Intrapsychic Dynamics Research Articles

Selected for Solitude: A Case Report of Loneliness.

The U.S. Surgeon General, Vivek Murthy, recently declared loneliness a public health epidemic. For therapists, that is not likely to be a surprise: Loneliness is so common in people who seek therapy that it might be seen as the bread and butter of our work. Despite that, there has not been much serious examination of intrapsychic factors that may contribute to this painful condition. Public discourse has focused instead on cultural and societal causes of loneliness, and on practical steps that might be taken to decrease it. But practical advice is not always sufficient for people with longstanding loneliness. Longstanding loneliness may be fueled by intrapsychic dynamics and become embedded in character. In some cases, patients may relish companionship yet steadfastly avoid it in an attempt to master early childhood experiences of being emotionally neglected and deprived of love. They were starved of love as children and now choose to starve themselves in an unconscious attempt to master early deprivation by identifying with the aggressor. For patients like this, chronic loneliness may signal a certain kind of attachment disorder, for it is the visible sign of early attachment to a distant or rejecting parental figure. Loneliness of that kind can be a stubborn problem and one that poses a considerable therapeutic challenge.

Adolescence, migration, music and psychoanalytic tools into play

AbstractIn this article, the authors aim to exemplify how psychoanalysis can apply to the community partially modifying its external setting, such as opening to group settings and including arts and music, while remaining firm in some structural tools, such as psychoanalytical observation and listening, play and attention to the intrapsychic dynamics of participants, including the psychoanalysts and their countertransference. They illustrate the experience of some projects, in particular one carried out for 3 years and ongoing, where young migrants, hosted in Refugee Shelters, meet Italian students in Secondary Schools. This article also describes the value of Music as an element of ‘psychoanalytic play’, establishing intrapsychic and interpersonal links.

Gay men and extreme sexual practices in the era of chemsex and online digital dating platforms

Chemsex is a phenomenon in which, typically, gay men take very powerful and high-risk psychoactive drugs while having sex, often without a condom, otherwise known as bare backing. This frequently, but not exclusively, occurs in a group sex context in a residential or a commercial sex on premises establishment. This use of chemsex can lead to increased rates of HIV transmission, sexual and physical assault, a significant impact and corrosion of mental health and frequent occasions of fatality. Gay men are already a stigmatized group so those who engage in chemsex face multiple stigmas. Christopher Bollas’ seminal paper on Cruising in the Homosexual Arena 1993 (Bollas, 1993) was the inspiration for this article. This article attempts to provide a contemporary psychodynamic and group analytic understanding of the group and inter- and intra-psychic dynamics of more recent developments in gay male cruising practices at this later stage of the AIDS pandemic. The changes result from the demise of the gay male bar scene, its effective replacement with the availability of dating apps, the new digital hook up culture and the aggressive emergence of, for a small subgroup of gay men, the almost overnight replacement of the much less harmful dance floor drugs with extremely hazardous chemsex drugs such as crystal meth, mephedrone and GHB/GBL. Through a group analytic lens this article discusses the challenge of navigating the ungoverned spaces of the extreme and often very dangerous sexual practices in a small but significant subgroup of the modern gay male community.

Psychoanalytic Interventions with Abusive Parents: An Opportunity for Children's Mental Health.

Research has extensively shown that most people who experience maltreatment in their childhood develop mental disorders, psychosocial adjustment problems, and, in many cases, become maltreating adults themselves. Preventing child maltreatment and treating abused children and abusive parents are, therefore, pressing public health issues. As established by the UK Children Act in 1989, child development is enhanced by remaining in the family whenever the child’s safety is assured. Thus, developing prevention and intervention programs for the purpose of repairing, whenever possible, the child–parent relationship should be a social priority. This narrative review focuses on the psychoanalytic studies related to intrapsychic dynamics and therapeutic intervention for physically abusive parents. The role of the transgenerational transmission of abuse and parents’ narcissistic fragility is crucial. Psychoanalytic interventions focus on helping the parent work through their past painful experiences and narcissistic vulnerability. Parent–child psychotherapy and mentalization-based treatment have been found to be prevalent, while there is scarce literature regarding intensive individual psychoanalytic treatment. Within the framework of attachment theory, brief interventions were developed; however, they did not prove effective for those parents who suffered experiences of maltreatment or severe neglect in childhood and for whom long-term parent–child psychotherapy resulted, which proved to be the most effective.

The Use of Interpretive Dynamic Transactional Analysis Psychotherapy (IDTAP) in Facilitating Structural Integration When Working With Reenactments of Developmental Trauma in the Psychotherapeutic Setting

The author considers how through reenactments, early developmental trauma and potential impairments in personality functioning may manifest in the psychotherapeutic relationship and how such reenactments may be underpinned by the individual’s need to control the intrapsychic dynamics through the use and control of interpersonal relationships. Some of the common transference manifestations are considered along with how they present fertile ground for resolution of the underlying internal conflicts. The article addresses this mainly through the theory and clinical examples from clients presenting with some level of personality impairment. In terms of psychotherapeutic technique, the author falls back on what he refers to as interpretive dynamic transactional analysis psychotherapy (IDTAP). There is a particular focus on reenactments of the destructive internal parts embedded in the client’s attachment to the internal bad object. The dangers of the therapist’s intention to provide the reparative relational experience are addressed along with the importance of analysis and resolution of the idealizing transference. The importance of the therapist’s function to endure and contain the negative countertransference is also discussed. Some potential interventions aimed at improving personality functioning are considered as are the implications of working with extratransference.

The OPD-CA-2 axis interpersonal relations: A helpful tool for treatment planning? Relationship patterns of adolescent patients with persistent intrapsychic conflicts, structural deficits and trauma sequelae disorders

The axis interpersonal relations of the Operationalized Psychodynamic Diagnosis in Childhood and Adolescence (OPD-CA-2; OPD-CA-2 Task Force, OPD-CA-2. Operationalized Psychodynamic Diagnosis in Childhood and Adolescence. Theoretical Basis and User Manual. Hogrefe, 2017) allows to describe how children and adolescents handle relationships both with relevant attachment figures (e.g., parents) and with the examiner in a standardized way. In the current study, the axis interpersonal relations was used in an inpatient adolescent sample. The aim of the study was to identify typical relationship patterns depending on the patients’ structural level. By inspecting the relationship patterns of all ratings, we identified three groups of patients: The first group included patients with a limited structural level and clearly recognizable intrapsychic conflict dynamics (“focus: conflict”), the second group included patients with a low structural level (“focus: structure”), and the third group included patients who had been exposed to severe traumatic experiences with relevant attachment figures (“focus: trauma”). The relationship characteristics of these three groups were described and illustrated by prototypical cases. Conclusions for clinical practice were discussed as well.

Vying voices of the pandemic

This article documents and explores the painful impact of a gruesome racial attack during the first lockdown in the wake of the Covid-19 pandemic. It occurred less than a fortnight before the brutal murder of George Floyd in America. It is a reflection on the issue of racism and the marginalisation of less dominant groups in and outside the borders of Great Britain. It is the recognition and exploration in myself of an internalised colony of voices emerging as a response to the traumatic event. Tracking the intra-psychic and interpersonal dynamics involved in the racism and the subsequent attempt at an anti-racist answer leads to self-reflection on my part and the confrontation of my own bias. Eventually, I can feel my underlying vulnerability and the resulting shift. The sense of self-awareness and agency evolves into the mobilisation of an extensive mentalizing process. The article attempts to capture the subtle, insidious nature of othering and the fear behind the defences we use to keep this in place; the centrality of our capacity to courageously embrace our vulnerability as crucial to our ability to embrace and treat with dignity people who are different from us. The article touches on hopefulness that one day this socially constructed monster, racism, would be a thing of the past, not just on paper but in the human psyche also.

‘What are you looking for?’: a psychoanalytically oriented qualitative study of men’s compulsive use of internet pornography

Internet pornography use is an extremely widespread human engagement. A minority of viewers finds it compelling and experience distress and/or functional impairment due to their use. There is a tension in how internet pornography is considered culturally; privately, it is approached and engaged with, publicly it is distanced from and rejected. Empirical research into this phenomenon has tended to shy away from exploring the underlying elements inherent in engaging with pornography online, perhaps mirroring this cultural tension. This study used a psychoanalytically oriented multi-interview method and analysis, with five men, to explore the intrapsychic dynamics underpinning their compulsive use of internet pornography. Three themes emerged from this data: ‘searching for something’, ‘holding it all in and then just explode’, and ‘two separate personas’. Emergent themes were linked to psychoanalytic concepts including Laplanche’s concept of the enigmatic signifier and the Kleinian concepts of the paranoid-schizoid and depressive positions. Clinical implications for working with compulsive users of internet pornography and pathways for future research are discussed.

‘Analysing a parent’s capacity to change: towards a model for child protection social workers’

ABSTRACT In cases where child protection concerns are evident, a central query within inter-professional, safeguarding assessments, centres on the parents’ capacity to change to enhance their child’s lived experience. Social workers, as key professionals co-ordinating such assessments, require analytical tools and models to enable them and others to reach a considered judgement on this pressing, complex aspect of case inquiry. This article describes one such model. The model builds on the C-Change Approach which reviews the change process from a mainly cognitive-behavioural perspective. While recognising the strengths of this contribution to child protection assessment, the authors have extended it by examining change from a psycho-dynamic orientation. This orientation takes account, not only of the intra-psychic dynamics within the individual, but also the relational forces at work between people. Lastly, the authors consider how this extended model can be utilised to analyse and facilitate desired changes in parenting practices. Here, they draw on the helpful notion of a force-field analysis: a conceptual representation of the dynamics of change within a social situation.

The psychoanalytically-informed interview in social work research

ABSTRACT British psycho-social studies is a new paradigm of transdisciplinary scholarship situated at the borderlands of social and psychological theory. Its development has been represented as providing avenues for a more critical and reflexive engagement with psychoanalysis in social work, disentangled from the unfavourable meanings with which psychoanalysis has been associated (e.g. as apolitical and reductively focussed on intrapsychic dynamics). However, much remains to be said about the implications of methodological developments and debate in psycho-social studies for social work research, particularly in terms of the impetus it provides for reflecting on the transformations brought about in resituating psychoanalytic concepts and practices away from their traditional clinical context in social research and theory. This article draws from doctoral research concerned specifically with the theory and practice of research interviewing. It provides an account of the development of this research and explores the role of interpretation as part of a psychoanalytically-informed interview approach.

THE DISSOCIATIVE CONFABULATORY PROBLEM

Motivation/Background: The dissociative identity disorder implies as central defense the dissociation, that is being more recently studied. With the identification of the importance of this mechanism of functioning, the modern psychiatrists show the interest of this area, not only about the spectrum of the discharge, as was the case in Freud's time. Dissociative identity disorder involves a patient who can function in any registry, be it neurotic, psychotic or disharmonic.
 Method: Study of specialized literature, psychodynamic and psychoanalytic psychiatric perspective, psychiatric evaluation, evaluation of intrapsychic dynamics, transfer and countertransference analysis, hypnosis option study.
 Results: Psychically, patients function within a DID, with particularities such as the construction of illogisms, reversing the cause with the effect, sliding the speech towards the secondary meanings of the words, sliding easily from general to particular and from abstract to concrete. From the dissociative dimension we find the impersonal speech or the use of several pronouns with reference to the self and the denial of reality as a handy way to deal with the trauma, which we suppose from the register of abuse.
 Conclusions: We find several personalities with symbolic meanings, with a deficit of mentalization, sometimes with an emphatic laugh and an attitude of superiority.

In Recognition of Their Desperation: Sonic Relationality and the Work of Deep Listening

ABSTRACTThis essay places composer Pauline Oliveros’s philosophy and practice of Deep Listening in conversation with analytic theories of listening in a duet that explores one central question: What can listening do? Thinking through the impact of cultivated listening practices on the sensorium, the relational implications of listening across difference, and the centrality of practices of listening to the therapeutic action of psychoanalysis as well as the transformational capacity of performance, this essay claims Oliveros as a practitioner and theorist of a central psychoanalytic practice: listening. Deep Listening has the capacity to act as an amplifier for extending the reach of analytic listening beyond the clinic into an expanded cultural field. Likewise, psychoanalytic thinking allows for a rich exploration of the interpersonal and intrapsychic dynamics of Oliveros’s sonic meditations as they resonate in the circuits between the psyche and the social. Her 1970 composition To Valerie Solanas and Marilyn Monroe In Recognition of Their Desperation acts as a case study for exploring the dynamics of feminist listening.

Life History and Personality Characteristics of Marital Aggressors: Psychoanalytic Contributions

Abstract Research indicates that trauma (sexual, physical, and emotional abuse) is a factor commonly present in the life of marital abusers. This study aimed to investigate the life history characteristics and personality of men who perpetrated violence against women and were detained in the Central Prison of Porto Alegre, Brazil. We also identified sociodemographic characteristics, the presence of psychopathological symptoms and understood the intrapsychic dynamics involved in the participants’ marital choice, as well as their perception regarding the experience of detention. Three participants filled out a personal data sheet, answered the Rorschach method, the MINI Interview, and participated in three semi-structured interviews. The interviews were examined from the interpretative analysis technique based on psychoanalytic theory. The results allow us to understand the violence committed by the participants as a result from a life story marked by traumatic experiences that produced narcissistic flaws and the expression of aggressiveness.

Ettan, le petit accordeur des filiations – Ou la nécessité de penser l’altérité en consultation d’adoption internationale

This article explores the dynamic of a therapeutic group setting addressed to adopting families. On the basis of a case study, the problematics presented by the adopting family are analyzed in reference to the collective, intersubjective and individual perspectives. From a collective perspective, the problematics question the parental representations of their child's cultural belonging. From an intersubjective perspective, they shed light on the family's dynamic, notably the couple's difficulties. From an individual perspective, the problematics shed light on intrapsychic dynamics of each parent. Finally, the case study highlights the multiple scenes of the child's otherness display that necessitate a multidimensional analysis. Systemic, psychoanalytical and transcultural perspectives are needed to better understand the complex intertwining of the collective, intersubjective and individual dynamics underpinning the suffering in an adopting family.

Meaning making after a near-death experience: The relevance of intrapsychic and interpersonal dynamics

ABSTRACTThis study aims to investigate the processes used by individuals to integrate a near-death experience (NDE) and to discuss the use of a meaning-making component to help people who have had such experiences. A psychotherapist interviewed six individuals who reported having had a NDE. Transcripts of the interviews were coded using an interpretative phenomenological analysis. The authors identified intrapsychic and interpersonal dynamics implicated in the individuals’ meaning-making processes, and the problems encountered during their integration of the experience. Meaning-based approaches are a feasible theoretical framework for shedding light on the NDE and providing support for people who have lived through them.

La classification de la paranoïa dans la psychiatrie américaine contemporaine : une revue de la littérature

ObjectiveThe main objective of this paper is to undertake a literature review on the classification of the paranoia in contemporary American psychiatry. MethodThe authors review two facets (“paranoid personality disorder” and “delusional disorder”) of paranoia, still present in the DSM-IV-TR, before their controversial disappearance from the new hybrid model of personality disorders in the DSM-5. The authors present delusional disorder, a clinical entity that is both singularly complex and too polymorphic to obtain any consensus in the scientific community. They then explore some effects of the emergence of the dimensional approach to mental disorders, leading on to the thorny issue of the differential diagnosis between paranoia and schizophrenia. ResultsThe emergence of the dimensional approach in a a-theoretical model that recuses the intrapsychic dynamics that organize the functioning of personality led the authors of the DSM-5 to consider paranoid personality as solely a personality trait, and not as a structural constitution. DiscussionParadoxically, work in English-speaking countries has shown clinical differences between schizophrenia and paranoia, such as social adjustment and prognosis which are better for people with paranoia, although medication therapy and research are more problematic in this case. ConclusionTo improve the care, we think crucial to combine a dimensional approach with markers of intrapsychic functioning, including privileged defense mechanisms, avoiding the trap of the use of self-questionnaires which ultimately appeared inadequate.

On Knowing but Not Knowing in the Aftermath of Traumatic Betrayal: Discussion of Paper by Dianne Elise

There is a long tradition of analysands who have remained silent after traumatic betrayals. The difficulty in speaking to what happened has its origins in intrapsychic, intersubjective, and institutional dynamics. In this discussion of Dianne Elise’s paper, the author explores some of the factors involved, including the sense of uncertainty about what happened and its meaning, the transference concerns about how the new analyst views the former analyst, the countertransference paralysis of the new analyst, the disillusionment of members of the analytic community, the striking differences across the spectrum of analysands in their reactions to boundary violations, and the pairing phenomenon described by Bion as it applies to groups of analysts in a community.

Jointed Journey of Knowing Thyself

Introduction Narcissistic pathology and its presentation has been a part of our cultural heritage since times immemorial. Aside from the myth of Narcissus, the narcissistic bipolar self and its constant pain which arises from disharmony of mental representations of actual and the ideal self can be found in folk tales, written literature, films and even definitions of the present society. Shiva, Dr. Jekyll &Mr. Hide, Kent Clark& Superman are just a few examples of the above mentioned dichotomy of impotence and power, of fragile and grandiose self. Sometimes the sense of entitlement and unrealistic goals results in failure and uncontrollable aggresion, which often includes rebellious and manipulative suicidal behaviour. Objectives Exploring the types of defence mechanisms used by therapists dealing with narcissistic patients and their agressive behaviour. Aims Presenting the diversity of possible clinicians' emotional responses and in parallel raising awareness of deficient literature and lack of quantitative studies on that matter Methods Case presentation of a 40-year-old narcissistic patient with manipulative behaviour and suicidal threats, including a range of personal responses of the involved members of our team in addition to integrative psychopharmacological and psychodynamic approach. Result Several clinician-focused researches and our own experience indicate the provocation of various emotions and defense mechanisms, which consequently may alter the treatment efficacy. Conclusion The awareness of one’s spontaneous emotional reactions to a patient may be useful in understanding the patient’s intrapsychic dynamics, thereby considered as an important factor in therapeutic alliance and treatment outcome.

Psychiatrie et psychanalyse : le divorce est-il consommé ? À propos des « troubles bipolaires »

Background Following the publication of the proceedings from the conference on bipolar disorders and psychoanalysis organized in March 2012 in Paris, the authors propose deepening the discussion regarding the diagnosis and treatment of bipolar disorders given recent advances in the scientific understanding of this disease and its etiology. It could be argued that the term “bipolar” has become a source of confusion for the medical community and the general public alike. As Jean Delay emphasized, mood is by nature bipolar and is “a fundamental affective disposition, rich with all the emotional and instinctual aspects, which gives each of our moods a pleasant or unpleasant tone, oscillating between the two extremes of pleasure and pain.” While the pathophysiology of the bipolar disorder is now much better known and understood, the “extended bipolar spectrum” as a nosological concept may be ill-defined in that certain personality disorders or neurotic problems may be mis-diagnosed within this spectrum. In many cases, this may inhibit further medical exploration as well as lead to inappropriate therapeutic management. Moreover, this is a troublesome development in that the bipolar disorder has seen a significant diagnostic inflation over the past 20 years, most noticeably in the United States but as well as in Europe. Within the context of modern science and current medical understanding, the authors reflect on the role of psychoanalysis as a potential therapeutic treatment for this disorder?

Psycholinguistic analysis of intrapsychic dynamics of personality changes in the course of psychoanalysis

Psycholinguistic analysis of intrapsychic dynamics of personality changes in the course of psychoanalysis