British Journal of Psychotherapy最新文献

The aim of this article is to present and discuss the unconscious psychological issues involved in bariatric surgery, in the light of the notion of the “weaning complex”. After highlighting the risk of post-operative suicide, we present the psychic mechanisms of decompensation among the patients concerned. We then recall that hyperphagia leading to obesity is a prevalent form of addiction in consumer societies. We also explore the notion of the “weaning complex” which was developed by Lacan, and show that bariatric surgery is a type of paradoxical and abrupt weaning. Based on the clinical case of a patient suffering from post-operative psychic decompensation and who was previously obese and addicted to food, the article explains that post-operative decompensation results from a major difficulty of shifting the drive satisfaction of food addiction to another object. In conclusion, we argue that restoring a taste for speech to these patients in the context of a clinical encounter is a central issue in countering the exacerbation of the death drive associated with the operation.

This work consists of an approach to the concept of Social Defences, which consolidates one way of applying psychoanalytic thinking to human institutionality. The author briefly describes the path psychoanalytic theory takes towards the outline of this concept, to emphasise later the implications it has for health institutions. There is a statement about the importance of considering the ways in which individual defences tend to collude with the institutionalized group's unconscious mechanisms, where certain conditions will be determined for the containment of primitive states of mind. Emphasis is made about the possibility that these dynamics have concrete effects on the workers' capacities and health, on the patients' treatment, and mainly on the loss of meaning that these people experience in their link with this institution. Two vignettes are included to attempt an illustration of these dynamics.

The recent explosion of populist narratives around ‘narcissistic abuse’ on social media has prompted millions to seek answers in online self-help communities. Many are advised to enter personal therapy. This paper asks whether consuming such narratives supports or hinders subsequent psychodynamic treatment. To address this, the social media discourses are critiqued through a psychodynamic lens, contrasting them with psychodynamic aims. The author conceptualises patients' relationship difficulties as stemming from internalised traumatic relational patterns. The theories of Fairbairn and Ferenczi are reprised. Case material illustrates the challenges that arise when these patients enter therapy armed with preconceived diagnoses, seeking confirmation of online-informed hypotheses. Those clinging rigidly to simplistic social media narratives often struggle to engage deeply in treatment. The author argues that adherence to reductive formulas should concern psychotherapists given the expansion of social media self-help. It is suggested the field would benefit from psychotherapists publicly addressing the risks of simplistic narratives and highlighting psychodynamic complexity. Modelling nuanced thinking may counteract the confirmation bias patients encounter online.

This paper re-evaluates improvisation as a central dynamic in psychoanalytic practice, allowing practitioners to harness momentum and address the states of being ‘stuck’ described by Freud, Jung, Lacan and other analytic thinkers. It takes up Freud's nachträglichkeit, the effects of Derrida's différance, and the affect-focused neuropsychoanalytic approaches cultivated by Solms, Panksepp and others. It proceeds to show how a discourse on sociality developed by Fred Moten and others in the context of Black and performance studies can contribute to psychotherapeutic understanding of the effect of intimacy and the sharing of difference. Interesting connections emerge between an understanding of blackness and an understanding of transference as ‘movement’. Improvisation helps participants in therapy shift between homeostatic balancing and entropic pulls, stimulating emotional flexibility. This paper advocates for psychoanalysis as a social psychotherapy. Clinically, it emphasises the possibilities of fluidity and receptiveness over an emphasis on integration, attachment and individuation.

Risk management in all institutions can become unthinking and process-led, and in this paper we, as psychosocial nurses, have sought to convey how we think about risk at weekends for our patients at the Cassel Hospital. In contrast to many mental health inpatient settings, inpatients at the Cassel go home for the weekend. On one hand, this supports the development of their responsibility for themselves and their social relationships, and on the other, it raises difficulties around separation. These two aspects present us with questions around how to manage risk when patients are not in the hospital. We took as our starting point formal discussions with our inpatient group and nurse team, and linked the ideas that emerged from those discussions with ideas from former members of Cassel staff, drawing on psychoanalytic and psychosocial theories. A dominant theme that emerged was the existence of two selves in the patients' minds – their home self and their Cassel self, and the anxiety shared by patients and nurses about how these two selves can become integrated. Such learning can inform practitioners and policy makers interested in creating services that use relational practice as well as trauma-informed care. These principles could be considered applicable also to health, social care and criminal justice systems.

This paper looks at those resolutions of the Oedipal situation that are characterised as defeat or triumph. We argue that both are defeats and the situation best resolves when intergenerational rivalry is contained and supportive co-operation is dominant. We are struck by the Narcissistic quality we find especially in triumph and note that Oedipus and Narcissus both lived in a false reality constructed to avoid the shame of their own rejection. We are especially concerned about what happens when the child builds a life based on either defeating or being defeated by the same-sex parent and how this appears and may find resolution in analytic psychotherapy. We consider the situation for the girl as well as for the boy and feel there are important distinctions that warrant further thought. Anonymised clinical material is provided to exemplify how this may play out in life and in our practices.

During the worldwide COVID-19 pandemic, important changes were made to the psychotherapeutic process whereby remote treatments became normalised and suicidal distress was communicated from afar. We consider lessons that may be learnt from this experience about the communication of suicidal desperation and engaging the distressed patient through remote mechanisms.