British Journal of Psychotherapy最新文献

People who seriously consider killing themselves over a protracted period of time, usually years, represent great treatment challenges. Chronic suicidal ideation represents a communication of conscious and unconscious wishes that may be clarified through psychotherapy leading to various outcomes. For one group of patients, this focus will eventually change as they move gradually, over long periods of time, towards more life-affirming goals; a second group will continue to think intensely about suicide for many years, despite various psychotherapeutic interventions, without resorting to self-destructive action; and a third group will go on to attempt suicide which may or may not end in death. In this paper, we present two case studies describing the treatment of patients struggling with chronic suicidality who engaged in psychotherapy but with different outcomes. We discuss the possible outcomes and consider influential factors and suggestions for therapeutic interventions.

The 2020 Black Lives Matter (BLM) protests were a stark reminder of the reality of problematic ‘race’ relations. This paper, originally conceived in the aftermath of George Floyd's murder with his final words ‘I can't breathe!’, examines the psychoanalysis of anti-black racism as a contemporary problem to address. This raises important epistemological questions about the forms of knowledge that get produced given the complex relationship between psychoanalysis and coloniality. Frantz Fanon unpacked the impact of racial violence and the white gaze as one of alienation, nonbeing and Black Rage in White Skin, Black Masks. This paper makes use of Fanon's 1952 thesis and clinical vignettes from analysts of colour in relation to ‘race’ as well as secondary literature on psychoanalysis and postcoloniality inviting the reader to appreciate Black Rage as a legitimate and constructive affect. I submit two ‘anchors’ for psychoanalysis to consider in theory and in practice for the birth of a physical and psychic ‘room to breathe’, a place for the black individual to exist with more psychological sovereignty: (1) an extension of Melanie Klein's depressive position and (2) an extension of the concept of mourning, as crucial intrapsychic processes for black lives to matter. The argument advanced is that, due to the extraordinary historical, social and political circumstance placed on black people as a racially oppressed group, the trauma of racism is one of alienation to a zone of nonbeing, a ‘space’ which, incidentally, offers radical hope in the form of Black Rage. Psychoanalysis is adequately positioned to acknowledge Black Rage as a powerful affect and civic tool, and this may be thought about through intrapsychic processes originating in classical psychoanalytic theory as well as Kleinian object relations, principally the concepts of mourning and depressive awareness, which considered together liberate aspects of therapeutic work.

In this paper, the author highlights some aspects of the psychoanalytic process through the perspective of poetic metaphors. In reading new metaphors, we often become bewildered. A literal reading, and a first hand meaning, comes to nothing. A concrete reference, as well as truth, is likewise destroyed. On the ruins of these literary dimensions, however, a second hand reading, meaning, world, and truth may be formed. To take a step from literal understanding to a metaphoric one is demanding, as the former provides safety. The same is true of the position of the psychoanalytic patient. He or she needs to leave an idiosyncratic, well known, way of apprehending world and others, to take perspectives never tried before. The challenges and vulnerabilities the patient meets when facing the possibilities of starting a psychoanalytic process are compared to the position of the reader of poetic metaphors. The argument is illustrated with a psychoanalytical case.

Many patients enter psychotherapy while being on antidepressant medication. This article outlines and discusses the main effects of antidepressant medication both on the patient and on the psychotherapy process. Although widely prescribed, the effectiveness of antidepressant medication is still open to debate, and several authors have questioned whether it is more effective than placebo. The multi-faceted adverse effects of antidepressants include emotional blunting, sexual dysfunction, a number of physical ailments and chronicity in the course of depression. These adverse effects are often not easy to identify as stemming from the medication and may be mistakenly attributed to the patient's own emotional difficulties. This presents a challenge to the process of psychotherapy with the risk of creating an impasse and unfavourable outcome. In most cases, a gradual process of withdrawal from antidepressant medication is necessary to reduce the impact of these side effects both on the patient's quality of life and on the psychotherapy process. A clinical case of a patient with a 10-year history of psychiatric medication and hospitalisations, who was suffering from medication stressful adverse effects while not improving psychiatrically. A gradual withdrawal of psychiatric medication coupled with a combination of supportive and exploratory psychotherapy led to a more favourable prognosis and clear improvements in the patient's life.

This preliminary study should be regarded as a pilot piece of research designed specifically to explore some of the unconscious dynamics that operate within the Balint Group process. A brief history is offered by introduction, which aims to set this research in the wider context of the influences that shaped Michael Balint's thinking, particularly the view that the primary obstacles in therapeutic work derive from the analyst's own resistances. The study itself attempts to highlight the presence or absence of ‘domains of implicit relational knowing’ between Balint Group participants, within which ‘moments of meeting’ may take place, leading to a change in the thinking/feeling of the Presenter about their case. It is suggested that such domains emerge through unconscious interactions and that the Group Matrix contains and fosters such activity. The rationale for the use of a 7-point scale of participants' subjective evaluations of feeling attuned/connected or mis-attuned/unconnected towards the Group, the Presenter and the Conductor is drawn from Attachment/Neuroscience research. The data gathered from two groups, each engaging in two presentations, reveal patterns of identical scores suggesting the presence of ‘domains’, and marked discrepancy scores suggesting their absence. Sufficient ‘domains’ accompanied a change in thinking/feeling for the Presenter, while few ‘domains’ and marked discrepancy scores did not do so. These observations are tentatively discussed with reference to the early origins of unconscious communications.

The nature of Anna Freud and Dorothy Burlingham's 5-decade-long personal and professional relationship has always been subject to speculation. This paper considers the historiography of this important and enigmatic relationship from 1920s Vienna to today. Drawing on Sara Ahmed's Queer Phenomenology, which theorises sexual orientation and whiteness in spatial terms, I illustrate how the relationship was seen as deviating from the ‘straight lines’ of mid-20th century heteronormative society. I extend this queer phenomenological approach to think about cultural orientations to the relationship through an examination of its depiction in biographies published in the 1980s, the collections at the Freud Museums in London and Vienna, and a fictionalised account of Anna Freud's life published in 2014. Extending Ahmed's queer phenomenological vocabulary, I identify examples of ‘straightening up’, ‘straightening devices’ and ‘straightening up by queering’. The possibility of finding ‘queer angles’ in Anna Freud's early clinical writings, in contrast to the normative tendencies of her later writing on ego psychology, is explored as a counterbalance to discussions about non-normative sexuality and gender in psychotherapy which typically position these as something new. The relevance for clinical practice today is considered through the lens of an ethical imperative to find space for queer angles in the history of psychoanalysis.