British Journal of Psychotherapy最新文献

Research shows eating disorders increase the mortality rate: anorexia nervosa has the highest mortality rate and yet an accurate morbidity rate of bulimia nervosa remains hidden. However, research on the endopsychic structural dynamics that perpetuate in patients with eating disorders is scant. This essay depicts the use of Fairbairn's theory of endopsychic personality structure in understanding anorexia nervosa, binge eating disorder and bulimia nervosa. Fairbairn, of the independent group of British object relations theorists, provides a picture of the endopsychic structure based on the conscious and unconscious psychodynamics between partial ego/part-object dyads. Using three case histories, the following pages illustrate the incessantly present endopsychic permutations of the aforementioned dynamics and the possibility of the entrapment in one of these or swinging from one to the other in eating disorders. The essay also shows that early traumatic experiences are present in the case history of individuals with any one of these eating disorders and despite their manifested behavioural differences, they result from the widening of fissures in the universal split in the psyche due to emotional and/or physical abuse. Finally, using Fairbairn's theory, the analysis in the essay explains the comorbidity of certain eating disorders and borderline personality structure.

Psychotherapy is broadly concerned with secrets. Often our clients bring us things which they have never told anyone, subjects they have felt unable to broach. What happens in the relationship when a secret is uncovered? In this article, I discuss how one's secrets finally being uncovered can invoke shame. However, the shame of being seen in a new way can also create an opening that allows for a deeper intersubjective experience to unfold. Using Sartre's concept of the gaze of the other alongside Merleau-Ponty's ideas of dehiscence, visibility/invisibility and intertwining, I explore the meaning of secrecy, guilt and shame for both therapist and client within the therapeutic relationship.

Many individuals who have been through transition struggle to obtain the necessary medical and psychological support. This paper explores the importance of psychological support for post-transition individuals. In my experience, there is a subgroup of patients who struggle to come to terms with life post-transition, particularly the losses involved. They remain stuck in the mourning process. There is a loss of fantasies regarding an ideal transition, and the gap between the hoped-for transition outcomes and the post-transition reality can be painfully large. In addition, issues that the transition was meant to address remain in some form for some people, and they may also be haunted by misgivings about how the transition occurred. This paper employs a heavily anonymised composite case to illustrate and elaborate on how these issues emerged and were dealt with in the context of a psychotherapeutic process. Working through issues that led to transition and grievances about perceived and actual failures in care from the past allowed the patient to mourn the loss of her pre-transition image. The patient was able to come to terms with the reality of her transfer from male to trans-female and her body and life post-transition and to shift from a preoccupation with the past to move on with her life.

The psychological impact of cancer is becoming well-acknowledged. Given its prevalence, practitioners will encounter cancer in their therapy rooms. There is limited research on the experience and application of psychodynamic therapy for clients with cancer. This study generates a new understanding through the experience of psychodynamic practitioners. Semi-structured interviews were conducted with eight UK psychodynamic therapists on their lived experience of working with client(s) with a recent (less than 5 years) diagnosis of cancer. The data were analysed using Interpretative Phenomenological Analysis. The findings reveal that psychodynamic therapists' experience with clients with cancer is emotionally demanding, mentally stimulating and deeply personal. They point to the unique space that psychodynamic therapy provides and highlight some of the challenges. The analysis is understood through the framework of psychodynamic theory and practice.