"This paper explores the mind - brain relationship, using insights from contemporary neuroscience. It seeks to investigate how our brains become who we are, how subjective experience arises. In order to do this some explanation is given of the basic concepts of how the brain produces our subjective mental life. Current neuropsychological and neurobiological understanding of early brain development, memory, emotion and consciousness are explored. There is also an attempt at mapping the mind - brain-self relationship from a uniquely Jungian perspective. Clinical material is included in order to show the relevance of these insights to our work in the consulting room, arguing the value of the affect-regulating, relational aspects of the analytic dyad that forge new neural pathways through emotional connection. Such experience forms the emotional scaffolding necessary for the emergence of reflective function.
What is the mind? Is it merely the brain at work? Not so. In the 1990's, ‘the decade of the brain’, new research tools have enabled more detailed knowledge of brain processes. Gone forever are the unquestioning days of the dualism of Descartes, when mind and brain could be understood as two entirely separate entities and scholars of one would not have been expected to be acquainted with the scholarship of those who studied the other. Neuroscientists such as Panksepp have become aware that ‘we shall not really understand the brain and the nature of consciousness until we begin to take emotional feelings more seriously, as internally experienced neuro-symbolic SELF- referenced representations’ (Panksepp 1998, p. 339). As neuroscientists still have to come to terms with the emergence of subjective experience, of consciousness and of mind, so those of us whose engagement is with the mind still need to come to terms with the significance of ‘the decade of the brain’ for our own thought and work." (p. 83)
The emergence of the self
"The last area I have chosen to look at is the self. It is this area of depth psychology where a Jungian perspective is most relevant to the last ten years of empirical studies in neuroscience, although one must always ask what exactly does the writer mean by the word ‘self’. Jung's notion of the self as a totality, and Fordham's notion of the infant as ‘a psychosomatic unity or self’ which will contribute by deintegration to all psychic structures as they differentiate in growth’ are particularly congruent with the work of Damasio, Panksepp and LeDoux. The notion of the awareness of self as a consciousbeing with a mind capable of intentionality, desire, belief and emotion is less compatible with the neuroscientists’ concept of self. Damasio, for example, suggested a ‘preconscious biological precedent’, entirely outside of consciousness, that he termed the ‘protoself’ (Damasio 1999, p. 153). By this he meant an essentially unconscious bodily-based foundation to the self, from which the core self, which we each sense within, may develop.
Neuroscientists stress the importance of zones of convergence that receive and integrate inputs from many different brain areas. Solms and Turnbull note the particular areas of the upper brainstem that receive input from all the sensory modalities and that produce a ‘virtual map’ of the muscoskeletal body. They are adjacent to the area where the mapping of inner visceral states takes place. They suggest that these two maps together, mapping the ‘inner’ and ‘the outer’ generate a rudimentary representation of the whole person, the inner and outer virtual bodies combined (Solms & Turnbull 2002, p. 110). It is this region that also leads Panksepp to posit a coherent foundational process that he terms the ‘self-representation’ or ‘primordial self-schema’ that ‘provides input into many sensory analysers and … is strongly influenced by the primal emotional circuits’. He chooses to call this the SELF by which he means ‘a Simple Ego-type Life Form deep within the brain’. He suggests that the SELF first arises during early development from a coherently organized motor process in the sub-cortical mid-brain, even though it comes to be represented in widely distributed ways through the higher regions of the brain as a function of neural and psychological maturation. He continues: ‘basic affective states, which initially arise from the changing neurodynamics of a SELF-representation mechanism, may provide an essential psychic scaffolding for all other forms of consciousness (Panksepp 1998, p. 309). Thus just as an interactionist developmental view is appropriate for our understanding of archetypal theory, so it is for a full appreciation of the Jungian archetypal view of the self.
In fact, despite Panksepp's choice of Freudian terminology, his understanding of SELF appears to be much closer to that of Jung who argued that ‘The self is not only the centre but also the whole circumference which embraces both conscious and unconscious; it is the centre of this totality, just as the ego is the centre of the conscious mind’ (Jung 1944, para. 44). And ‘The self is a quantity that is superordinate to the conscious ego. It embraces not only the conscious but the unconscious psyche, and is therefore, so to speak, a personality which we also are … There is little hope of our ever being able to reach even approximate consciousness of the self, since however much we may make conscious there will always exist an indeterminate and indeterminable amount of unconsciousmaterial which belongs to the totality of the self (Jung 1926, para. 274).
LeDoux, in his book The Synaptic Self, writes that ‘the self is the totality of what an organism is physically, biologically, psychologically, socially and culturally’, and in so doing comes close to the Jungian view of the self as a totality. He continues, ‘that all aspects of the self are not usually manifest simultaneously and that different aspects can even be contradictory, may seem to present a hopelessly complex problem’. He adds, ‘different components of the self reflect the operation of different brain systems … while explicit memory is mediated by a single system, there are a variety of brain systems that store information implicitly, allowing for many aspects of the self to coexist’ (LeDoux 2002, p. 31). Information processing (including interpretations) is highly biased towards the left hemisphere, towards the explicit, declarative, hippocampal field. For patients who have experienced early relational trauma the key will be stored in the implicit emotional amygdaloid memory of the right hemisphere, known only through ways of being, feeling and behaving. Jung suggested that ‘the existence of complexes throws serious doubt on the naïve assumption of the unity of consciousness, which is equated with ‘psyche’, and on the supremacy of will’ (Jung 1934a, paras. 200-203). He noted ‘that the individuation process is confused with the coming of the ego into consciousness and that the ego is in consequence identified with the self, which naturally produces a hopeless conceptual muddle. Individuation then is nothing but ego-centredness.… The self comprises infinitely more than a mere ego’ (ibid., para. 432). (pp. 90-92)
Conclusion
....However we can say that, although the methods and outcomes of the two disciplines are very different, the findings of neuroscience do tend to confirm the value of the affect-regulating, relational aspects of the analytic dyad.
LeDoux comments: ‘Most of the time the brain holds together pretty well. But when connections change personality too can change … if the self can be disassembled by experiences that alter connections … it also can be reassembled by experiences that establish, change or renew connections’ (LeDoux 2002, p. 307). In the consulting room with many patients our task may well be to enable to help them to come to terms with damaging early relational trauma, laid down in implicit, amygdaloid, emotional memory, revealed in feelings of abandonment, terror and dread. I conclude that the developing emotional connectivity that occurs within the analytic dyad forms the essential psychic scaffolding that enables the complementary work, known traditionally as the talking cure. The vicissitudes of experience within the analytic dyad facilitate the development of self-regulatory capacity and the emergence of the reflective function." (p. 98)
Margaret Wilkinson (2004). The mind - brain relationship. Journal of Analytical Psychology, Vol. 49, pp. 83-101
Tuesday, February 26, 2013
Sunday, February 24, 2013
Mark Solms - On the Neurosciences and Freud's "Interpretation of Dreams"
(from Solms, 2001, pp. 88-89)
"The picture of the dreaming brain which emerges from recent neuroscientific research may therefore be summarized as follows: the process of dreaming is initiated by an arousal stimulus. If this stimulus is sufficiently intense or persistent to activate the motivational mechanisms of the brain (or if it attracts the interest of these mechanisms for some other reason), the dream process proper begins. The functioning of the motivational systems of the brain is normally channelled toward goal-directed action but access to the motor systems is blocked during sleep. The purposive action which would be the normal outcome of motivated interest is thereby rendered impossible during sleep. As a result (and quite possibly in order to protect sleep), the process of activation assumes a regressive course. This appears to involve a two-stage process. First, the higher parts of the perceptual systems (which serve memory and abstract thinking) are activated; then the lower parts (which serve concrete imagery) are activated. As a result of this regressive process, the dreamer does not actually engage in motivated activity during sleep, but rather imagines himself to be doing so. Due to inactivation during sleep of the reflective systems in the frontal part of the limbic brain, the imagined scene is uncritically accepted, and the dreamer mistakes it for a real perception.
There is a great deal about the dreaming brain that we still do not understand. It is also evident that we have not yet discovered the neurological correlates of some crucial components of the ‘dream-work’ as Freud understood it. The function of ‘censorship’ is the most glaring example of this kind. However, we are beginning to understand something about the neurological correlates of that function, and we know at least that the structures which are most likely to be implicated (Solms 1998) are indeed highly active during dreaming sleep (Braun et al. 1997, 1998).
Hopefully it is apparent to the reader from this brief overview that the picture of the dreaming brain which has begun to emerge from the most recent neuroscientific researches is broadly compatible with the psychological theory that Freud advanced. In fact, aspects of Freud's account of the dreaming mind are so consistent with the currently available neuroscientific data that I personally think we would be well advised to use Freud's model as a guide for the next phase of our neuroscientific investigations. Unlike the research effort of the past few decades, the next stage in our search for the brain mechanisms of dreaming (if it is to succeed) must take as its starting point the new perspective we have gained on the role of REM sleep. REM sleep, which has hitherto diverted our attention away from the neuropsychological mechanisms of dreaming, should simply be added to the various ‘somatic sources’ of dreams that Freud discussed in chapters 1 and 5 of his book (Freud 1900a). The major focus of our future research efforts should then be directed towards elucidating the brain correlates of the mechanisms that Freud discussed in his chapters 6 and 7—the mechanisms of the dream-work proper:
We shall feel no surprise at the over-estimation of the part played in forming dreams by stimuli which do not arise from mental life. Not only are they easy to discover and even open to experimental confirmation; but the somatic view of the origin of dreams is completely in line with the prevailing trend of thought in psychiatry today. It is true that the dominance of the brain over the organism is asserted with apparent confidence. Nevertheless, anything that might indicate that mental life is in any way independent of demonstrable organic changes or that its manifestations are in any way spontaneous alarms the modern psychiatrist, as though a recognition of such things would inevitably bring back the days of the Philosophy of Nature, and the metaphysical view of the nature of mind. The suspicions of the psychiatrists have put the mind, as it were, under tutelage, and they now insist that none of its impulses shall be allowed to suggest that it has any means of its own. This behaviour of theirs only shows how little trust they really have in the validity of a causal connection between the somatic and the mental. Even when investigation shows the primary exciting cause of a phenomenon is psychical, deeper research will one day trace the path further and discover an organic basis for the mental event. But if at the moment we cannot see beyond the mental, that is no reason for denying its existence. (Freud 1900a, pp. 41-42)"
Mark Solms (2001). The Interpretation of Dreams and the Neurosciences. Psychoanalysis and History, Vol. 3, pp. 79-91
"The picture of the dreaming brain which emerges from recent neuroscientific research may therefore be summarized as follows: the process of dreaming is initiated by an arousal stimulus. If this stimulus is sufficiently intense or persistent to activate the motivational mechanisms of the brain (or if it attracts the interest of these mechanisms for some other reason), the dream process proper begins. The functioning of the motivational systems of the brain is normally channelled toward goal-directed action but access to the motor systems is blocked during sleep. The purposive action which would be the normal outcome of motivated interest is thereby rendered impossible during sleep. As a result (and quite possibly in order to protect sleep), the process of activation assumes a regressive course. This appears to involve a two-stage process. First, the higher parts of the perceptual systems (which serve memory and abstract thinking) are activated; then the lower parts (which serve concrete imagery) are activated. As a result of this regressive process, the dreamer does not actually engage in motivated activity during sleep, but rather imagines himself to be doing so. Due to inactivation during sleep of the reflective systems in the frontal part of the limbic brain, the imagined scene is uncritically accepted, and the dreamer mistakes it for a real perception.
There is a great deal about the dreaming brain that we still do not understand. It is also evident that we have not yet discovered the neurological correlates of some crucial components of the ‘dream-work’ as Freud understood it. The function of ‘censorship’ is the most glaring example of this kind. However, we are beginning to understand something about the neurological correlates of that function, and we know at least that the structures which are most likely to be implicated (Solms 1998) are indeed highly active during dreaming sleep (Braun et al. 1997, 1998).
Hopefully it is apparent to the reader from this brief overview that the picture of the dreaming brain which has begun to emerge from the most recent neuroscientific researches is broadly compatible with the psychological theory that Freud advanced. In fact, aspects of Freud's account of the dreaming mind are so consistent with the currently available neuroscientific data that I personally think we would be well advised to use Freud's model as a guide for the next phase of our neuroscientific investigations. Unlike the research effort of the past few decades, the next stage in our search for the brain mechanisms of dreaming (if it is to succeed) must take as its starting point the new perspective we have gained on the role of REM sleep. REM sleep, which has hitherto diverted our attention away from the neuropsychological mechanisms of dreaming, should simply be added to the various ‘somatic sources’ of dreams that Freud discussed in chapters 1 and 5 of his book (Freud 1900a). The major focus of our future research efforts should then be directed towards elucidating the brain correlates of the mechanisms that Freud discussed in his chapters 6 and 7—the mechanisms of the dream-work proper:
Thursday, February 21, 2013
Jonathan Shedler - The Efficacy of Psychodynamic Psychotherapy
Abstract
Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as "empirically supported" and "evidence based." In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.
Discussion
One intent of this article was to provide an overview of some basic principles of psychodynamic therapy for readers who have not been exposed to them or who have not heard them presented by a contemporary practitioner who takes them seriously and uses them clinically. Another was to show that psychodynamic treatments have considerable empirical support. The empirical literature on psychodynamic treatments does, however, have important limitations. First, the number of randomized controlled trials for other forms of psychotherapy, notably CBT, is considerably larger than that for psychodynamic therapy, perhaps by an order of magnitude. Many of these trials—specifically, the newer and better-designed trials—are more methodologically rigorous (although some of the newest psychodynamic randomized controlled trials, e.g., that of Clarkin et al., 2007, also meet the highest standards of methodological rigor). In too many cases, characteristics of patient samples have been too loosely specified, treatment methods have been inadequately specified and monitored, and control conditions have not been optimal (e.g., using wait-list controls or "treatment as usual" rather than active alternative treatments — a limitation that applies to research on empirically supported therapies more generally). These and other limitations of the psychodynamic research literature must be addressed by future research. My intent is not to compare treatments or literatures but to review the existing empirical evidence supporting psychodynamic treatments and therapy processes, which is often underappreciated.
In writing this article, I could not help being struck by a number of ironies. One is that academicians who dismiss psychodynamic approaches, sometimes in vehement tones, often do so in the name of science. Some advocate a science of psychology grounded exclusively in the experimental method. Yet the same experimental method yields findings that support both psychodynamic concepts (e.g., Westen, 1998) and treatments. In light of the accumulation of empirical findings, blanket assertions that psychodynamic approaches lack scientific support (e.g., Barlow & Durand, 2005; Crews, 1996; Kihlstrom, 1999) are no longer defensible. Presentations that equate psychoanalysis with dated concepts that last held currency in the psychoanalytic community in the early 20th century are similarly misleading; they are at best uninformed and at worst disingenuous.
A second irony is that relatively few clinical practitioners, including psychodynamic practitioners, are familiar with the research reviewed in this article. Many psychodynamic clinicians and educators seem ill-prepared to respond to challenges from evidence-oriented colleagues, students, utilization reviewers, or policymakers, despite the accumulation of high-quality empirical evidence supporting psychodynamic concepts and treatments. Just as antipsychoanalytic sentiment may have impeded dissemination of this research in academic circles, distrust of academic research methods may have impeded dissemination in psychoanalytic circles (see Bornstein, 2001). Such attitudes are changing, but they cannot change quickly enough.
Researchers also share responsibility for this state of affairs (Shedler, 2006b). Many investigators take for granted that clinical practitioners are the intended consumers of clinical research (e.g., Task Force on Promotion and Dissemination of Psychological Procedures, 1995), but many of the psychotherapy outcome studies and meta-analyses reviewed for this article are clearly not written for practitioners. On the contrary, they are
densely complex and technical and often seem written primarily for other psychotherapy researchers — a case of one hand writing for the other. As an experienced research methodologist and psychometrician, I must admit that deciphering some of these articles required hours of study and more than a few consultations with colleagues who conduct and publish outcome research. I am unsure how the average knowledgeable clinical practitioner could navigate the thicket of specialized statistical methods, clinically unrepresentative samples, investigator allegiance effects, inconsistent methods of reporting results, and inconsistent findings across multiple outcome variables of uncertain clinical relevance. If clinical practitioners are indeed the intended "consumers" of psychotherapy research, then psychotherapy research needs to be more consumer relevant (Westen, Novotny, & Thompson-Brenner, 2005).
With the caveats noted above, the available evidence indicates that effect sizes for psychodynamic therapies are as large as those reported for other treatments that have been actively promoted as "empirically supported" and "evidence based." It indicates that the (often unacknowledged) "active ingredients" of other therapies include techniques and processes that have long been core, centrally defining features of psychodynamic treatment. Finally, the evidence indicates that the benefits of psychodynamic treatment are lasting and not just transitory and appear to extend well beyond symptom remission. For many people, psychodynamic therapy may foster inner resources and capacities that allow richer, freer, and more fulfilling lives.
Jonathan Shedler (2010) The Efficacy of Psychodynamic Psychotherapy, American Psychologist, Vol. 65, No. 2, 98–109
Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as "empirically supported" and "evidence based." In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.
Discussion
One intent of this article was to provide an overview of some basic principles of psychodynamic therapy for readers who have not been exposed to them or who have not heard them presented by a contemporary practitioner who takes them seriously and uses them clinically. Another was to show that psychodynamic treatments have considerable empirical support. The empirical literature on psychodynamic treatments does, however, have important limitations. First, the number of randomized controlled trials for other forms of psychotherapy, notably CBT, is considerably larger than that for psychodynamic therapy, perhaps by an order of magnitude. Many of these trials—specifically, the newer and better-designed trials—are more methodologically rigorous (although some of the newest psychodynamic randomized controlled trials, e.g., that of Clarkin et al., 2007, also meet the highest standards of methodological rigor). In too many cases, characteristics of patient samples have been too loosely specified, treatment methods have been inadequately specified and monitored, and control conditions have not been optimal (e.g., using wait-list controls or "treatment as usual" rather than active alternative treatments — a limitation that applies to research on empirically supported therapies more generally). These and other limitations of the psychodynamic research literature must be addressed by future research. My intent is not to compare treatments or literatures but to review the existing empirical evidence supporting psychodynamic treatments and therapy processes, which is often underappreciated.
In writing this article, I could not help being struck by a number of ironies. One is that academicians who dismiss psychodynamic approaches, sometimes in vehement tones, often do so in the name of science. Some advocate a science of psychology grounded exclusively in the experimental method. Yet the same experimental method yields findings that support both psychodynamic concepts (e.g., Westen, 1998) and treatments. In light of the accumulation of empirical findings, blanket assertions that psychodynamic approaches lack scientific support (e.g., Barlow & Durand, 2005; Crews, 1996; Kihlstrom, 1999) are no longer defensible. Presentations that equate psychoanalysis with dated concepts that last held currency in the psychoanalytic community in the early 20th century are similarly misleading; they are at best uninformed and at worst disingenuous.
A second irony is that relatively few clinical practitioners, including psychodynamic practitioners, are familiar with the research reviewed in this article. Many psychodynamic clinicians and educators seem ill-prepared to respond to challenges from evidence-oriented colleagues, students, utilization reviewers, or policymakers, despite the accumulation of high-quality empirical evidence supporting psychodynamic concepts and treatments. Just as antipsychoanalytic sentiment may have impeded dissemination of this research in academic circles, distrust of academic research methods may have impeded dissemination in psychoanalytic circles (see Bornstein, 2001). Such attitudes are changing, but they cannot change quickly enough.
Researchers also share responsibility for this state of affairs (Shedler, 2006b). Many investigators take for granted that clinical practitioners are the intended consumers of clinical research (e.g., Task Force on Promotion and Dissemination of Psychological Procedures, 1995), but many of the psychotherapy outcome studies and meta-analyses reviewed for this article are clearly not written for practitioners. On the contrary, they are
densely complex and technical and often seem written primarily for other psychotherapy researchers — a case of one hand writing for the other. As an experienced research methodologist and psychometrician, I must admit that deciphering some of these articles required hours of study and more than a few consultations with colleagues who conduct and publish outcome research. I am unsure how the average knowledgeable clinical practitioner could navigate the thicket of specialized statistical methods, clinically unrepresentative samples, investigator allegiance effects, inconsistent methods of reporting results, and inconsistent findings across multiple outcome variables of uncertain clinical relevance. If clinical practitioners are indeed the intended "consumers" of psychotherapy research, then psychotherapy research needs to be more consumer relevant (Westen, Novotny, & Thompson-Brenner, 2005).
With the caveats noted above, the available evidence indicates that effect sizes for psychodynamic therapies are as large as those reported for other treatments that have been actively promoted as "empirically supported" and "evidence based." It indicates that the (often unacknowledged) "active ingredients" of other therapies include techniques and processes that have long been core, centrally defining features of psychodynamic treatment. Finally, the evidence indicates that the benefits of psychodynamic treatment are lasting and not just transitory and appear to extend well beyond symptom remission. For many people, psychodynamic therapy may foster inner resources and capacities that allow richer, freer, and more fulfilling lives.
Jonathan Shedler (2010) The Efficacy of Psychodynamic Psychotherapy, American Psychologist, Vol. 65, No. 2, 98–109
Tuesday, February 19, 2013
Effectiveness of Jungian Analytic Therapies
On the effectiveness and efficacy of outpatient Jungian psychoanalysis and psychotherapy
- a catamnestic study
W. Keller, G. Westhoff, R. Dilg, R. Rohner, H.H. Studt
and the study group on empirical psychotherapy research in analytical psychology
Department of Psychosomatics and Psychotherapy, University Medical Center Benjamin Franklin, Free University of Berlin
All members of the German Society for Analytical Psychology, the umbrella organization of Jungian psychoanalysts (DGAP) were asked to participate in this retrospective study. 78% anwered our request, 24.6% participated.
On the basis of their notes, the participating therapists in private practice documented all their cases (including dropouts) finished in 1987 and 1988 with a basic questionnaire regarding clinical and socio-demographic data and setting characteristics at the onset of therapy and gave a retrospective global assessment of their patients' state at the end of therapy.
Based on the applications for payment of the former therapists, in a consensus rating a retrospective ICD-10 classification was carried out by two independent raters and additionally the severity of disease before treatment was assessed using the Schepank method of impairment severity index (BSS, 1987, 1994).
In 1994 111 former patients, who finished either psychoanalysis or long-term-psychotherapy in 1987 or 1988 and who agreed to take part could be included in the study sending back a complete follow-up questionnaire consisting different self-assessments of life satisfaction, well-being, social functioning, personality traits, interpersonal problems, self rated health care utilization and some psychometric tests (SCL-90R, VEV, Gießen-Test). In 33 cases (regional sample of Berlin) a follow-up interview was carried out and an actual health status was rated by two independent psychologists trained in psychoanalysis.
Additionally objective data on utilization of health care services were recorded from health insurance companies (number of work disability days and inpatient hospital days) 5 years before and after therapy. In this comparison only those cases were included with complete pre and post data. Thus, for this calculation the sample was reduced to 47 (work disability) respective 58 (hospital days). Both subgroups did not differ from the entire sample in socio-demographic data, pre treatment characteristics or criteria of treatment success.
The selection of the follow-up sample was controlled by comparing the included patients with the total of 358 therapist documented therapies finished in 1987 and 1988 with respect to central socio-demographic and clinical characteristics. The selection of therapists participating in the study was controlled by an independent survey of all DGAP members with respect to central therapist's and setting characteristics. There was no difference in both comparisons.
Conclusion
The effectiveness of Jungian psychoanalysis and psychotherapy was determined on the basis of 5 different perspectives and different success criteria. 76% of the patients examined had had psychoanalysis so that empirical proof of the effectiveness of long-term analyses could be demonstrated after an average of 6 years. Even after 5 years, the improvement in the patients' state of health and attitude toward the disease still resulted in a markedly constant reduction of health insurance claims (work disability days, hospitalization days, doctor's visits and drug intake) in a large number of the patients treated and thus in a reduction of costs. Cost effectiveness aspects increasingly play an important role as success criteria especially for health adminstrations. As we have demonstrated in this retrospective study, psychotherapy apparently also has a long-lasting effect on the patients' health care utilization. The complete recording of these data (in Germany) requires great care and a methodologically confirmed approach toward the interpretation of these data (Richter et al. 1994). However, when these prerequisites are provided, convincing arguments for the effectiveness of psychotherapy or psychoanalysis together with the clinical results can be found even for a retrospective design.
Friday, February 15, 2013
Ferro & Foresti - Characters in Psychoanalytic Dialogue
"Every analysis session is characterized by the emergence and taking shape of stories in which "characters" of various forms and emotional depth play a significant role. These characters emerge to a greater or lesser extent from the discourse that the analytical couple develops: they supply complex and often enigmatic storylines that, in the course of the work, will prove to be more or less important and/or constant. In order for the therapeutic process to progress, the analyst must firstly try to understand the psychic function of these figures, and secondly intuit how they can be used to develop the couple's interaction and dialogue. To this aim, the therapist uses the conceptualizations and indispensable theoretical options that are the foundation of his professional and personal identity.
We believe that the interdisciplinary study of the "character" can be a useful addition to the traditional psychoanalyst's conceptual tools: the transference and the object. We will try to show the ideas that lie behind how different clinical-theoretical models of psychoanalysis look at characters...
The authors propose the use of the narratological category of "character" in psychoanalysis. They consider this notion useful in studying clinical material because it may help in making clearer the distinction between the clinical development of dialogue and the theoretical options that can be used to conceptualize the interaction. In order to facilitate theoretical comparison and effective technical integration, the authors outline three main schemes commonly found in different psychoanalytic traditions: (a) the models with a strong bias toward a reality-oriented approach, which could be defined "individual-historical;" (b) the models focused on the patient's internal world, which will be defined as "individual-phantasmatic;" and (c) the models centered on the study of the intersubjective clinical facts and usually referred to as theories of the "bipersonal psychoanalytic field." The hypothesis developed in the paper is that the characters of the psychoanalytic materials are to be considered both as a part of a text, which is endowed with a certain stability in the patient's inner world, and as a component of a dialogue that is prone to living dialectical exchanges and transformations." (p. 71)
Antonio Ferro and Giovanni Foresti (2008). "Objects" and "Characters" in Psychoanalytical Texts/Dialogues. International Forum of Psychoanalysis, Vol. 17, pp. 71-81
We believe that the interdisciplinary study of the "character" can be a useful addition to the traditional psychoanalyst's conceptual tools: the transference and the object. We will try to show the ideas that lie behind how different clinical-theoretical models of psychoanalysis look at characters...
The authors propose the use of the narratological category of "character" in psychoanalysis. They consider this notion useful in studying clinical material because it may help in making clearer the distinction between the clinical development of dialogue and the theoretical options that can be used to conceptualize the interaction. In order to facilitate theoretical comparison and effective technical integration, the authors outline three main schemes commonly found in different psychoanalytic traditions: (a) the models with a strong bias toward a reality-oriented approach, which could be defined "individual-historical;" (b) the models focused on the patient's internal world, which will be defined as "individual-phantasmatic;" and (c) the models centered on the study of the intersubjective clinical facts and usually referred to as theories of the "bipersonal psychoanalytic field." The hypothesis developed in the paper is that the characters of the psychoanalytic materials are to be considered both as a part of a text, which is endowed with a certain stability in the patient's inner world, and as a component of a dialogue that is prone to living dialectical exchanges and transformations." (p. 71)
Antonio Ferro and Giovanni Foresti (2008). "Objects" and "Characters" in Psychoanalytical Texts/Dialogues. International Forum of Psychoanalysis, Vol. 17, pp. 71-81
Friday, February 8, 2013
Donald Kalsched - Jung's Most Significant Clinical Contributions to Analytic Practice
"1. His emphasis on the primacy of affect as the central organizing principle of psychic life—instead of the drives—and how this leads to an understanding of the psyche's inherent dissociability.
2. His insistence that psychoanalysis was best conducted in a "bipersonal field" in which both partners sit face-to-face and mutually influence the result.
3. His understanding of dreams and the symbolic expressions of fantasy life as images that give form to unconsciousaffects and hence are agents of evolving consciousness, not "compromise formations." This led Jung to use various nonverbal techniques within the analytic situation, including drawing, painting, and active imagination.
4. His structural model (archetypes) of the psyche, which includes a "collective" or "psychoid" layer in which events occur that are not just psychological but psysical as well (echoing recent discoveries in both psychosomatics and atomic physics). This "magical" or "mystical" realm is the basis for religious experience and for synchronicity and other noncausal connective events otherwise known as "transgressive" or "paranormal." Many patients have religious or mystical experiences when this layer is stimulated (e.g., in the psychotic-like transferences, known in analytical psychology as archetypal transferences). To be familiar with this layer and its phenomenology is enormously helpful in supporting certain patients through a phase of deep healing." (p. 473)
Donald Kalsched. (2000). Jung's Contribution to Psychoanalytic Thought. Psychoanalytic Dialogues, Vol. 10, pp. 473-488
2. His insistence that psychoanalysis was best conducted in a "bipersonal field" in which both partners sit face-to-face and mutually influence the result.
3. His understanding of dreams and the symbolic expressions of fantasy life as images that give form to unconsciousaffects and hence are agents of evolving consciousness, not "compromise formations." This led Jung to use various nonverbal techniques within the analytic situation, including drawing, painting, and active imagination.
4. His structural model (archetypes) of the psyche, which includes a "collective" or "psychoid" layer in which events occur that are not just psychological but psysical as well (echoing recent discoveries in both psychosomatics and atomic physics). This "magical" or "mystical" realm is the basis for religious experience and for synchronicity and other noncausal connective events otherwise known as "transgressive" or "paranormal." Many patients have religious or mystical experiences when this layer is stimulated (e.g., in the psychotic-like transferences, known in analytical psychology as archetypal transferences). To be familiar with this layer and its phenomenology is enormously helpful in supporting certain patients through a phase of deep healing." (p. 473)
Donald Kalsched. (2000). Jung's Contribution to Psychoanalytic Thought. Psychoanalytic Dialogues, Vol. 10, pp. 473-488
Tuesday, February 5, 2013
John Fiscalini - Coparticipant Inquiry
"Two paradigms have dominated psychoanalytic praxis: the classical model that views the impersonal analyst as objective mirror, and the interpersonal-relational model that views the analyst as intersubjective participant-observer. A shift in psychoanalytic consciousness, however, has been taking place, giving rise to coparticipant inquiry, a third paradigm that integrates the individualistic emphasis of classical theory and the social focus of participant-observation, avoiding the reductionism of each. This new perspective, which is rooted in the radical teachings and clinical experiments of Sandor Ferenczi and the early writings of Benjamin Wolstein, presents a significantly different concept of analytic data, technique, and process, and a different perspective on the nature of analytic participation. This essay articulates the seven guiding principles of coparticipant inquiry and reviews their implications for such analytic issues as transferernce and countertransferenceanalysis, defenseanalysis, the therapeutic role of immediate experience, the uses of self-disclosure, and the curative effects of the living through process. The clinical dialectics of the interpersonal and the personal dimensions of the coparticipant self are examined. The inherent mutuality, bidirectionality, psychic symmetry, egalitarianism and dyadic uniqueness of coparticipant inquiry and its implications for analytic work are examined. In all this, the unifying theme is that of psychoanalytic inquiry as a personal encounter." (p. 437)
"As a concept of inquiry, coparticipation represents a clinical philosophy, a way of living psychoanalysis, rather than a defined set of prescribed techniques, clinical strategies, or rules of praxis.
Coparticipant inquiry is not exclusively associated with any one school of psychoanalysis, though it has been most fully developed in the interpersonal school, and, more recently, in post-Kohutian intersubjective psychoanalysis and other relational offshoots. The most comprehensive expression of coparticipant inquiry is that form of inquiry that is practiced by those analysts who make up the "radical empiricist" wing of contemporary interpersonal psychoanalysis(Fiscalini, 2004).
One may ask, Why use the term coparticipation instead of simply using a better-known, less awkward, term? I use the rubric coparticipation to emphasize the intrinsic mutuality, motivational reciprocity, psychic symmetry, coequality of analytic authority, and participatory bidirectionality of the analytic relationship.
Any psychoanalytic dyad or member of that dyad, out of personal reserve, individual inclination, or obsessional need for control, may proscribe inquiry into particular aspects of their coparticipant functioning and experience. There is, in such instances, an ongoing, continuing Co-participant process, but not a full coparticipant inquiry in that process. Nevertheless, in the coparticipant experience formed by the two copartners, they each, inevitably bring all of themselves into the analytic situation, whether or not this is recognized, acknowledged, or worked with. In other words, all analyses are coparticipant processes, but not all are Co-participant inquiries.
Coparticipant inquiry, the therapeutic use of coparticipant concepts, is premised on seven interrelated principles:
(1) The analytic situation is seen as an interpersonal field within which patients and analysts mutually create a shared field of experience. The coparticipants together forge a dyadic encounter unique to them, conjointly shaping the individual course and nature of their relationship.
(2) Analytic relatedness is seen as a working dialectic between interpersonal processes (intersubjectivity) and personal processes (unique individuality)—between, in other words, social adaptiveness and individual self-expressiveness. This brings to psychoanalytic practice a concept of a personal, nonrelational self in dynamicrelation to an interpersonal self, or "me" pattern. With the concept of personal "I" processes, of unique individuality and capability, such concepts as will, choice, self-determination, and agency come into analytic play. Too, the range of analytic metapsychologies expands to include personal fulfillment, or self-actualization, as a central dynamic.
(3) Analysts and patients are treated as analytic equals, co-analysts. Both analyst and patient are seen as continuously involved (to the best of their ability and desire) in the analysis of their transferential, resistant, and anxious co-participation with each other. Thus patients are actively encouraged to take a proactive role as analytic copartners. Therapeutic exploration, observation, confrontation, and interpretation are considered bidirectional and conjoint processes.
(4) Patients' personal and interpersonal responsiveness, responsibility, and resourcefulness are recognized and emphasized. Patients and analysts alike are seen as both open to interpersonal influence and as simultaneously self-determining, having final responsibility for their life choices.
(5) Metapsychological (interpretive) and methodological (technical) pluralism is emphasized. A radical individuation of interpretive myth and metaphor and of analytic method is encouraged. Given the psychic uniqueness of patient and analyst, and by extension, the dyadic uniqueness of their analytic relationship, it follows quite naturally that coparticipant inquiry calls for a radical individuation of metapsychologies. An even more radical, and potentially liberating, implication of coparticipation inheres in the assertion of a radical individuation of methodologies—that there is no right or proper or "standard" technique or form of inquiry that fits all.
(6) A technically freer, more self-expressive, and spontaneous inquiry is supported.
(7) The therapeutic importance of immediate experience in psychoanalytic exploration and the curative impact of new relational experience is emphasized, as opposed to the traditional focus on the curative primacy of formulative interpretation.
These characteristics or features of coparticipant inquiry comprise a view of the analysts expertise as residing, not in his or her "expert" knowledge of psychodynamics or "proper" technique, but in his or her capacities for facilitating and participating in an alive, creative, and imaginative inquiry." (pp. 441-443)
John Fiscalini (2006). Coparticipant Inquiry: Analysis as Personal Encounter. Contemporary Psychoanalysis, Vol. 42, pp. 437-451
"As a concept of inquiry, coparticipation represents a clinical philosophy, a way of living psychoanalysis, rather than a defined set of prescribed techniques, clinical strategies, or rules of praxis.
Coparticipant inquiry is not exclusively associated with any one school of psychoanalysis, though it has been most fully developed in the interpersonal school, and, more recently, in post-Kohutian intersubjective psychoanalysis and other relational offshoots. The most comprehensive expression of coparticipant inquiry is that form of inquiry that is practiced by those analysts who make up the "radical empiricist" wing of contemporary interpersonal psychoanalysis(Fiscalini, 2004).
One may ask, Why use the term coparticipation instead of simply using a better-known, less awkward, term? I use the rubric coparticipation to emphasize the intrinsic mutuality, motivational reciprocity, psychic symmetry, coequality of analytic authority, and participatory bidirectionality of the analytic relationship.
Any psychoanalytic dyad or member of that dyad, out of personal reserve, individual inclination, or obsessional need for control, may proscribe inquiry into particular aspects of their coparticipant functioning and experience. There is, in such instances, an ongoing, continuing Co-participant process, but not a full coparticipant inquiry in that process. Nevertheless, in the coparticipant experience formed by the two copartners, they each, inevitably bring all of themselves into the analytic situation, whether or not this is recognized, acknowledged, or worked with. In other words, all analyses are coparticipant processes, but not all are Co-participant inquiries.
Coparticipant inquiry, the therapeutic use of coparticipant concepts, is premised on seven interrelated principles:
(2) Analytic relatedness is seen as a working dialectic between interpersonal processes (intersubjectivity) and personal processes (unique individuality)—between, in other words, social adaptiveness and individual self-expressiveness. This brings to psychoanalytic practice a concept of a personal, nonrelational self in dynamicrelation to an interpersonal self, or "me" pattern. With the concept of personal "I" processes, of unique individuality and capability, such concepts as will, choice, self-determination, and agency come into analytic play. Too, the range of analytic metapsychologies expands to include personal fulfillment, or self-actualization, as a central dynamic.
(3) Analysts and patients are treated as analytic equals, co-analysts. Both analyst and patient are seen as continuously involved (to the best of their ability and desire) in the analysis of their transferential, resistant, and anxious co-participation with each other. Thus patients are actively encouraged to take a proactive role as analytic copartners. Therapeutic exploration, observation, confrontation, and interpretation are considered bidirectional and conjoint processes.
(4) Patients' personal and interpersonal responsiveness, responsibility, and resourcefulness are recognized and emphasized. Patients and analysts alike are seen as both open to interpersonal influence and as simultaneously self-determining, having final responsibility for their life choices.
(5) Metapsychological (interpretive) and methodological (technical) pluralism is emphasized. A radical individuation of interpretive myth and metaphor and of analytic method is encouraged. Given the psychic uniqueness of patient and analyst, and by extension, the dyadic uniqueness of their analytic relationship, it follows quite naturally that coparticipant inquiry calls for a radical individuation of metapsychologies. An even more radical, and potentially liberating, implication of coparticipation inheres in the assertion of a radical individuation of methodologies—that there is no right or proper or "standard" technique or form of inquiry that fits all.
(6) A technically freer, more self-expressive, and spontaneous inquiry is supported.
(7) The therapeutic importance of immediate experience in psychoanalytic exploration and the curative impact of new relational experience is emphasized, as opposed to the traditional focus on the curative primacy of formulative interpretation.
These characteristics or features of coparticipant inquiry comprise a view of the analysts expertise as residing, not in his or her "expert" knowledge of psychodynamics or "proper" technique, but in his or her capacities for facilitating and participating in an alive, creative, and imaginative inquiry." (pp. 441-443)
John Fiscalini (2006). Coparticipant Inquiry: Analysis as Personal Encounter. Contemporary Psychoanalysis, Vol. 42, pp. 437-451
Saturday, February 2, 2013
James A. Hall, M.D.: 1934-2013
James A. Hall, M.D.
died at his home in Dallas, Texas on January 22, 2013, after living for almost
22 years with “locked-in” syndrome as the result of a stroke in 1991. Dr. Hall graduated from Southwestern Medical
School in 1961. After a residency
in Psychiatry at Duke Medical School and Hospital, he served as a Captain in
the U.S. Army at Fort Bragg, North Carolina, from 1965 to 1968. In 1968, he moved to Zürich, Switzerland, to
pursue certification as a Jungian psychoanalyst at the C. G. Jung Institute -
graduating in 1972.
Dr. Hall was the author
of seven books in the field of Jungian psychology: 1) Clinical Uses of Dreams: Jungian Interpretations and Enactments, 2)
The Unconscious Christian: Images of God
in Dreams, 3) Hypnosis: A Jungian Perspective, 4) The Jungian Experience: Analysis and Individuation, 5) Jungian Dream Interpretation: A Handbook of
Theory and Practice, 6) Patterns of
Dreaming: Jungian Techniques in Theory and Practice, 7) Locked in to Life (with Patton
Howell). He also authored many
articles on Jungian psychoanalysis and was a well regarded lecturer on the same.
In addition to his private practice, Dr. Hall was Associate Professor of Psychiatry at Southwestern Medical School and Adjunct Professor of Psychology at Perkins School of Theology. He was a member of the Texas Medical Society, the American Psychiatric Association, and the American Society for Clinical Hypnosis. Dr. Hall was also a founding member of the Inter-Regional Society of Jungian Analysts; the National Association for the Advancement of Psychoanalysis; the Dallas Group Psychotherapy Training Institute; and the Dallas Training Seminar of the Inter-Regional Society of Jungian Analysts.
Subscribe to:
Posts (Atom)