Supervision work in a prison Therapeutic Community is used to explore countertransference implications for staff engaging with residents' disturbed states of mind. Parallel process (a psychoanalytic concept supported by contemporary neurological findings and particularly relevant to supervisory relationships) is used to explore vulnerabilities within the staff group towards acting out the dynamics they are working with therapeutically such as attacks on linking, feelings of helplessness and cynicism, and the denial of aggression. Conversely, the development and reinforcement of the staff group's capacity to generate and preserve a thinking space while under threat has a therapeutic effect upon residents' states of mind, again through the workings of parallel process. The establishment of this benign parallel process is a central task of the Therapeutic Community, and underpins its effectiveness. Its relevance for effective therapy with disturbed states of minds in other settings is also considered.
The dilemma of using case material for publication is considered in the light of the conflicting claims upon the practising psychotherapist to provide convincing clinical substantiation of theory and at the same time to protect patients’confidentiality. Professional ethical codes and commonly employed safeguards are reviewed in terms of their efficacy, and the significance of obtaining patients’consent to publication is discussed.
Session frequency can be seen as definitive of psychoanalytic identity but contemporary relational and constructivist perspectives and trends towards psychoanalytic work being conducted at lower and varying frequencies are leading increasingly to a rift between psychoanalytic work as theorized and practised on the one hand and as ‘taught at’ specified frequencies within psychoanalytic institutions on the other. The value of high‐frequency work in the right conditions is considered, while automatic equations between high‐frequency, high‐intensity and high‐value clinical work are questioned. Pressure towards higher frequency work, sometimes to meet training requirements, may imperil the psychoanalytic stance it seeks to preserve, particularly the recognition of patients’ frequency preferences as a psychic phenomenon requiring understanding rather than manipulation. The roots of coercive attitudes to session frequency in unresolved issues relating to institutional psychoanalytic superegos are explored; implications for training, ethics and the status of psychoanalytic work are considered.
Reparation, in psychoanalytic and particularly Kleinian thinking, is often seen as central to the establishment of a creative capacity for love and concern. But apparent reparative urges may have obsessional and narcissistic aspects which militate against the capacity to use an object and thus against the emergence of genitality and true creativity. In particular, ‘reparative’ strivings may be a defence against feared parental envy and against the agonies and anxieties inherent in the act of asserting a separated self. The obsessional need to repair is considered in developmental and clinical terms and in relation to the practice and culture of psychoanalysis.
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