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Whose skin is it anyway? Some reflections on the psychic function of necrophilic fantasies
No full textMaternal hyperinvestment of the child's bodily self sometimes results in the child's terror of the feminine body, which manifests as sexual excitation in association with necrophiliac fantasies. Such a dynamic constellation is observed in people who express psychic discomfort through the body. The necrophiliac fantasy gains a stronghold in order to reverse a narcissistic injury; it involves feelings recruited to satisfy excessive maternal demands, whereby one feels particularly humiliated by the mother specifically on the level of the body. Here the object, in the very fact of being similar to a dead body, feels himself to be a prisoner and incapable of pushing back the other, the self of the fantasized person; he cannot turn his gaze to the subject—he is a non-seeing object. The Author presents an analysis conducted at five times per week, that of a patient with eczema who, during the treatment, expressed necrophiliac fantasies
Dynamic Interpersonal Therapy (DIT): Developing a new psychodynamic intervention for the treatment of depression
No full textThis article outlines the development of a manualized, brief (16 session) psychodynamic intervention—Dynamic Interpersonal Therapy (DIT). DIT is easily confused with Interpersonal Therapy (IPT), because both therapies are interpersonal in their focus. However, IPT is not a psychodynamic therapy and this is reflected in the competences required to deliver it (Lemma, Roth, and Pilling, 2010), which are quite different to the psychoanalytic competences required to deliver DIT. DIT is based on a distillation of the evidence-based brief psychoanalytic/psychodynamic treatments pooled together from manualized approaches that were reviewed as part of the competence framework for psychological therapies first commissioned in the United Kingdom by the Department of Health. This article begins with a description of the methodology underpinning the competence framework, followed by an overview of the model, its relevance to depression, and, finally, its strategies and techniques, which are illustrated through a case study
Placement breakdown in foster care with children under-five: A psychoanalytic view of the caregiving relationship under stress
Get PDFThis study explores the interactional processes between a foster carer and a child, aged
under-five, who has experienced early abuse and neglect. Data was gathered from semistructured interviews with six foster carers, who had ultimately agreed for the child to
be removed from their care. The data was analysed using Interpretative
Phenomenological Analysis. The proposal is that an understanding of psychoanalytic
concepts can bring insight to situations which were felt to be unbearable and beyond
understanding. The study suggests that knowledge about external reasons for placement
breakdown is not enough without a focus on internal factors, and shows how a
psychoanalytic perspective can elucidate the processes occurring between child, carer
and their family, and the wider system. The focus is on the meaning of behaviour, rather
than just descriptions of it, and the impact of the emotional experience of looking after
the children. The need for a reflective space and the use of reflective practice is
emphasised, as is training for all concerned
Anxieties and dilemmas relating to breaks in the therapeutic relationship with children whose relationships in early infancy were reported to have been emotionally unstable and traumatised: A systematic study of child psychotherapy with a young child who had suffered early abuse and neglect
Get PDFThe present study is a psychoanalytic single case study; the intended aims of
which were: a) to perform a systematic exploration of core features of the therapeutic relationship with children who have suffered early abuse and neglect; b) to
investigate possible links between such core features and breaks; and c) to contribute to the development of a transparent and systematic methodology for the
psychoanalytic case study by application of rigorous qualitative research methodology.
The clinical research data was case-file material from a concluded child
psychotherapy case as well as transcripts from interviews with the six years old
child’s birth and foster parents, conducted 2 ¾ years after the end of therapy. The
case material was analyzed in three different steps; at each step principles for
transparent data selection and analytic strategies developed:
1) Inductive analysis highlighting four relational themes as central in the first
24 therapy sessions.
2) Deduction of empirical consequences from the central themes as distilled by
the inductive analysis; the resulting predefined themes subsequently studied
in notes from 4 consecutive Christmas break-sets, each consisting of 2 before-break sessions, 2 after-break sessions, and 2 no-break sessions. Christmas breaks chosen as the potentially most agonizing break of the year, especially for children in care.
3) Finally, the same predefined themes were studied with regard to how they
appeared in reports from the child’s various caregivers from infancy through
her day-to-day life during and after therapy.
The inductive part of the study identified four relational themes characterizing the interaction and dialogue between therapist and child. A subsequent deductive analysis convincingly showed breaks a convenient way to highlight core features of the therapeutic process; suggesting the child’s reactions to breaks to be a
good indicator of change. Conspicuous links between breaks and the eruption of
hostile parental and sibling figures in the mind seemed especially pertinent as well
as characteristic difficulties of symbol formation in before-break sessions.
The completed data analysis strongly corroborated Hinshelwood’s assumption that the relational themes found to be central in the therapeutic relationship
would also permeate the child’s past and current relationships (1991a).
With regard to the research method, the detailed results concerning breaks
and the similarity of relational themes inside and outside therapy seem to confirm
the value of systematic integration into the psychoanalytic single case study of
inductive-deductive analytic principles from the qualitative research methodology
of Interpretative Phenomenological Analysis. This combination of methods led to
unexpectedly rich insights; it may be of special importance in the development of
psychoanalytic and psychotherapeutic theory through single case studies
Being taken in: How can psychoanalytic psychotherapy lead to better relationships for an adopted child?
Get PDFNeuroscience now demonstrates that a child’s early relationships establish
the brain patterns that make a mind (Balbernie, 2001). Through
intersubjectivity, the qualities of these earliest relationships set up a frame of
reference for understanding experience, as a way of getting to know the world
to which the child must adapt in order to survive. They are thus framing
relationships, which set a template for relating through which experience is
understood. The template for neglected, abused and deprived children is
adapted to a neglectful, abusive and depriving world, with the result that this is
not just what they expect, it is what they experience, even when other
possibilities are on offer. The question is, how do you develop if development
happens through intersubjectivity in relationship and you experience the
mechanism of change, the relationship itself, as suspect - even dangerous?
I address this question through investigating the process of intersubjectivity in
psychoanalytic psychotherapy with an adopted boy of nine. Clinical material
demonstrates how the early template, adapted to adversity, is applied to the
present moment. The evidence suggests that the process of psychoanalytic
psychotherapy, working by the same intersubjective process in which the
brain was wired early on, is potentially a re-framing relationship. Its reflexive
nature offers a way of addressing the problem that the mechanism of change,
the relationship itself, is suspect. I offer findings from neuroscience and
clinical material which support the view that the integration of intersubjective
emotional regulation with attuned reflexivity constitutes the mechanism of
change for disturbed children
Statutory health assessments for pre-school foster children fail to screen accurately for mental health disorders
No full textThe aim of this study was to determine the diagnostic accuracy of statutory health assessments in identifying existing mental health disorders in pre-school foster children. It was examined whether a foster carer completed screening instrument could enhance accuracy. A representative sample of 43 pre-schoolers under the care of one inner-city local authority underwent comprehensive multidimensional mental health assessments as the reference standard. Statutory health assessments gave false negative results for 65% (95% confidence interval (CI) 44-82%) of children diagnosed with at least one mental health disorder according to the reference standard and 18% (95% CI 3-52%) of children with developmental delay. The Ages & Stages Questionnaire completed by the foster carers failed to identify 65% (95% CI 44-82%) of the children with diagnosed mental health disorders. There was no evidence of selective underreporting by foster carers in relation to specific diagnostic categories. In conclusion, statutory health assessments in their current form may fail to identify the majority of pre-school foster children with mental health disorders. Adding a screening instrument to the assessment process may not be adequate to improve diagnostic accuracy
