[Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government]. / Unterstützung von Kindern mit psychisch erkrankten Eltern: Stand der Forschung, Vorstellung von zwei Praxisprojekten und Forderungen an die Bundesregierung.

Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government Children of parents with a mental illness (COPMI) are at an increased risk to develop (severe) mental disorders (SMI) themselves. Estimates for Germany result in about 25 % of COPMI. This is thus a large and high risk group. On the other hand, prevention programs for COPMI are still scarce, especially in Germany, and central features of the transgenerational transmission of mental disorders have not been studied in conjunction to shed light on potential transmission mechanisms. The current article presents two current research projects on COPMI focusing on preventive approaches. The BMBF funded project "Children of Parents with a Mental Illness At Risk Evaluation" (COMPARE) targets parents of children aged 1.5 to 16 years of age. Parents need to fulfil a current DSM-5 based diagnosis of a mental disorder and then receive either 25-45 sessions gold standard cognitive behavioural therapy (CBT) or CBT plus 10 sessions Positive Parenting Program (PPP) to test the effects of parental therapy on the children and whether an additional parent training results in incremental effects above and beyond CBT alone. The project "The Village" is a model project in the region Tyrol, Austria, targeting the improved identification and collaborative care of COPMI.

The affective basis of violence.

Violence is a complex matter, and understandingly perhaps, it is the objective, behavioral aspects that are commonly focused on. Here, however, it is the subjective psychological and especially affective substrates of violence that are brought to the fore. Psychoanalytic perspectives provide a way of thinking about these that also sets them in a human-developmental context. In this essay, psychoanalytic ideas about aggression and violence are considered, and what they have to say about the relationship between states of mind and behavior is critically reviewed. There also is an exploration of the ways that some recent findings in developmental science and neuroscience can refine and augment an understanding of these relationships, facilitating the construction of a psychobiological model, which may be placed in a social context. From this biopsychosocial perspective, aggression is seen as a heuristic concept that encapsulates numerous interacting elements that in ordinary development integrate and serve to promote optimal organism survival: By contrast, from this perspective, in humans violence may be understood as a pathological variant of aggression.

Healthy narcissism and individuation - clinical, cultural and political manifestations.

This paper explores the healthy narcissism related to self-expression and looks at how this is frequently pathologized and split-off, with problematic consequences for the individual and for culture. This is explored through Yeats' poem, 'The Second Coming', as are other personal, cultural and clinical manifestations, with a split evident between those who advocate self-denial and those who are 'full of passionate intensity' and seen as narcissistic. The paper argues that the process of individuation requires us to embrace a multiplicity of self-states, and thus a broadening of ego-identifications, including states of vulnerability, self-denial, self-centredness, murderousness and power, in contrast to the unworkable unitary identifications of previous eras, where such states were projected onto scapegoat groups in, for example, racism. The neurobiological underpinnings of the core self are outlined which, the paper argues, help us better understand and accept the broad range of narcissistic phenomena. Embracing guilt, out of care and concern as described by Loewald (1979), and thus addressing states of both passive and active blindness to the other, allows us to put a 'human head on the lion's body', described in Yeats' poem. Some clinical manifestations and dynamics are also outlined.

Cet article explore le bon narcissisme, qui est en lien avec l'expression de soi. L'article observe comment cela est fréquemment considéré comme pathologique et clivé, avec des conséquences problématiques pour l'individu et la culture. Ceci est examiné à travers le poème de Yeats « La Seconde Venue ¼, comme le sont d'autres manifestations personnelles, culturelles et cliniques, avec un clivage évident entre ceux qui se font l'avocat du déni de soi et ceux qui sont « plein d'intensité passionnée ¼ et considérés comme narcissiques. L'article soutient que le processus d'individuation nous demande d'englober une multiplicité d'états de soi, et ainsi un élargissement d'identifications du moi, qui incluent des états de vulnérabilité, de déni de soi, de centration sur soi, de puissance et d'envie de meurtre, en contraste avec les identifications d'époques précédentes, unitaires et impraticables. Dans ces époques précédentes de tels états furent projetés sur des groupes pris comme boucs émissaires, par exemple dans le racisme. Les fondations neurobiologiques du noyau du soi sont exposées dans les grandes lignes afin, comme le soutient l'article, de nous aider à mieux comprendre et à accepter le vaste panorama des phénomènes narcissiques. Accepter pleinement la culpabilité, motivée par le soin et la sollicitude - tels qu'ils sont décrits par Loewald (1979) - et ainsi s'occuper d'états passifs et actifs d'aveuglement à l'autre, nous permet de mettre « une tête humaine sur un corps de lion ¼ comme Yeats le décrit dans son poème. Quelques manifestations et dynamiques cliniques sont également soulignées.

El presente trabajo explora el narcisismo saludable con relación a la autoexpresión, y examina cómo esto es frecuentemente patologizado y disociado, con consecuencias problemáticas para el individuo y la cultura. A través del poema de Yeats 'The Second Coming', se explora este tema junto a las manifestaciones personales, culturales y clínicas, con una disociación evidente entre quienes son partidarios de la auto negación, y quienes están 'llenos de una intensidad apasionada' y son vistos como narcisistas. El trabajo argumenta que el proceso de individuación requiere que aceptemos la multiplicidad de estados del self, ampliando así las identificaciones del ego, incluyendo estados de: vulnerabilidad, autonegación, auto-centración, sentimientos homicidas, y poder, en contraste con las identificaciones unitarias inviables de eras previas, en las que estos estados eran proyectados en grupos chivos expiatorios, por ejemplo, el racismo. Se describen las bases neurobiológicas del self nuclear, las cuales nos ayudan a comprender mejor y a aceptar un amplio espectro de fenómenos narcisistas. Abrazar la culpa, desde el cuidado y el interés, como lo describe Loewald (1979), y así dar cuenta de los estados de ceguera activa y pasiva hacia el otro, nos permite colocar 'una cabeza humana en el cuerpo del león', descripto en el poema de Yeats. También se delinean algunas manifestaciones y dinámicas clínicas.

Este artigo explora o narcisismo saudável relacionado à autoexpressão e analisa como isso é frequentemente patologizado e dividido, com consequências problemáticas para o indivíduo e para a cultura. Explorado no poema de Yeats, 'A Segunda Vinda', assim como em outras manifestações pessoais, culturais e clínicas, com uma divisão evidente entre aqueles que defendem a abnegação e aqueles que são "cheios de intensidade apaixonada" e vistos como narcísicos. O artigo argumenta que o processo de individuação exige que abracemos uma multiplicidade de autoestados e, portanto, uma ampliação das identificações do ego, incluindo estados de vulnerabilidade, abnegação, egocentrismo, assassinato e poder, em contraste com as identificações unitárias impraticáveis de eras anteriores, onde tais estados foram projetados em grupos de bodes expiatórios, por exemplo, no racismo. Os fundamentos neurobiológicos do eu central são delineados, argumenta o artigo, o que nos ajuda a entender e aceitar melhor a ampla gama de fenômenos narcísicos. Abraçar a culpa, por cuidado e preocupação, conforme descrito por Loewald (1979), e assim abordar estados de cegueira passiva e ativa para o outro, nos permite colocar uma "cabeça humana no corpo do leão", descrita no poema de Yeats. Algumas manifestações clínicas e dinâmicas também são descritas.

I thought I was being blessed.

This is a clinical case presentation of a Catholic hospital chaplain, who, like thousands of deeply wounded children from around the world, was sexually abused by his parish priest. Believing he had received 'a special blessing' contributed to his denial, rationalization and ultimate identification with his abuser. For 58 years, having repressed his earlier experience, this man lived as a Catholic cleric, abusing others. Entering analysis provided him with an opportunity to work with his dreams and memories. Analysis enabled him to consciously come to terms with and benefit from a future that fostered his individuation and allowed him to become a spokesman for the rehabilitation of others suffering a similar fate.

Ceci est la présentation d'un cas clinique, celui d'un aumônier catholique des hôpitaux qui, comme des milliers d'enfants profondément blessés dans le monde entier, fut abusé sexuellement par le prêtre de sa paroisse. Sa croyance - qu'il avait reçu « une bénédiction spéciale ¼ - contribua à son déni, à sa rationalisation et finalement à son identification avec son agresseur. Pendant 58 années, ayant réprimé ses expériences précoces, cet homme a vécu comme un membre du clergé catholique, abusant d'autres personnes. Entrer en analyse lui a fourni l'opportunité de travailler avec ses rêves et ses souvenirs. L'analyse l'a rendu capable de faire face consciemment à un avenir qui soutiendrait son individuation et lui permettrait de devenir un porte-parole pour la réhabilitation d'autres personnes victimes d'un même destin.

Esta es la presentación de un caso clínico de un capellán católico de un hospital, quien, como miles de niños profundamente heridos de alrededor del mundo, fue abusado sexualmente por el sacerdote de su parroquia. La creencia de que había recibido 'una bendición especial' contribuyó a su negación, racionalización, y a la identificación con su abusador. Habiendo reprimido esta experiencia temprana, este hombre vivió como un clérigo católico, abusando de otros, durante 58 años. El inicio de análisis le dio la oportunidad de trabajar con sus sueños y memorias. El análisis le permitió una confrontación consciente y también la posibilidad de beneficiarse de un futuro que favorezca su individuación, permitiéndole devenir en portavoz para la rehabilitación de otros que sufren destinos similares.

Esta é uma apresentação de caso clínico de um capelão do hospital católico, que, como milhares de crianças profundamente feridas de todo o mundo, foi abusada sexualmente por seu pároco. Acreditar que ele havia recebido "uma bênção especial" contribuiu para sua negação, racionalização e identificação final com seu agressor. Por 58 anos, tendo reprimido sua experiência anterior, esse homem viveu como clérigo católico, abusando dos outros. Entrar na análise proporcionou a ele a oportunidade de trabalhar com seus sonhos e memórias. A análise permitiu que ele concordasse conscientemente e se beneficiasse de um futuro que promoveu sua individuação e lhe permitiu se tornar um porta-voz da reabilitação de outros que sofrem um destino semelhante.

Identification - obstacle to individuation, or: on how to become 'me'.

This paper will explore the use of identification with aspects of a lost object as a defensive strategy to cope with traumatic loss, and will show how in the depth of the analytic work this identification can be accessed and made conscious. Descriptions of work with a three-year-old boy illustrate how the sudden loss of his mother's breasts had made weaning un-accessible to him, and how, in the absence of a good experience of separation, the process of mourning had not been able to take place. Instead, identification with aspects of the lost breast was used as a defence against pain, and this state of affairs was proving a hindrance to individuation. In the discussion of the case material, the use of identification as a defence will be highlighted, and a differentiation made between abandonment and separation as this illuminates the link between mourning and individuation.

Chilled to the bone: embodied countertransference and unspoken traumatic memories.

Starting from a deeply challenging experience of early embodied countertransference in a first encounter with a new patient, the author explores the issues it raised. Such moments highlight projective identification as well as what Stone (2006) has described as 'embodied resonance in the countertransference'. In these powerful experiences linear time and subject boundaries are altered, and this leads to central questions about analytic work. As well as discussing the uncanny experience at the very beginning of an analytic encounter and its challenges for the analytic field, the author considers 'the time horizon of analytic process' (Hogenson ), the relationship between 'moments of complexity and analytic boundaries' (Cambray ) and the role of mirror neurons in intersubjective experience.

Embodying analysis: the body and the therapeutic process.

This paper considers the transfer of somatic effects from patient to analyst, which gives rise to embodied countertransference, functioning as an organ of primitive communication. By means of processes of projective identification, the analyst experiences somatic disturbances within himself or herself that are connected to the split-off complexes of the analysand. The analysty's own attempt at mind-body integration ushers the patient towards a progressive understanding and acceptance of his or her inner suffering. Such experiences of psychic contagion between patient and analyst are related to Jung's 'psychology of the transference' and the idea of the 'subtle body' as an unconscious shared area. The re-attribution of meaning to pre-verbal psychic experiences within the 'embodied reverie' of the analyst enables the analytic dyad to reach the archetypal energies and structuring power of the collective unconscious. A detailed case example is presented of how the emergence of the vitalizing connection between the psyche and the soma, severed through traumatic early relations with parents or carers, allows the instinctual impulse of the Self to manifest, thereby reactivating the process of individuation.

Análisis psicoanalítico sobre las problemáticas en la identificación con la función parental en la adolescencia: la transición hacia la adultez como un espacio de transformación / Psychoanalytic analysis about identification problems with the parental function in adolescence: transition toward adulthood as a transformative space / Análise psicanalítica sobre os problemas na identificação com a função parental na adolescência: a transição para a vida adulta como espaço de transformação) / Analyse psychanalytique sur les problématiques concernant l'identification à la fonction parentale durant l'adolescence: la transition vers l'âge adulte comme espace de transformation

Mediante una viñeta clínica se propone analizar cómo se lleva a cabo, durante la adolescencia, un proceso de identificación y transmisión de la función parental en la relación entre el adolescente y sus padres, que podría permitir pensar los avatares de los procesos de transición hacia la adultez. Se discute acerca de cómo la inclusión de estos procesos, en la clínica con adolescentes, podría enriquecer los análisis con perspectivas históricas e intersubjetivas que posibilitarían la reflexión sobre el rol de los padres en la clínica con adolescentes, el duelo respecto a la propia adolescencia y las problemáticas actuales en la transición hacia la adultez en adolescentes.

Por meio de uma vinheta clínica, a proposta é analisar como, durante a adolescência, ocorre um processo de identificação e transmissão da função parental na relação entre o adolescente e seus pais, o que permitiria pensar nos avatares dos processos de transição para a vida adulta. Discute-se como a inclusão desses processos na clínica com adolescentes poderia enriquecer as análises com perspectivas históricas e intersubjetivas que possibilitariam refletir sobre o papel dos pais na clínica com adolescentes, sobre o luto com relação à adolescência e sobre os problemas atuais na transição para a vida adulta.

A clinic vignette is used to analyze how in adolescence the process of identification and transmission of parental function is realized in the relation between adolescents and their parents. This analysis could allow us to think about the processes of transition toward adulthood. The inclusion of these processes in the clinic with adolescents could enrich the analyses with intersubjective and historical perspectives, which would allow to reflecting on the roles of parents in the clinic with adolescents, the grief in relation to the adolescence, and the current problems in the transition toward adulthood.

En utilisant une vignette clinique à titre d'illustration, ce travail vise à analyser comment, à l'adolescence, a lieu un processus d'identification et de transmission de la fonction parentale dans la relation entre l'adolescent et ses parents, ce qui pourrait permettre de penser aux vicissitudes des processus de transition vers l'âge adulte. Une discussion est menée pour déterminer comment l'inclusion de ces processus à la clinique avec des adolescents pourrait approfondir les analyses en adoptant des perspectives historiques et intersubjectives, ce qui permettrait de réfléchir au rôle des parents à la clinique avec des adolescents, au deuil de sa propre adolescence et aux problématiques actuelles lors de la transition vers l'âge adulte pour des adolescents.

Anhand einer klinischen Vignette analysiert dieser Artikel, wie in der Adoleszenz der Prozess der Identifikation und Übertragung der elterlichen Funktion in der Beziehung zwischen Jugendlichen und ihren Eltern stattfindet, was uns erlaubt, über die Avatare der Transitionsprozesse ins Erwachsenenalter nachzudenken. Es wird diskutiert, wie die Einbeziehung dieser Prozesse in die Klinik von Jugendlichen die Analysen mit historischen und intersubjektiven Perspektiven bereichern könnte, was außerdem ermöglichen würden, die Rolle der Eltern in der Klinik von Jugendlichen zu überdenken, sowie die Trauer in Bezug auf die eigene Adoleszenz und die aktuellen Probleme von Jugendlichen beim Übergang ins Erwachsenenalter.

O método psicanalítico e suas extensões: escutando jovens em situação de vulnerabilidade social / The psychoanalytic method and its extensions: listening to young people in situation of social vulnerability / La méthode psychanalytique et son développement hors du champ classique: l’écoute des jeunes en situation de vulnérabilité sociale / El método psicoanalítico y sus extensiones: escuchando a jóvenes en situación de vulnerabilidad social / Die psychoanalytische Methode und ihre Erweiterungen: Jungen Leuten in sozialer Vulnerabilität zuhören

Este artigo visa discutir o trabalho de construção de espaços de escuta para jovens em situação de vulnerabilidade social. Para tal, foram configuradas duas modalidades de intervenção, desenvolvidas no âmbito individual e grupal, nomeadas, respectivamente, papo reto e tá na roda. Propostas como estas permitem o avanço em direção a estratégias de construção de dispositivos alternativos ao setting clássico, estendendo as contribuições do método psicanalítico para a saúde, para a educação e para a cultura.

This paper discusses efforts to establish places for listening to young people in social vulnerability situations. To this end, two types of intervention were created; they were developed at individual and group scope, and respectively named “papo reto” (straightforward conversation) and “tá na roda” (let’s share). Proposals such as these allow for progress towards the establishment of tools that are an alternative to classical settings, extending the psychoanalytic method’s contributions to health, education and culture.

Cet article présente le travail de construction d’espaces d’écoute pour des jeunes en situation de vulnérabilité sociale. Pour ce faire, deux modalités d’intervention ont été mis en place, la première dans le domaine individuel et la deuxième dans celui du groupe, nommées respectivement « papo reto ¼ et « tá na roda ¼. Ces propositions ont pour objectif d’établir une collaboration visant à construire des dispositifs alternatifs au setting classique afin de développer la contribution de la méthode psychanalytique à la santé, à l’éducation et à la culture.

Este artículo propone una discusión sobre el trabajo de construcción de espacios de escucha para jóvenes en situación de vulnerabilidad social. Para ello, fueron configuradas dos modalidades de intervención, desarrolladas en los ámbitos individual y grupal, denominadas, respectivamente, “papo reto” (charla directa) y “tá na roda” (discutiendo juntos). Propuestas como estas permiten el avance en dirección a estrategias de construcción de dispositivos alternativos al setting clásico, extendiendo las contribuciones del método psicoanalítico a la salud, la educación y la cultura.

Der vorliegende Artikel diskutiert die Bildung von Bereichen des Zuhörens für junge Menschen, die sozialer Vulnerabilität ausgesetzt sind. Dazu wurden zwei Interventionsarten gewählt, die im Bereich des Individuums und der Gruppe entwickelt wurden und jeweils „Klartextreden“ und „in die Runde bringen“ genannt wurden. Vorschläge dieser Art zielen darauf hin, neben dem klassischen Setting Alternativen zu setzen und die Beiträge der psychoanalytischen Methode zum Gesundheits-, Erziehungs- und Kulturwesen zu erweitern.

A mulher: um sintoma para o homem? / The woman, a man’s symptom? / La femme, symptôme de l’homme? / La mujer: ¿un sintoma para el hombre?

Na última década de seu ensino, Jacques Lacan propõe que uma mulher pode ser um sintoma para um homem. Este artigo revê uma abordagem da teoria freudiana da identificação de gêneros para discutir a proposta de Lacan.

Jacques Lacan suggested that the woman could be man's symptom in the last decade of his teaching. This article proposes to survey some of the Freudian theory of gender identification to discuss Lacan’s hypothesis.

Au cours de la dernière décennie de ses enseignements, Jacques Lacan a suggéré que la femme pourrait être un symptôme de l'homme. Cet article propose la révision d'une approche de la théorie freudienne sur l'identification de gendres pour pouvoir mettre en discussion la proposition de Lacan.

En su última década de enseñanza, Jacques Lacan sostiene que una mujer puede ser un síntoma para un hombre. Este artículo revisa la aproximación de la teoría freudiana de la identificación de géneros para discutir la propuesta de Lacan.

La fonction des identifications “comme si” dans un cas de psychose masquée / A função das identificações “como se” em um caso de psicose mascarada / The function of “as if” identifications in a case of disguised psychosis / La función de las identificaciones “como si” en un caso de psicosis enmascarada

Nous partirons de l’hypothèse que le diagnostic, dans l’approche psychanalytique, ne se détermine pas à partir d’une classification des troubles. Pour le démontrer, nous analyserons le cas d’un jeune homme où la psychose ne s’est pas manifestée avec une sémiologie évidente (hallucination, délire, troubles du langage, etc). C’est la reconstruction des processus identificatoires, demeurés inaboutis pour le sujet, qui nous orientera vers un diagnostic de psychose.

Partiremos da hipótese de que o diagnóstico, na abordagem psicanalítica, não se determina a partir de uma classificação dos transtornos. Para demonstrá-la, analisaremos o caso de um homem jovem para o qual a psicose não se manifestou com uma semiologia evidente (alucinação, delírio, transtornos de linguagem etc.). É a reconstrução dos processos identificatórios, mantidos inacabados para o sujeito, que nos orientará para um diagnóstico de psicose.

We shall assume that the diagnosis, in psychoanalytical approach, is not determined by a classification of psychic disorders. To demonstrate that, we shall analyze the case of a young man whose psychosis did not occur according to an evident semiology (hallucination, delusion, speech disorder, etc.). The reconstruction of the subject’s identification processes, which had remained unfinished, will help us to establish the diagnosis of psychosis.

Partiremos de la hipótesis de que el diagnóstico, en el enfoque psicoanalítico, no se determina desde una clasificación de los disturbios. Para demostrarlo, analizaremos el caso de un joven en quien la psicosis no se manifestó a través de una semiología evidente (alucinación, delirio, disturbio del lenguaje, etc.). Es la reconstrucción de los procesos de identificación, inacabados para el sujeto, que nos orientará hacia un diagnóstico de psicosis.