British Journal of Psychotherapy最新文献

In the shadow of the COVID-19 pandemic, familiar life may be said to have become unequivocally altered as a result of the diffuse death threat posed by the virus and the unprecedented experience of a global lockdown. The unexpected superposition of familiarity and unfamiliarity can be linked to the psychoanalytic notion of the uncanny. For Freud, the uncanny was considered a derivative of the reappearance of the repressed, whose context is dominated by the alien nature of the repression. I suggest that a further perspective can be implied—that the sudden disruption of what is familiar is traumatic and engenders a sense of the uncanny. Reflecting on the COVID-19 pandemic, this dynamic can be identified in the following aspects: (i) an overwhelming intrusion of an unfamiliar virus upon familiar life, encouraging paranoid denial and projection of the threat and increasing the tendency to stigmatise; (ii) a continuous re-manifestation of hidden familiarities, both repressed individual conflicts and collective inequalities, illustrating the fragility of the ‘norm’; and (iii) the sudden disruption of an adopted belief (that the virus is beatable), and re-confrontation with the threat of death following lockdown failure.

In this article, I describe my work with a patient who presented as a creative individual, yet felt like a fictional character. He was driven by a compulsion to maintain and repair broken connections at any cost, utilising his creativity for this purpose. My work with this patient, among others, allowed me to identify a group of patients who feel forced to constantly integrate and transform their external environment. I call them bricoleurs and explain the difference between bricolage and Donald Winnicott's play and Hanna Segal's reparation. I propose that the emergence of this psychological structure is caused by the child's early experiences with significant objects—the childhood necessity to constantly repair and enliven the disturbed mind of the caregiver. One of the metaphors of the article is that of the machine, through which I aim to illustrate the automated internal world of the bricoleur, generated not only by the compulsion to destroy but also by the compulsion to repair and create. In the article, I highlight that working with such patients requires the analyst to carefully examine countertransference and to fully mourn the illusion created in the analytic process. I also reflect on the categories of true and false self, pondering the possibility of moving beyond the binary nature of this division.

The purpose of this article is to recount the early history of the Rorschach's inkblots test in Europe and the USA; its subsequent application in highlighting the ill effects on children of bombing during the Second World War; its wartime use in selecting military personnel; its post-war use in selecting patients for psychotherapy at the Tavistock Clinic in London and subsequent decline in this use of Rorschach's inkblots in favour of focus on the psychotherapy patient's transference experience of the psychotherapist treating them. The article ends with evidence of interest, beyond psychotherapy, in Rorschach's inkblots and with the implications of this for the author's principal conclusion regarding the value of these inkblots in evoking the free association and conversation crucial to psychotherapy.

Acquiring competence in psychotherapy is a mandatory part of psychiatric training in the UK. Within their first 3 years of ‘Core Psychiatry’ training, doctors are expected to deliver both short-term and long-term psychotherapy treatments, supervised by the local Medical Psychotherapy tutor. During the Covid-19 pandemic, these treatments and their supervisions were carried out remotely. This pan-London qualitative research study, commissioned by the Health Education England London School of Psychiatry, aimed to explore trainees' and trainers' experiences of the psychotherapy curriculum within Core Psychiatric training, as well as their experiences of remote work during the pandemic. Seventeen participants were interviewed (out of 19 who came forward), including both trainees and trainers working within the London region. Thematic analysis of the transcripts of the semi-structured interviews identified five main themes with associated sub-themes. The results suggest that trainees found their psychotherapy experience to be enriching. However, there is work to be done around barriers and anxieties faced by trainees, for instance concerning the impact of patient drop out on training progression. Remote work posed additional issues for trainers and trainees in addressing psychotherapy competencies, with feelings of disconnection and loss being prominent.

Psychodynamic psychotherapy does not feature in current treatment guidelines for attention-deficit hyperactivity disorder (ADHD) in the United Kingdom. However, there is some psychoanalytic understanding of the disorder, which is corroborated in current neuroscientific theory, and supports clinicians in thinking beyond the behaviourally biased diagnosis and treatment models. One of the core features of ADHD is distortions in chronoception. This clinical paper therefore explores the psychoanalytic and neuroscientific theories of time perception as a way of exploring a discrete element of the complex idea of executive functioning more generally. It supports therapists approaching such executive dysfunction and to reconsider the treatment guidelines. A case example is used to explore how a transference-, affect- and relationally-focussed therapy can effect lasting change for people with ADHD in a way that behavioural and medication approaches do not. It is argued that such an intervention can improve oscillatory attention between subjective- and objective-time and increase the capacity to self-contain emotions. This brings patients into alignment with reality and restarts their psychic development towards themselves, others, the parental couple and grieving, which stalled in infancy. The internalised schema of the 50-minute therapy session also provides a frame of reference for future tasks.