Homework assignments in relational psychoanalytic treatment of personality disorders: A case study of a patient with narcissistic personality disorder.

Homework assignments, or specific tasks patients are asked to engage in or complete between sessions, are a controversial topic among psychoanalysts. While many argue these interventions contradict psychoanalytic principles, others believe they can help address problems and promote coping skills. We propose that homework can be a legitimate aspect of relational psychoanalysis when used in a way that is attuned to the patient's experience and that homework may be an important component of treating personality disorders (PD). We present the case of a man diagnosed with narcissistic PD. He often felt superior to and reported that he despised others, though the core self-image was of fragile. He embraced the role of the omnipotent caregiver, which came with boredom and anger and lack of satisfaction in his social life. The patient tried to control therapy, asserting that he could psychoanalyze himself. As a result, therapy was stalled and progress was limited. At this point, the therapist asked him to complete homework assignments that encouraged him to refrain from his compulsive caregiving to better understand what motivated this behavior. Through this process, the patient came to realize he acted out of avoidance, as he did not want to disclose his own vulnerabilities and flaws. At that point he was able to experience relationships while adopting different stances and finding new meanings. We argue that homework can be fully integrated into the relational psychoanalytic repertoire to improve self-reflection and foster change in patients with PD.

Psychological Approach in the Interpretation of 20th Century Kazakh Postmodern Literature.

The aim of the study is to analyse contemporary postmodern literary works of Kazakhstan through the conceptual prism of Freudian and Jungian psychoanalysis. To achieve research goals, the following methods were used: axiomatic, content analysis, and comparative. The results of the study determined that contemporary Kazakh writers characterise a large field of motives and ideas that are revealed through text, symbols, and characters. Strong tools for their interpretation were the psychological approaches of Freud and Jung, which are the standards of psychoanalysis and have their own specific features of semantic content. Content analysis of postmodern materials has established that Kazakh stories trace the motives of mythology, religion, relationships and inner spiritual development, which consider the mental differences of the heroes of the storylines. During the psychoanalysis of the works, it was emphasised that postmodernism in the literature of Kazakhstan reflects the rejection of absolute truths, blurring the boundaries between genres, playing with traditional forms and content. Many of the characters in the stories are experiencing an identity crisis, which has been analysed through the Freudian triad and Jung's archetypal images. Kazakh literature, being woven into the cultural and historical heritage of the nation, reflects the features of mentality, socio-cultural transformations, identity and spiritual quest of heroes.

A misinterpreted psychoanalyst: Herbert Silberer and his theory of symbol-formation.

The primary aim of this article is to give a more detailed exposition of the cultural, personal, and theoretical contexts in which the Viennese psychoanalyst, Herbert Silberer's theories were born. When assessing the broader picture that this approach offers, it can be concluded that Silberer was an innovative thinker who inspired several of his contemporaries. Recognized in many respects by the society and scholars of this time, he represented quite a different viewpoint that was significantly influenced by several forms of Western esoteric thinking. Yet his main aim was to contribute to the field of psychoanalysis and develop a theory in which rationalistic psychoanalytic interpretations were combined with nonreductive approaches to mystical experiences. Silberer's name is frequently mentioned in a specific context in which his tragic suicide is emphasized rather than his innovations. Upon evaluating the materials recording Silberer's private life, it seems very likely that his suicide was not triggered by the criticism of Freud alone. Silberer's family affairs, his relationship with his father, and his financial and professional struggles could have all contributed to his tragic decision. This paper contends that Silberer's oeuvre deserves greater attention and must be evaluated based upon its own merit.

Engaging with the unknown: How Judaism enabled Freud's psychological discoveries.

A large literature has formed around the question of how Freud's Jewishness and/or Judaism influenced his psychological discoveries and development of psychoanalytic theory and methods. The article organizes the literature into several core theses but brings new clarity and insight by applying two essential criteria to demonstrate an impact of Judaism on Freud's thinking: direct content and historical timing. First, there should be evidence that Freud incorporated actual content from Jewish sources, and second, this incorporation must have occurred during the most crucial period of Freud's early discovery, conceptualization, and development of psychoanalysis, roughly 1893-1910. Thus, for example, Bakan's well-known theory that Freud studied Kabbala is completely negated by the absence of any evidence in the required time period. Part I reviews the literature on the influence of Freud's ethnic/cultural Jewish identity. Part II introduces the Judaic sacred literature, explores Freud's education in Judaism and Hebrew, and presents evidence that Freud had the motive, means, and resources to discover and draw from the "Dream Segment" of the Talmud-along with the traditional Judaic methods and techniques of textual exegesis. Freud then applied these same Judaic word-centered interpretive methods-used for revealing an invisible God-to revealing an invisible Unconscious in four successive books in 1900, 1901, and 1905.

The neglected object: A history of the concept of dreams in Polish psychiatry and psychology in the interwar period, 1918-1939.

The development of the concept of dreams in interwar Polish psychiatry and psychology was influenced by Western European concepts as well as by sociocultural factors of the newly independent state. Few Polish psychiatrists addressed the subject of dreams. They were influenced mainly by Sigmund Freud's psychoanalytic concept of dreams, but also by Alferd Adler's, Carl Gustav Jung's, and Wilhelm Stekel's ideas. Nevertheless, they approached psychoanalysis critically. The most comprehensive concept of dreams in Polish psychiatry was oneiroanalysis by Tadeusz Bilikiewicz. Oneironalysis was a method of dream analysis based on psychoanalysis but it rejected the psychoanalytic method of free associations and challenged psychoanalytic approaches to the interpretation of dream symbols. Polish psychologists were even less interested in dreams than psychiatrists. Problems with dreams, the most elaborate psychological work by Stefan Szuman consisted of an outline of epistemological problems with general theories of dreams and a harsh critique of psychoanalysis. The neglect of the subject of dreams in Polish psychiatric society can be seen as connected with the social and professional reception of psychoanalysis in Poland. Psychoanalysis was met with opposition from conservative scholars and publicists presenting nationalistic and anti-Semitic attitudes. It was also criticized by the biologically oriented majority of psychiatrists of the Polish Psychiatric Association. In the case of psychology, the most influential Polish psychological school, Lvov-Warsaw School, promoted Brentanian intentionalism, introspection, and psychology of consciousness, therefore, leading to psychologists' reluctance to explore unconscious states like dreams.

Child development, film evidence, and epidemiological sciences: Elwyn James Anthony and the 1957 Zurich International Congress of Psychiatry.

In 1957, the British-Indian child psychiatrist Dr Elwyn James Anthony travelled to the Zurich International Congress of Psychiatry to show a film featuring 70 children with such complex symptomatology and behaviour that they betrayed the certainty of contemporary theories of developmental psychology and psychoanalysis. This article examines the significance of Anthony's film to the creation of new scientific models in international developmental psychology and psychiatric epidemiology. It marked a significant change in the use of filmed evidence that sought to create a truly global and universalist approach to atypical child development based purely on scientific observations. This new observational work was important in shaping new internationally ratified models to study the epidemiology of children's psychiatric conditions.

Trauma: open concept.

This paper presents and discusses two sets of theories concerning trauma. The first involves a contemporary social theory of "cultural trauma" and the second refers to psychoanalytic theories on psychic trauma. We argue that these two groups of theories have some relevant elements in common, despite social theorists' critique of psychoanalytic understanding on the matter. In our view, the most important meeting points between these groups of theories concern (a) the possibility to think that trauma is not welded to events but has a formation process, one of attribution of meaning, (b) that this process has a temporality of its own, and (c) that the environment (the objects, actors, and agents that compose it) has a fundamental and determinant role in trauma formation. Further, we suggest that trauma is still an open concept in psychoanalysis.

Soft diamonds: poetic sentiment, poetic speech, and poetic specimen in the clinical hour.

Three links between poetry and psychoanalysis are highlighted in this paper. These refer to the presence, in the clinical hour, of (i) poetic sentiment, (ii) poetic speech, and (iii) poetic specimen. Each is elucidated in detail and with the help of socio-clinical vignettes. The aim of the paper is to demonstrate that, through the affirmative holding and partial unmasking of the instinctual-epistemic conflation in verse and free-association, both poetry and psychoanalysis seek to transform the private into shared, the hideous into elegant, and the unfathomable into accessible.

Somatization and symbolization.

Psychoanalysis had its origins in an era when feelings that could not be recognized by the mind were being manifested in the body. Psychoanalysis works towards resolving this type of split by recognizing the existence of a dual language structure that includes both body and mind as constituents of the fabric of embodied meanings. The field of psychosomatics helps to provide keys to this language, marking the essential, patterned truths that are recognized at very basic levels and increasingly organize our perceptions as we make sense of the world. In disrupting the integration of embodied meanings, trauma impedes identity development. For some patients, learning to make meaning from somatic symptoms is an important adjunct to coming to know their own embodied experience. Two cases will be offered in which somatic symptoms provided important information that was channeled through the analytic experience as a way of making sense of what otherwise remained unknown.

BACK TO THE FUTURE WITH SENECA'S PRACTICAL PHILOSOPHY IN MIND.

This paper regards Seneca's practical philosophy as ancestor to psychoanalytically informed psychotherapy and as a progenitor of ongoing contemporary praxis in applied ideas of mind. Facing forward into the Anthropocene, as psychoanalysis encounters Artificial Intelligence, the convergence with contemporary psychoanalytic psychotherapy of value concepts developed from Antiquity is discussed. Drawn from Seneca's Letters on Ethics, constellations of significant ideas present in ancient practical philosophy resonate with similar configurations developed two millennia later, and central to the practice of contemporary psychotherapy.

When psychoanalytic dyads are forced into the virtual world.

The Covid pandemic changed the daily routines for millions of people. This was the case for those who were gainfully employed, especially for those who work as psychoanalysts and psychodynamic psychotherapists. At least for a good while, the practice of psychotherapy and psychoanalysis moved from the consulting room to the virtual world of the internet. The author explores the impact virtual therapy had on three different patients. One began a three time a week analysis during the pandemic. The duo met virtually for a year and a half before their first in person meeting. The other two patients had begun twice a week analyses a few years before the pandemic, met virtually for two years, until in person sessions restarted. The patients and the author describe their experiences.

The elephant in the zoom: will psychoanalysis survive the screen?

While screen-mediated analysis long predated the pandemic, it was largely seen as non-equivalent to in-person treatment by analysts and patients alike. When COVID forced us to move our entire practices to the screen, our concerns about its limitations were replaced by relief; we could continue doing analytic work during a terrifying and challenging time. Three years later, many have chosen to continue practicing remotely for reasons that are no longer driven by fears of exposure. We mostly minimize or deny our earlier concerns about the limitations of screen work. Have we chosen convenience, ease, and a personal sense of safety over togetherness, while ignoring the underbelly of remote work? This paper identifies the convergence of several forces underlying our decision to stay remote, including guilt and anxiety about privileging our own self-interest, unmourned losses and collective PTSD, fear of the future and existential anxiety about living in a techno-culture that threatens to replace us. Our denial of these powerful forces makes it easy to rationalize a decision to embrace remote work and disavow the threat it poses to our field.

[The controversial election of Amsterdams first professor in child psychiatry]. / De controversiële benoeming van Amsterdams eerste hoogleraar Kinderpsychiatrie.

BACKGROUND: The history of psychiatry is also determined by the choice of full professors. The appointment of mrs. dr. E.C.M. Frijling-Schreuder in 1965 as the first full professor in child psychiatry at the University of Amsterdam was controversial. She was not a psychiatrist. Furthermore, a successful lecturer in child psychiatry was already present at the university for ten years, dr. F. Grewel. AIM: Investigating the motives of the appointment and how it came about. METHOD: Consulting literature and archives. RESULTS: The psychiatry professor at the same university, dr. P.C. Kuiper, put forward dr. Frijling-Schreuder, with whom he was in psychoanalysis at the time. To enable this, an academic sidetrack was created for dr. Grewel – an appointment as professor in orthopedagogy. CONCLUSION: In choosing a professor in child psychiatry at the University of Amsterdam in 1965 a psychoanalytical stance was of more significance than child psychiatric expertise.

Obra completa. Del psicoanálisis a la psicología social.

Reseña de la obra completa de Enrique Pichon-Rivière. Del psicoanálisis a la psicología social, 1967-1977. Establecimiento, Introducción y Notas: Fernando Fabris, con la colaboración de Joaquín Pichon-Rivière. Paidós, 2023.

The multi-level outcome study of psychoanalysis for chronically depressed patients with early trauma (MODE): rationale and design of an international multicenter randomized controlled trial.

BACKGROUND: Whether and how psychotherapies change brain structure and function is unknown. Its study is of great importance for contemporary psychotherapy, as it may lead to discovery of neurobiological mechanisms that predict and mediate lasting changes in psychotherapy, particularly in severely mentally ill patients, such as those with chronic depression. Previous studies have shown that psychoanalytic psychotherapies produce robust and enduring improvements in not only symptom severity but also personality organization in patients who have chronic depression and early life trauma, especially if therapy is delivered at a high weekly frequency. METHODS/DESIGN: Patients with chronic major depression and a history of early life trauma will be recruited, assessed, and treated across 3 international sites: Germany, Switzerland, and the United States. They will be randomized to one of two treatment arms: either (1) once weekly psychoanalytic psychotherapies, or (2) 3-4 times weekly psychoanalytic psychotherapies. They will have full clinical characterization as well as undergo MRI scanning at study baseline prior to randomization and again one year later. A group of matched healthy controls will undergo similar assessments and MRI scanning at the same time points to help discern whether study treatments induce brain changes toward or away from normal values. Primary study outcomes will include anatomical MRI, functional MRI, and Diffusion Tensor Imaging measures. Study hypotheses will be tested using the treatment-by-time interaction assessed in multiple general linear models with repeated measures analyses in an intent-to-treat analysis. DISCUSSION: MODE may allow the identification of brain-based biomarkers that may be more sensitive than traditional behavioral and clinical measures in discriminating, predicting, and mediating treatment response. These findings could help to personalize care for patients who have chronic depression patients and early life trauma, and they will provide new therapeutic targets for both psychological and biological treatments for major depressive illness.

From Interactive Regulation in Infancy to Relationship-Focused Interventions.

In interaction with their mother, infants not only learn how human relationships work, but - on an even more basic level - the continuous bidirectional, interactive regulation between mother and infant shapes the infant's socioemotional development. Coordinated interactions alternate with uncoordinated ones, the latter resulting in momentary ruptures during this dyadic exchange. Usually, these are quickly repaired. The mother's capacity for engaging with her infant in a sensitive and appropriate manner is crucial for successful socioemotional development. On a transgenerational level, a mother will draw on her own relational experiences - embodied as implicit memory - when interacting with her baby. Thus, comprehensive and effective treatment of maternal postpartum disorders that often impair the mother's interactive skills and capacity for maternal bonding is of great importance. One aim of modern mother-infant treatment is to target dysfunctional interactive patterns, often with the help of video feedback and microanalysis of behavioral observations. In this paper, after giving an overview of affective regulation in mother-infant dyads and the role of maternal factors and postpartum mental health, we describe relationship-focused approaches to mother-infant treatment. Our focus lies on video feedback and body-oriented interventions. We also explore classical as well as contemporary theoretical underpinnings in mother-infant research and how psychoanalytic concepts like containment and mentalization not only enrich approaches to mother-infant treatment but also adult treatment in general. We conclude that working with and expanding one's own implicit relational knowledge is central for the therapeutic process and can be initiated by video-based interventions or by genuinely experiencing and reflecting on interactions in dyads and groups.

The Dreamwork of the Symptom: Reading Structural Racism and Family History in a Drug Addiction.

A key tenet of critical health research is that individual symptoms must be considered in light of the social and political contexts that shape or, in some cases, produce them. Precisely how oppressive social forces give rise to individual symptoms, however, remains challenging to theorize. This article contributes to debates over the interpretation of symptoms through a close reading of the case of Leon, an African American man struggling with an addiction to crack cocaine. Leon presented a complex illness narrative in which his addiction was clearly a product of structural racism, but also the result of dynamics within his family. Drawing on critical reevaluations of Freud's concept of the dreamwork, I call attention to the surface elements of Leon's narrative-what I term the surface of the symptom-and to the formal mechanisms by which latent contents (such as the social, the political, and the personal) are transformed into the manifest form of his symptom. This formal mode of reading offers a productive way of approaching questions of demystification and interpretation, one that holds in tension the register of social causation with the singularities of individuals and their symptoms.

[Online Therapy as an Add-on to Psychoanalysis? What Needs for Online Therapy Modules do Psychodynamic Psychotherapists in Private Practice Express for Their Outpatient Work?] / Online-Therapie zusätzlich zur Psychoanalyse? Welche Bedarfe formulieren niedergelassene psychodynamische Psychotherapeut:innen an Online-Therapie Module für ihre ambulante Arbeit?

OBJECTIVE: In recent years, psychotherapists have been increasingly confronted with the challenge of meeting treatment needs efficiently with limited time resources and at the same time achieving stable treatment success in the long term. One way to address this is to integrate Internet-based interventions (IBI) into outpatient psychotherapy. While there is a lot of research on IBI based on cognitive-behavioral therapy, little is known about the same for psychodynamic treatment models. Therefore, the question will be answered as to what specific online modules would need to look like that psychodynamic psychotherapists would use in their outpatient practice to support their regular face-to-face therapies. METHODS: In this study, 20 psychodynamic psychotherapists were asked about their requirements on the content of online modules that could be integrated into outpatient psychotherapy, using semi-structured interviews. The transcribed interviews were analyzed using Mayring's qualitative content analysis. RESULTS: Results showed that some psychodynamic psychotherapists already use exercises or materials which could be transferred into the online format. In addition, general requirements about online modules emerged, such as an easy handling or a playful character. At the same time, it became clear when and with what kind of patient groups online modules would be integrated into psychodynamic psychotherapy. DISCUSSION: The interviewed psychodynamic psychotherapists considered it an attractive approach to offer online modules as a supplement to psychotherapy and in a broad spectrum of content. They gave practical advice for the design of possible modules, both on the level of general handling and regarding concrete contents, words, and ideas. CONCLUSION: The results contributed to the development of online modules for use in routine care, the effectiveness of which will be investigated in a randomized controlled trial in Germany.

The poisoned father: Jane Campion's The Power of the Dog and the unexpected relevance of Lacan to psychiatric practice.

OBJECTIVE: Lacan is often deemed an obscure theorist with little clinical application. However, in film studies his psychoanalytic theory has been highly influential. This paper is part of a series of articles published in this journal accompanying a psychiatry registrar teaching programme on film and psychodynamic concepts. It introduces the Lacanian ideas of the Symbolic, Imaginary and Real as they appear in Jane Campion's The Power of the Dog, and discusses their societal and clinical significance. CONCLUSIONS: A Lacanian reading of Power of the Dog offers insights into 'toxic masculinity'. Furthermore, it demonstrates how clinical symptoms can represent an escape from socially mediated toxicities.

Observing and interpreting clinical process: Methods and findings from 'Layered analysis' of parent-infant psychotherapy.

This paper describes a method for investigating clinical process, Layered Analysis, which combines therapist countertransference reports and multi-faceted microanalytic research approaches. Findings from the application of Layered Analysis to video-recorded micro-events of rupture and repair in four psychoanalytic parent-infant psychotherapy sessions are presented. Layered analysis showed that countertransference and observation are complementary perspectives, which enable concomitant study of interactive events, conscious internal experiences, as well as nonconscious and unconscious elements of therapeutic interaction. Interactional rupture and repair were found to constitute co-constructed micro-events that occurred fleetingly and often implicitly, and differed in the structure, coherence and flow of interactions and in the relationship between verbal and nonverbal communication. Furthermore, interactional ruptures were found to sometimes 'get into' the therapist and transiently disrupt their self-organization, such that the therapist became a locus of disruption for the patient(s), actively contributing to the rupture, which thus became embedded in the therapeutic system. Interactive repair was found to be most often initiated by the therapist and to be underpinned by the therapist re-establishing self-regulation, through metabolizing embodied and verbal aspects of the rupture. Studying such processes can enhance our understanding of clinical process, inform therapist training and clinical supervision, and contribute to clinical outcomes.

Este ensayo describe un método para investigar un proceso clínico, Análisis en Capas, el cual combina los reportes de contratransferencia del terapeuta y los acercamientos investigativos micro analíticos multifacéticos. Se presentan los resultados de aplicar Análisis en Capas a micro eventos, grabados en video, de ruptura y reparación en cuatro sesiones de sicoterapia sicoanalítica de progenitor e infante. Los Análisis en capas mostraron que la contratransferencia y la observación son perspectivas complementarias que, en combinación, permiten el estudio concomitante de eventos interactivos, experiencias internas conscientes, así como elementos no conscientes de la interacción terapéutica. Adicionalmente, los resultados mostraron que la ruptura y la reparación constituyen micro eventos co-construidos que ocurren muy fugazmente y a menudo implícitamente, y que difieren en la estructura, coherencia, flujo de interacciones y en la relación entre la comunicación verbal y no verbal. Es más, rupturas interaccionales pueden 'meterse en' el terapeuta y transitoriamente interrumpir su autoorganización, de manera que el terapeuta se convierte en un punto de interrupción para el paciente y la ruptura pasa a ser parte del sistema terapéutico. La reparación interactiva está sostenida por, y depende de, la metabolización del terapeuta de los aspectos incorporados y verbales de la ruptura. Estudiar tales procesos puede mejorar nuestra comprensión del proceso clínico y ser usado en entrenamiento y supervisión de terapeutas.

Cet article décrit une méthode d'investigation du processus clinique d'Analyse Multidimensionnelle en Couches, qui combine des rapports de contre-transfert du thérapeute et des approches de recherche micro-analytique à facettes multiples. Les résultats de l'application de l'analyse multidimensionnelle en couches à des micro-événements enregistrés à la vidéo de rupture et de réparation dans quatre séances de psychothérapie psychanalytiques parent bébé sont présentés. L'analyse multidimensionnelle en couches a montré que le contre-transfert et l'observation sont des perspectives complémentaires qui, combinés l'un avec l'autre, permettent une étude concomitante d'événements interactifs, d'expériences internes conscientes et d'éléments non-conscients de l'interaction thérapeutique. De plus, les résultats ont montré que la rupture et la réparation constituent des micro-événements co-construits, qui se passent très fugacement et souvent implicitement et diffèrent en structure, cohérence et flux des interactions et dans la relation entre la communication verbale et non verbale. Enfin les ruptures interactionnelles peuvent 'entrer' dans le thérapeute et perturber de façon transitoire leur auto-organisation, de telle manière que le thérapeute devient le locus de la perturbation pour le/la/les patient(e/s) et la rupture s'encastre dans le système thérapeutique. La réparation interactive est étayée par, et elle en dépend également, la métabolisation d'aspects verbaux et incarnés de la rupture du thérapeute. L'étude de tels processus peut améliorer notre compréhension du processus clinique et être utilisée dans la formation et la supervision des thérapeutes.