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Showing papers in "Journal of Child Psychotherapy in 2006"


Journal ArticleDOI
TL;DR: Fonagy as discussed by the authors reviewed the history of case study as a research method, and argued that there are a broad range of approaches to the study of the single case, each of which may be appropriate depending on the particular research question.
Abstract: Since Freud's own time, there has been great deal of debate about the most appropriate research methodology for investigating psychoanalytic psychotherapy [Fonagy, Journal of Child Psychotherapy, 29 (2): 129 – 136, 2003; Rustin, Journal of Child Psychotherapy, 29 (2): 137–145, 2003]. The single case study, which has a long tradition both within child psychotherapy and the wider research field, has been widely criticised as an approach to research, even while its contribution to clinical practice, the development of new ideas and teaching have been acknowledged. After reviewing the history of case study as a research method, this paper argues that there are a broad range of approaches to the study of the single case, each of which may be appropriate depending on the particular research question. Each of these approaches, however, must respond to the three perceived weaknesses of the clinical case study as a research method: the ‘data problem’, the ‘data analysis problem’ and the ‘generalisability ...

75 citations


Journal ArticleDOI
TL;DR: In this paper, the authors review Freud's (1914) seminal paper "On Narcissism: an introduction" and discuss Freud's applications of his ideas about narcissism in relation to homosexuality, hypochondria and psychosis.
Abstract: The author reviews Freud's (1914) seminal paper ‘On narcissism: an introduction’. Freud's paper is briefly set in the historical context of the evolution of psychoanalysis and psychoanalytic theories, and Freud's metapsychology up to the publication of his Narcissism paper is outlined. A detailed and comprehensive description of the content of the paper is given, accompanied by commentary on, and critical analysis of, Freud's ideas. Freud's applications of his ideas about narcissism in relation to homosexuality, hypochondria and psychosis are elucidated and discussed. The author concludes by considering some of the influences of Freud's ideas about narcissism on Kleinian and post-Kleinian developments in psychoanalytic theory.

60 citations


Journal ArticleDOI
TL;DR: In this article, a well-suited partnership between psychoanalytic clinical research and grounded theory is proposed to provide explanatory mechanisms, findings that are translatable to routine clinical practice, and discover new ways of grouping young people so that they are alike in the most significant aspects of their mental health presentations.
Abstract: Research is a ‘core activity’ of ‘central importance in improving mental health and social care’ (NIME, CAMHS National Conference, 2005). This paper examines the philosophical issues confronted when considering psychoanalytic clinical research. It is argued that a well-suited partnership can be formed between psychoanalytic clinical research and Grounded Theory. The methodological issues encountered when using Grounded Theory to analyse qualitative clinical data are explored. The well-suited partnership formed between Grounded Theory and psychoanalytic clinical research has the capacity to provide explanatory mechanisms, findings that are translatable to routine clinical practice, and to discover new ways of grouping young people so that they are alike in the most significant aspects of their mental health presentations. This makes further clinical trials more reliable. Psychoanalytic clinical findings are used together with a range of material from different sources to develop concepts and theor...

51 citations


Journal ArticleDOI
TL;DR: In this article, Bick's classic distinction between states of helpless unintegration and states of defensive disintegration is discussed, as well as the difference between a state and a phase.
Abstract: The paper attempts some clarifications and differentiations concerning (1) Bick's classic distinction between states of helpless unintegration and states of defensive disintegration; (2) the difference between a state and a phase, and Bick's apparent challenge to some aspects of object relations thinking. The paper then lists some types of early pre-depressive and pre-Oedipal integrations and integrators: these include, as well as various kinds of containment, the role of the interested, interesting, and occasionally reclaiming object.

39 citations


Journal ArticleDOI
TL;DR: This paper argued that the adolescent process needs to be accorded its own particularity of reference, especially where narcissism is concerned, and drew on literary and clinical examples to describe what is termed the "adolescent organisation".
Abstract: This paper argues that the adolescent process needs to be accorded its own particularity of reference, especially where narcissism is concerned. The paper draws on literary and clinical examples to describe what is termed the ‘adolescent organisation’. In many ways, this organisation reflects post-Kleinian theory of what constitutes narcissistic pathology. Yet the essential fluidity of the organisation, its culture of experiment and self-exploration, its rootedness in transition and, despite all the usually glaring and obvious signs to the contrary, its developmental potential, tell a different story.

31 citations


Journal ArticleDOI
TL;DR: In this article, a model for understanding three interlaced levels at which change might occur if a psychodynamic, systemically sensitive, therapeutic intervention is offered is proposed. But the model is not suitable for parents with preverbal infants.
Abstract: This paper offers a way of thinking about the process of parent–infant psychotherapy. I start by outlining some ideas as to what can go awry in troubled parent–infant relationships, and then a way of working with parents with pre-verbal babies. I suggest a model for understanding three interlaced levels at which change might occur if a psychodynamic, systemically sensitive, therapeutic intervention is offered. I describe a particularly challenging clinical case in which a mother and I also worked with video material of her and her son.

17 citations


Journal ArticleDOI
TL;DR: In this article, the authors describe clinical work carried out as part of the Tavistock Clinic Under Fives Service, which offers brief focused psychoanalytically based interventions to families with young children, as well as longer-term work.
Abstract: This paper describes clinical work carried out as part of the Tavistock Clinic Under Fives Service, which offers brief focused psychoanalytically based interventions to families with young children, as well as longer-term work. It elaborates psychoanalyst Annette Watillon's idea that it is the dramatic way in which children enact their (and their family's) predicament in the consulting room which speeds up the process of change. The author clusters clinical cases into three categories, each cluster representing a different kind of ‘dramatic’ enactment and leading to a different kind of intervention relating to the therapist's role, the structure of the interventions and the ‘ports of entry’ for the work. The categories are defined as: ‘child-led drama’ with the therapist in the role of ‘therapeutic observer’; ‘internal parental drama’ with the therapist in the role of ‘therapeutic consultant’; and ‘external parental drama’ with the therapist in the role of ‘therapeutic modulator’. The author defi...

12 citations


Journal ArticleDOI
TL;DR: In this article, a qualitative analysis of transcripts from groups run in the development of an adoption-specific parenting program that emphasises play as a form of communication was conducted, finding that adoptive parents habitually coped with play using counterproductive strategies that were predominantly avoidant or controlling; the programme facilitated some suspension of these defences.
Abstract: Research has increasingly focused on play as a social rather than a solitary domain. Play is a stage on which conflicts and wishes may be expressed to a responsive and containing other. As a group, late-adopted latency children show high levels of inhibition, regression and catastrophe in play, and adoptive parents may find this hard to engage with. The current study undertook a qualitative analysis of transcripts from groups run in the development of an adoption-specific parenting programme that emphasises play as a form of communication. Results indicate that adoptive parents habitually coped with play using counterproductive strategies that were predominantly avoidant or controlling; the programme facilitated some suspension of these defences. These findings are discussed with reference to children in therapy and individual work with their parents, who may be enabled better to support play through exploring their own conflicts and assumptions. La recherche tend de plus en plus a etudier le jeu...

12 citations


Journal ArticleDOI
Abstract: This paper presents a detailed theoretical discussion of destructive narcissism in relation to Freud and Rosenfeld and later theorists. In destructive narcissism, the destructiveness is itself idealised and overrides ‘the vital functions which serve the purpose of self-preservation’ (Freud, S., 1914, ‘On narcissism’ S.E. 14: 87) – a feature which is essential to Freud's theory of narcissism and Rosenfeld's theories. Adolescents may move into or away from destructive narcissism, either in a relatively transient way, or more chronically leading to an internalised pathological organisation that is part of character structure. We emphasise the need to understand and interpret in their clinical context movements towards and away from destructive narcissism. Two examples are given from an adolescent unit, one an assessment of an anorexic girl (DF), and in the second half of the paper a detailed clinical account (HS) of internal movements in a highly disturbed adolescent who is nonetheless able to turn ...

9 citations


Journal ArticleDOI
TL;DR: In this paper, a response to a review of the conference titled, "Unintegration, disintegration and integration", written by Cathy Urwin and Maria Rhode in the ACP Bulletin is given.
Abstract: This paper is a response to a review of the conference titled, ‘Unintegration, Disintegration and Integration’, written by Cathy Urwin and Maria Rhode in the ACP Bulletin. The review mentioned Michael Fordham, noting that he referred to a ‘good’ kind of unintegration. In this paper, I point out that this is a somewhat misleading reference to what he termed ‘deintegration’. I describe Fordham's model and draw upon observational material and developmental studies in order to illustrate his model. I try to demonstrate that his model is useful and relevant in two particular areas; firstly, it is a psychodynamic model that encompasses the functional unity of the infant and, secondly, the model has adapted readily to the wealth of developmental research that arose at the end of the last century.

7 citations


Journal ArticleDOI
TL;DR: A revised version of the introduction to the ACP Study Day in February 2005 on integration, unintegration and disintegration is given in this paper, in which Alvarez and O'Shaughnessy had presented and which the author had chaired.
Abstract: This introduction to the two papers that follow by Anne Alvarez and Edna O'Shaughnessy is a revised version of the introduction to the ACP Study Day in February 2005 on ‘Integration, Unintegration, Disintegration’, at which Alvarez and O'Shaughnessy had presented and which the author had chaired. The background to the debate is given in terms of how the ACP Study Day itself came about, and the central theme is highlighted in terms of the question of whether unintegration is conceived of as a normal stage of development or only a temporary state of mind in response to catastrophic anxieties. Brief clinical material from a case supervised by the author is discussed in order to elaborate this central question.

Journal ArticleDOI
TL;DR: In this article, it is argued that an infant's state of passive unintegration in which the object functions as a'skin' to bind together the parts of the personality is not a normal first stage of development, as Esther Bick suggested, but rather a sign of an aberrant and already disturbed development resulting from trauma; in such a situation, overwhelming primitive anxiety threatens annihilation, or gives rise to terror of catastrophic dispersal of the self, leading to a desperate defence involving a survival fantasy of lying passive in a containing skin.
Abstract: This paper discusses the beginnings of post-natal psychic life, what constitutes the ordinary state of unintegration in the neonate, the nature of the baby's ego, and the clinical relevance of these questions. It is argued that an infant's state of passive unintegration in which the object functions as a ‘skin’ to bind together the parts of the personality is not a normal first stage of development, as Esther Bick suggested, but rather a sign of an aberrant and already disturbed development resulting from trauma; in such a situation, overwhelming primitive anxiety threatens annihilation, or gives rise to terror of catastrophic dispersal of the self, leading to a desperate defence involving a survival fantasy of lying passive in a containing skin. This is contrasted with normal development in which the baby in a state of ordinary unintegration actively searches for an object. This aberrant state of unintegration, and its clinical relevance, is illustrated with reference to a case involving a 12-ye...

Journal ArticleDOI
TL;DR: In this article, a difference in emphasis between Bick's early and later account of the functions of the skin in object relations is identified, which to some has suggested a greater distancing from a Kleinian position.
Abstract: This paper contextualises Bick's contribution historically, particularly in relation to Winnicott's work which challenged the Kleinian tradition to provide a developmental account of psychotic phenomena that would give a role to environmental factors. A difference in emphasis between Bick's early and later account of the functions of the skin in object relations is identified, which to some has suggested a greater distancing from a Kleinian position. A review of contemporary developmental psychology evidence argues for sophisticated coordinations in many perceptual, motor and communication systems in human neonates that apparently disappear within the course of the first few months, to be gradually re-coordinated later in development. The attempt to explain these phenomena has demonstrated that it is necessary to incorporate both integrative and differentiation processes into developmental accounts. While many of Bick's observations and conceptualisations have found confirmation in empirical rese...

Journal ArticleDOI
TL;DR: In this article, the meaning, reference and clinical relevance of Winnicott's concept of "riddance" were examined. But the subsequent eclipse of the riddance concept and the possible reasons for this are discussed.
Abstract: This paper considers the meaning, reference and clinical relevance of Winnicott's concept of ‘riddance’. Taking its starting point from the infant's behaviour in letting go the spatula, as described in his paper, ‘The observation of infants in a set situation’, it explores his explanation of riddance activity in the context of Freud's earlier description of his own grandchild's losing and letting go of objects, in ‘Beyond the pleasure principle’. Particular attention is paid to Klein's influence on Winnicott's formulations about riddance activity. It is argued that this had the effect of lessening the distinctiveness of his own initial explanation of the phenomena. Discussion of the paper is set against the background of Winnicott's contemporaneous treatment of Klein's son Eric and the ideological differences prevalent within the British Institute of Psycho-Analysis at the time. The subsequent eclipse of the riddance concept in Winnicott's writings and the possible reasons for this are discussed,...

Journal ArticleDOI
TL;DR: In this paper, the authors explored the nature and function of a suicide fantasy in the context of the impact of puberty on the female body image and against the background of the pre-Oedipal and Oedipal father's relationship with his daughter.
Abstract: During a pre-suicide state, the enactment of a suicide fantasy is the motive force. The nature and function of a suicide fantasy is explored in this paper in the context of the impact of puberty on the female body image and against the background of the pre-Oedipal and Oedipal father's relationship with his daughter. Case material from the analysis of an adolescent girl is presented to illustrate the crucial role of the father, in the transference, prior to a suicide attempt. La force motrice qui sous-tend l'etat pre-suicidaire est la mise en acte d'un fantasme suicidaire. Cet article explore la nature et la fonction du fantasme suicidaire dans le contexte de l'impact, chez une adolescente, de la puberte sur son image du corps avec, en toile de fond, la relation que le pere, preœdipien et œdipien, entretient avec sa fille. Un materiel clinique extrait de l'analyse d'une adolescente est presentee afin d'illustrer le role crucial du pere au sein du transfert avant la tentative de suicide. Mots-cles...

Journal ArticleDOI
TL;DR: In this article, the authors illustrate one kind of "impasse" in psychoanalytic psychotherapy described by Rosenfeld (1987 [1995] and show that an internal combined object, with features of a fetish, enhanced the influence of destructive narcissism, inducing states of mind that tended to hold each patient in an impasse.
Abstract: This paper illustrates one kind of ‘impasse’ in psychoanalytic psychotherapy described by Rosenfeld (1987 [1995]. Clinical illustrations from the experiences of two adolescent patients are given. The author emphasises that perversion reinforced the confusion these patients felt in the transference and in their lives outside treatment. An internal combined object, with features of a fetish, enhanced the influence of destructive narcissism. A fetish, comprising good and bad features in a confusing way, induced states of mind that tended to hold each patient in an impasse. The author suggests that such enhancement of the organisation of narcissism may account for some characteristics of ‘psychic retreats’ described by Steiner (1993), and the ‘as if’ quality of some treatment relationships described by Britton (1998, Belief and Imagination; London and New York: Routledge).

Journal ArticleDOI
TL;DR: In this article, the authors explore the nature and consequences of early trauma on the mental development of a 9-year-old boy I have called Luke and describe how, during the course of 2 years of intensive treatment, Luke gradually became able to restore his capacity for mental functioning, which made it possible for him to begin to think about and make sense of his extreme emotional experiences.
Abstract: This paper attempts to explore the nature and consequences of early trauma on the mental development of a 9-year-old boy I have called Luke. The traumatic event occurred within the context of a more chronic and ongoing trauma, which was due to the lack of receptive and containing parental figures. The combination of these two kinds of traumatic experiences had a destructive impact on the making of Luke's internal world and greatly disrupted the development of his capacity for thought. I will specifically refer to the theory of trauma and to Bion's theory of thinking in order to illustrate the crucial link between trauma and mental work and the complex challenge it brings. I will describe how, during the course of 2 years of intensive treatment, Luke gradually became able to restore his capacity for mental functioning, which made it possible for him to begin to think about and make sense of his extreme emotional experiences. Dans cet article, l'auteur cherche a explorer la nature et les consequenc...

Journal ArticleDOI
TL;DR: In this paper, a wide-ranging discussion centred around Edna O'Shaugnessy's clinical material and its technical implications, and to her relationship to her g...
Abstract: [The] papers provoked wide-ranging discussion. Immediately after the presentations… some discussion centred around Edna O'Shaugnessy's clinical material and its technical implications, and to her g...