Pub Date : 2023-06-30DOI: 10.33212/att.v17n1.2023.100
S. Solinski
Two detailed clinical vignettes of dissociative identity disorder are presented that illustrate the sequelae of abnormal development resulting from childhood abuse. They focus on the patients’ internal world, an elaborate landscape exhibiting extreme developmental deficits. Its significance is considered both as a means of understanding the patient and as an aid to therapy. I highlight aspects of my own therapeutic approach and give clinical examples that are illustrative.
{"title":"Developmental devastation: dissociative identity disorder","authors":"S. Solinski","doi":"10.33212/att.v17n1.2023.100","DOIUrl":"https://doi.org/10.33212/att.v17n1.2023.100","url":null,"abstract":"Two detailed clinical vignettes of dissociative identity disorder are presented that illustrate the sequelae of abnormal development resulting from childhood abuse. They focus on the patients’ internal world, an elaborate landscape exhibiting extreme developmental deficits. Its significance is considered both as a means of understanding the patient and as an aid to therapy. I highlight aspects of my own therapeutic approach and give clinical examples that are illustrative.","PeriodicalId":296880,"journal":{"name":"Attachment: New Directions in Psychotherapy and Relational Psychoanalysis","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134054532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-30DOI: 10.33212/att.v17n1.2023.1
P. Fonagy
{"title":"Obituary - Mary Main","authors":"P. Fonagy","doi":"10.33212/att.v17n1.2023.1","DOIUrl":"https://doi.org/10.33212/att.v17n1.2023.1","url":null,"abstract":"","PeriodicalId":296880,"journal":{"name":"Attachment: New Directions in Psychotherapy and Relational Psychoanalysis","volume":"9 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123666732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-30DOI: 10.33212/att.v17n1.2023.69
Candace Orcutt
The focus on human personality and its disorders—extending beyond symptom-atology and inner fantasy to concern with the whole self and relationship—has created a paradigm shift in psychoanalysis. Detailed observation and study of growing children and their mothers lent impetus to this change, and gave increased relevance to the object relational concept of the infant’s psychic internalisation of external perception. A leading figure in the treatment of personality disorder, James F. Masterson drew much from Margaret Mahler’s developmental constructs and John Bowlby’s conceptualisations of attachment. In particular, Masterson’s work built upon Mahler’s subphases of separation–individuation in order to define the progression of unmet psychic needs underlying the schizoid, narcissistic, and borderline personality disorders. Relatedly, Masterson’s approach implemented Bowlby’s formulations of secure mother–child attachment in shaping an effective therapeutic alliance. Following Bowlby, Masterson emphasised the patient’s developmental need for a steadfast therapeutic frame and therapeutic respect for the despair suffered by patients coming to grips with the early trauma of insecure attachment. Extensive illustrations of Masterson’s specific interventions with the different personality disorder types are included.
对人类人格及其障碍的关注——超越症状学和内心幻想，关注整个自我和人际关系——在精神分析中创造了一个范式转变。对成长中的孩子及其母亲的详细观察和研究推动了这一变化，并增加了婴儿对外部感知的心理内化的客体关系概念的相关性。作为人格障碍治疗的领军人物，James F. Masterson从Margaret Mahler的发展结构和John Bowlby的依恋概念中汲取了很多。特别是，马斯特森的工作建立在马勒的分离-个性化子阶段的基础上，以定义未满足的精神需求的进展，这些需求是精神分裂、自恋和边缘型人格障碍的基础。与此相关，马斯特森的方法在形成有效的治疗联盟中实施了鲍尔比的安全母子依恋的构想。继鲍尔比之后，马斯特森强调了病人的发展需要一个坚定的治疗框架，以及对病人在处理不安全依恋的早期创伤时所遭受的绝望的治疗尊重。马斯特森对不同类型人格障碍的具体干预的大量插图包括在内。
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Pub Date : 2023-06-30DOI: 10.33212/att.v17n1.2023.82
S. Solinski
Developmental achievements during the first five years of life are described. From birth children are readily able to engage with and respond to their caregivers, whose attunement is crucial to their welfare. The child learns to differentiate objects and people and develops schemata of relating to others. Spatial exploration and the ability to categorise facilitate the attainment of object and other permanence at around eighteen months of age. At this time children begin to understand that others are intentional agents with internal states that are the sources of attitudes and actions. The child’s identification with others is salient to the formation of identity and the ability to differentiate from others. Play is vital to understanding the nature of symbols. When attachment is secure requisite transitional space is provided and mentalization is achieved. However, a grasp of beliefs and of the difference between appearance and reality is not yet achieved. Attachment characterised by misattunement and/or overt abuse may result in pathological dissociation resulting in developmental deficits that are most extreme in dissociative identity disorder.
{"title":"Development: nurturing and destroying a child","authors":"S. Solinski","doi":"10.33212/att.v17n1.2023.82","DOIUrl":"https://doi.org/10.33212/att.v17n1.2023.82","url":null,"abstract":"Developmental achievements during the first five years of life are described. From birth children are readily able to engage with and respond to their caregivers, whose attunement is crucial to their welfare. The child learns to differentiate objects and people and develops schemata of relating to others. Spatial exploration and the ability to categorise facilitate the attainment of object and other permanence at around eighteen months of age. At this time children begin to understand that others are intentional agents with internal states that are the sources of attitudes and actions. The child’s identification with others is salient to the formation of identity and the ability to differentiate from others. Play is vital to understanding the nature of symbols. When attachment is secure requisite transitional space is provided and mentalization is achieved. However, a grasp of beliefs and of the difference between appearance and reality is not yet achieved. Attachment characterised by misattunement and/or overt abuse may result in pathological dissociation resulting in developmental deficits that are most extreme in dissociative identity disorder.","PeriodicalId":296880,"journal":{"name":"Attachment: New Directions in Psychotherapy and Relational Psychoanalysis","volume":"10 22","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120930775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-30DOI: 10.33212/att.v17n1.2023.27
Susan Wright
Health experts have suggested that we face an epidemic of loneliness in the westernised world. But what do we mean by loneliness? In this article I explore what leads to states of chronic loneliness, the language people use to describe it—if they can, and why it is that some people savour solitude and others fear it. Here my thesis is that the former have benign internal objects to draw on, and this opens space for creativity and the imagination whereas the latter experience an inner void. I talk about the early experiences that contribute to feeling lonely, even when people are around, and to an inability to internalise supportive others. The article also includes a section on the connections between loneliness and shame. At the end I discuss what a therapeutic relationship, and in particular one grounded in a deep understanding of what being alone means to the therapist, can offer so that people suffering acute aloneness can move from fearing being on their own to valuing the transitional space of having time to themselves.
{"title":"“Loneliness and the void”: exploring different types of aloneness and the lack of benign internal objects","authors":"Susan Wright","doi":"10.33212/att.v17n1.2023.27","DOIUrl":"https://doi.org/10.33212/att.v17n1.2023.27","url":null,"abstract":"Health experts have suggested that we face an epidemic of loneliness in the westernised world. But what do we mean by loneliness? In this article I explore what leads to states of chronic loneliness, the language people use to describe it—if they can, and why it is that some people savour solitude and others fear it. Here my thesis is that the former have benign internal objects to draw on, and this opens space for creativity and the imagination whereas the latter experience an inner void. I talk about the early experiences that contribute to feeling lonely, even when people are around, and to an inability to internalise supportive others. The article also includes a section on the connections between loneliness and shame. At the end I discuss what a therapeutic relationship, and in particular one grounded in a deep understanding of what being alone means to the therapist, can offer so that people suffering acute aloneness can move from fearing being on their own to valuing the transitional space of having time to themselves.","PeriodicalId":296880,"journal":{"name":"Attachment: New Directions in Psychotherapy and Relational Psychoanalysis","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124513086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-30DOI: 10.33212/att.v17n1.2023.6
B. Kahr
{"title":"A tribute to Mary Main: the queen of attachment research","authors":"B. Kahr","doi":"10.33212/att.v17n1.2023.6","DOIUrl":"https://doi.org/10.33212/att.v17n1.2023.6","url":null,"abstract":"","PeriodicalId":296880,"journal":{"name":"Attachment: New Directions in Psychotherapy and Relational Psychoanalysis","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133208652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-30DOI: 10.33212/att.v17n1.2023.10
Anne M. Power
This article builds on an earlier piece in this journal (Power, 2018) which hypothesised about the differences between three routes into relationship: random romance, arranged marriage, and self-arranged relationships. Interviews with three couples, one from each tradition, are used to explore how attachment dynamics were creating both a challenge and a resource for each couple. This article uses psychoanalytic thinking to inquire about mate-selection, and then attachment theory and emotionally focused couple therapy (EFT)(Johnson, 2012) to understand how these couples built a long-term attachment bond in each tradition. The couples’ own words are presented with reflections by the author in order to demonstrate challenges that couples face and ways in which they can sometimes manage these.
{"title":"Making sense of contented couples—insights from attachment theory and emotionally focused couple therapy (EFT)","authors":"Anne M. Power","doi":"10.33212/att.v17n1.2023.10","DOIUrl":"https://doi.org/10.33212/att.v17n1.2023.10","url":null,"abstract":"This article builds on an earlier piece in this journal (Power, 2018) which hypothesised about the differences between three routes into relationship: random romance, arranged marriage, and self-arranged relationships. Interviews with three couples, one from each tradition, are used to explore how attachment dynamics were creating both a challenge and a resource for each couple. This article uses psychoanalytic thinking to inquire about mate-selection, and then attachment theory and emotionally focused couple therapy (EFT)(Johnson, 2012) to understand how these couples built a long-term attachment bond in each tradition. The couples’ own words are presented with reflections by the author in order to demonstrate challenges that couples face and ways in which they can sometimes manage these.","PeriodicalId":296880,"journal":{"name":"Attachment: New Directions in Psychotherapy and Relational Psychoanalysis","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124893241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-22DOI: 10.33212/att.v15n2.2021.214
Hannah Knafo
With growing attention being paid to perinatal mood and anxiety disorders (PMADs) in both medical and mental health settings, there is a need for further elaboration on meaningful and impactful treatments with this population. This article outlines some of the unique stressors and psychological states that come with pregnancy and parenting a newborn and infant. The concepts and experiences discussed include: primary maternal preoccupation (Winnicott, 1956), parental ambivalence, major changes to the physical body, and reorganisation of attachment representations and current family dynamics. Clinical material from therapy sessions with patients at a specialised perinatal centre is included in the discussion of using an approach informed by attachment theory (Bowlby, 1988).
{"title":"Attachment-informed interventions with the perinatal population","authors":"Hannah Knafo","doi":"10.33212/att.v15n2.2021.214","DOIUrl":"https://doi.org/10.33212/att.v15n2.2021.214","url":null,"abstract":"With growing attention being paid to perinatal mood and anxiety disorders (PMADs) in both medical and mental health settings, there is a need for further elaboration on meaningful and impactful treatments with this population. This article outlines some of the unique stressors and psychological states that come with pregnancy and parenting a newborn and infant. The concepts and experiences discussed include: primary maternal preoccupation (Winnicott, 1956), parental ambivalence, major changes to the physical body, and reorganisation of attachment representations and current family dynamics. Clinical material from therapy sessions with patients at a specialised perinatal centre is included in the discussion of using an approach informed by attachment theory (Bowlby, 1988).","PeriodicalId":296880,"journal":{"name":"Attachment: New Directions in Psychotherapy and Relational Psychoanalysis","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117234110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-22DOI: 10.33212/att.v15n2.2021.269
S. Partridge
I argue the time has come to expand the now recognised clinical diagnosis of boarding school syndrome to take account of its invisible precursors in the avoidant attachment patterns of British upper-class culture. This elite, comprising less than 1% of the population, has sustained fee-paying boarding “public” schools, and is sustained by them, in a remarkably effective nexus of power and influence. I propose to call this avoidant culture with its severe affective limits and entitled assumptions, “British upper-class complex trauma condition”. Until we can recognise it and understand it as a form of group trauma, we will not be able to deal with its grave incapacity when it comes to empathy with the lives of others. Like Bowlby1, I advocate the abolition of early boarding as a key part of transforming the condition’s psychosocial limitations, which profoundly impact us all.
{"title":"Boarding school syndrome: reconsidered in social context and through the lens of attachment theory","authors":"S. Partridge","doi":"10.33212/att.v15n2.2021.269","DOIUrl":"https://doi.org/10.33212/att.v15n2.2021.269","url":null,"abstract":"I argue the time has come to expand the now recognised clinical diagnosis of boarding school syndrome to take account of its invisible precursors in the avoidant attachment patterns of British upper-class culture. This elite, comprising less than 1% of the population, has sustained fee-paying boarding “public” schools, and is sustained by them, in a remarkably effective nexus of power and influence. I propose to call this avoidant culture with its severe affective limits and entitled assumptions, “British upper-class complex trauma condition”. Until we can recognise it and understand it as a form of group trauma, we will not be able to deal with its grave incapacity when it comes to empathy with the lives of others. Like Bowlby1, I advocate the abolition of early boarding as a key part of transforming the condition’s psychosocial limitations, which profoundly impact us all.","PeriodicalId":296880,"journal":{"name":"Attachment: New Directions in Psychotherapy and Relational Psychoanalysis","volume":"282 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134098677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-22DOI: 10.33212/att.v15n2.2021.236
S. Benamer
In the context of the body, the essentially female; wombs, menstrual cycles, and concurrent hormones, have seen women ascribed madness, insatiability, untrustworthiness, and danger. Female bodies have been identified in selective parts, considered in abstract, or envisaged as having overwhelming power over the mind. “Hysteria”, the problematic neurosis of uterine origin was at the heart of early psychoanalysis. This diagnosis enshrines a slippage from the physical to the fantastical, and ultimately to the denial of the lived reality of women’s and girl’s bodies. In apparent collusion with patriarchy the neglect of some female bodily experience is perpetuated in contemporary psychoanalytic theory. Nowhere is this more evident than around menopause and hysterectomy (as experienced by either client or therapist). There has been little or no exploration of how practitioners might best support clients for whom menopause is significant, or how we might facilitate women before or after gynaecological surgery. It is as if removal and psychological loss of the same female body parts that our forebears used to so neatly differentiate, diagnose, and pathologise women are now not of note. I am interested as to how we as psychotherapists reclaim female body narratives from this outdated theoretical paradigm to best serve clients experiencing menopause, gynaecological surgery, and mid life in the twenty-first century.
{"title":"Not so hysterical now? Psychotherapy, menopause, and hysterectomy","authors":"S. Benamer","doi":"10.33212/att.v15n2.2021.236","DOIUrl":"https://doi.org/10.33212/att.v15n2.2021.236","url":null,"abstract":"In the context of the body, the essentially female; wombs, menstrual cycles, and concurrent hormones, have seen women ascribed madness, insatiability, untrustworthiness, and danger. Female bodies have been identified in selective parts, considered in abstract, or envisaged as having overwhelming power over the mind. “Hysteria”, the problematic neurosis of uterine origin was at the heart of early psychoanalysis. This diagnosis enshrines a slippage from the physical to the fantastical, and ultimately to the denial of the lived reality of women’s and girl’s bodies.\u0000In apparent collusion with patriarchy the neglect of some female bodily experience is perpetuated in contemporary psychoanalytic theory. Nowhere is this more evident than around menopause and hysterectomy (as experienced by either client or therapist). There has been little or no exploration of how practitioners might best support clients for whom menopause is significant, or how we might facilitate women before or after gynaecological surgery. It is as if removal and psychological loss of the same female body parts that our forebears used to so neatly differentiate, diagnose, and pathologise women are now not of note.\u0000I am interested as to how we as psychotherapists reclaim female body narratives from this outdated theoretical paradigm to best serve clients experiencing menopause, gynaecological surgery, and mid life in the twenty-first century.","PeriodicalId":296880,"journal":{"name":"Attachment: New Directions in Psychotherapy and Relational Psychoanalysis","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123178844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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