of personality structure, whether this is psychotic, borderline/narcissistic or neurotic, is of the utmost importance. Experience shows that the ability of individuals to 'adjust' to the parameters of the therapeutic frame will be contingent upon the level of personality structure that has been attained. In turn, the particular forms of psychotherapy appropriate to the developmental level of individuals should be carefully considered. Generally, under-structured patients require a greater degree of supportive work, before movement towards a psychodynamically interpretative approach can be utilized. [ABSTRACT FROM AUTHOR]

This paper explores a particular kind of defensive structure - automata states - and examines elements of this mechanism as it may emerge in the therapeutic relationship. The ideas presented may be of particular interest to therapists treating so-called borderline patients, including patients who at times deploy high levels of aggression and violence, towards the self and others. Consideration is given to the re-firing of communicative projective processes, which may have been employed during infancy and childhood, and that may have been dormant for a lengthy period. Such projective dynamics are linked to grossly disorganized attachment patterns during infancy where, it would appear, there has been a critical lack of reflective function and mentalization on behalf of the primary caregivers. The author argues that, with certain individuals, it may be possible to approach new ways of exploring and expressing such underlying psychodynamics in the therapeutic relationship. Clinical case material is included, in order to contextualize and further develop the ideas presented. [ABSTRACT FROM AUTHOR]