Primitive Anxieties Research Articles

Climate change: the psychological impact of climate anxiety and trauma: understanding from the psychotherapeutic encounter

ABSTRACT Anthropogenic climate change has been a crisis that human beings have spent decades being in denial of, at great cost to nature, biodiversity and ultimately to ourselves. Facing the reality of this crisis and the damage done to the natural world has been unbearable and places us in touch with primitive anxieties about our own destructiveness. There is hope that our species can take a different path than the current one of living beyond our means. Some momentum towards change is beginning to occur: but will meaningful change be expedited soon enough to protect our struggling planet? The focus of this paper is to explore how psychoanalytic thinking can provide a deeper insight into the anxiety that the climate crisis is bringing to the fore, especially in young people who are wary of adult figures and institutions that are not seen to be doing enough to address this issue. Through the work of child and adolescent psychotherapy with a young person, the impact of climate change is considered in terms of the relationship between internal and external worlds. Also discussed is the importance of the psychotherapist themselves in bearing the reality of the climate crisis and its accompanying anxieties, especially when working with climate anxiety and climate trauma in our patients.

The work of family ties in anorexia

This article describes a type of anorexia that embodies in the eating disorder an attempt to control death anxiety of the symptomatic patient on behalf of her entire family. This death anxiety is rooted in the family history of trauma and a certain type of incestuous phantasy. A description of a family treatment demonstrates how presence and absence, and the inability to put primitive anxieties into words is dealt with through the analysis of the co-therapist's countertransference.

Making More From Less in a Corona-Encircled Analytic Frame and Situation.

The author describes how the parasitic coronavirus encircled and disrupted the analytic frame and situation, activating anxiety in both therapist and patient. A patient is described with core intimacy difficulties whose primitive anxieties manifested in him the dis-regulation of the too-far (agoraphobic), too-near (claustrophobic) intimacy dialectic. Drawing on Winnicott, the author describes how these increased dialectic tensions, when contained, created a potentially transformational transitional space that helped to enhance the patient's mental and symbolizing capacity, that is, a capacity to make more from less.

One smart object – three layers of smartphone use in discovering an encapsulated patient’s inner world*

ABSTRACT This paper explores the use of a smartphone within a therapy. It describes its use as a screen object in the service of survival-oriented infantile omnipotence, towards its use as a bridge that facilitated the structuring of internal space and the emergence of nascent capacities for relatedness and introspection. Clinical material from a ten year-long therapy with an adopted girl illustrates the presence of the smartphone on three layers of the therapeutic relationship. First, on a sensory level, the smartphone was used as an almost autistic screening object, but also as an auditory-visual envelope where therapist and patient could be immersed together. Second, on the level of patient-therapist communication and transference relations, the use of the smartphone revived infantile trauma involving the internalisation of a parental gaze that established a distorted internal and external gaze experience, which I termed ‘psychic cross-eyes’. Third, the smartphone served as a ‘third’ object that helped establish our shared observation of reality, and of the patient’s own psyche. By dwelling together, and developing a private language of ‘being-with’ ‘inside’ the phone, while gradually interpreting primitive anxieties and defences in terms of withdrawal from relatedness, we were able to add greater flexibility to the patient’s notion of relatedness, establish her binocular vision, and promote the development of the inner witness function. The paper thus explores the smartphone’s transition from a sterile, screening object, to a communicative, ‘object-seeking’ presence.

Group psychotherapy for parents of patients with borderline personality disorder: Βasic assumptions and group containing function.

Patients with borderline personality disorders (BPD) have great difficulties with interpersonal relations. Their extreme difficulties with interpersonal relations are illustrated in psychic family interaction. Parents become the recipients of conflicts and patient's aggressive behaviour, while family stress increases due to suicidal tendency, self-injuries and substance abuse. The current report presents the introduction of group psychotherapy for parents of young adult patients with BPD, treated in a special unit of personality disorders at Eginition Hospital. The aim is, through the parallel group therapy of patients and their parents, to establish the conditions of continuing therapy for the patients as well as maintaining therapy outcomes and to construct a facilitating environment where the family's mental pain, anxieties, anger, shame, guilt and sadness can be contained. Clinical material from the first sessions of a 13-member parent group is presented to illustrate the resistances, the primitive defenses and the basic assumptions of dependency and fight-flight developing in therapeutic work with parents. Furthermore, the groups' split and hostile transference communications and the therapists' countertransference reactions are discussed. Τhe containing function of the group is described as a therapeutic process of transformation of the primitive anxieties and projective identifications, which is gradually established through the therapists' elaboration of their countertransference reactions and their tolerance to hostility and confusion. Containment facilitates the establishment of a group culture of empathic understanding for parents' unconscious resistances, denial of the illness and negative projections onto their child and the therapists, so that resistances gradually to be curbed and archaic projections to be transformed. Hence, the group is expected to function as a safe space to allow the manifestation and relief of destruction anxieties, and the expression of unuttered and intolerable emotions. Finally, the group as a mother-object is expected to be internalised as a model of positive parental care, enhancing the empathic and reflective ability of the parents so that they may repeat the parental role in a process of reparation.

Primitive anxieties and the small group: multi-agency working and the risk of collaboration

ABSTRACT This paper explores some of the unconscious group processes that multi-agency teams face in the development of emotionally engaged collaborative relationships. Here, the term multi-agency team is used to refer specifically to groups of professionals drawn from different organisations who come together and disband around work with a specific young person and their family. Through the close analysis of observational material taken from a multi-agency meeting concerning a young person in temporary foster care, there is an exploration of the acute emotional pressures and unconscious processes present in this small group. Drawing together Bion’s and Canham’s work on group functioning, in conjunction with Lacan’s formulation of the mirror stage as central to ego development, the very particular and problematic nature of the anxieties provoked by the loss of individual coherence in multi-agency teams is explored. Consideration is given to how an increased awareness of the nature of the anxieties provoked by work in small groups, and of the unconscious processes that become operative in them, can offer professionals working in multi-agency teams an additional perspective from which to view the emotional vicissitudes present in this type of work. It is suggested that a greater awareness of the specific emotional challenges posed by the small group can improve the potential for emotionally engaged collaboration in multi-agency working.

The empty couch: Love and mourning in times of confinement

ABSTRACT This paper describes the psychoanalytic treatment of a woman patient during the first six months of the COVID-19 pandemic, when the setting was profoundly disrupted and was transferred from in-person psychoanalysis to telephone sessions. Drawing on Bleger’s formulations on the construction of the analytic frame and on André Green’s on the function of the framing structure in the construction and elaboration of phantasy life, the case study shows how, in the absence of the physicality of the setting, the most primitive anxieties about the symbiotic relationship with the mother were expressed and contained in the transference and countertransference in the analysis. The author offers some considerations about the notion of “background of the uncanny”, derived from Yolanda Gampel, which draws attention to the challenges when both patient and analyst are inserted into the same traumatic wider context. It is suggested that the production of an art object by the patient during this period represents a step in the elaboration of the work of mourning and towards symbolization.

When shock is not shocking: Psychodynamics underlying the acceptance of austerity

This paper explores the intrapsychic functioning underlying the acceptance of austerity imposed on southern European countries following the 2007–2008 global financial crisis. How does an external “There Is No Alternative” model become internalized into an internal one? Neoliberal economics produces shock and public disorientation among populations in order to impose economic shock therapy. This induces primitive anxieties and phantasies as a result of our incapacity to understand and to give meaning. In this state of mind, a great number of people become prey to authoritarian figures. This also leads to regression to schizoid-paranoid states where fear of the other and guilt-driven renunciation of individual and collective rights for the sake of a greater good duly follow.

‘Crying out for help’: containing primitive anxieties. From infant observation to under-5’s brief therapeutic intervention

ABSTRACT This paper describes a brief under 5’s intervention with a family who referred themselves to a hospital early intervention service. Material from the full piece of clinical work with the family is presented and discussed. The second session is presented in detail to give a sense of the distinctive features of the brief intervention for under-5’s. The whole family was invited to attend, and the work was shared by two psychotherapists trained in the under 5s model of brief work. The significance of psychoanalytic infant observation in this type of intervention is highlighted. Infant observation enables the therapists to gather detailed impressions and thoughts to make meaning and to connect verbal and non-verbal communication between children, parents and therapists. The end-result is the creation of a transitional space, in which differentiation, creative thinking and change can take place.

Psychoanalysis with adults inspired by parent–infant therapy: Reconstructing infantile trauma

ABSTRACT This the first in a series of articles on how Psychodynamic Therapy with Infants and Parents (PTIP) can inspire work with adult therapy. PTIP helps infants and parents improve their relationship and facilitate child development. During sessions, developmental hazards are dramatized by parent and baby, giving the therapist first-hand impressions of how conflictual relationships impact on the well-being of mother and child. This article argues that PTIP experiences may also inspire analytic work with adult patients. (1) It gives the analyst a foothold when reconstructing a patient’s infantile trauma and linking it with his/her present distress. (2) It deepens his/her attention on primitive anxieties, para-verbal communication and psychosomatic functioning. (3) PTIP experiences with high-speed interchanges between container and contained, personified by baby and parent, seem to induce more internal images and metaphors in adult work as well. (4) Working with two patients simultaneously means the analyst’s position resembles that of a couple therapist or a participant observer of the traffic between container and contained. This can make him/her more agile in dealing with corresponding movements between him/herself and the patient. The present article focuses on (1), reconstructive work in adult work inspired by PTIP experiences.

The Portable Psychoanalytic Frame: Evenly Suspended Attention, Bick’s Method of Infant Observation and Its [Unexpected] Application by an Observer in a Day Care

ABSTRACT This paper uses Freud’s idea of evenly suspended attention, as applied through Bick’s method of infant observation, to demonstrate a technique crucial to the work of the parent-infant clinician. Cultivating an evenly suspended state of attention is shown to be an indispensable technique for the clinician’s mind at work, especially for the parent infant clinician, whose external setting is unpredictable and challenging. Without a fixed external setting, a portable frame is required: the internal setting established by combining psychoanalytic theory with this specific kind of free-floating attention. This claim will be illustrated by an observer’s use of attentiveness in a daycare setting. The observer gathered the experience of a four-month-old infant in psychic peril. Lacking his caregiver’s attention, the infant was object-absent. The observer’s sensitive, absorbing stance was pivotal: not only to finding meaning and containing the primitive anxieties of an infant in trouble, but also – critically – to enabling the development of the infant’s sense of self by building a mental bridge to an unavailable caregiver, who could be reached and ultimately found a place in her mind for him.

Book Review Essay: Extending the Boundaries of Psychopathology and of its Psychoanalytic Treatment: A Review of Engaging Primitive Anxieties of the Emerging Self: The Legacy of Frances Tustin, Edited by B. Levine and D. G. Power. London: Karnac, 2017. 270 pp.

This is an important collection. It is both encyclopaedic and scholarly in its willingness to address a multitude of theoretical and technical implications of the efforts to treat extremely severe ...

The Dread of Falling and Dissolving: Further Thoughts

This paper aims to expand our thinking about and understanding of two very primitive anxieties that are prominent in various primitive mental states in general and in disorders found along the autistic spectrum, in particular: the fear of falling and the dread of self‐dissolution. These anxieties are illustrated through two personal dreams of the author, two clinical cases, various art works and Beckett's short story ‘The expelled’ (1946). Theoretical developments in psychoanalytic theories for understanding these anxieties are presented and discussed, with the aim to clarify the matrix of object relations specific to each of these two anxieties.

From the talking cure to a disease of silence: Effects of ethical violations in a psychoanalytic institute

ABSTRACTThis article presents an in-depth study of one institute’s efforts to recover from effects of ethical violations by two senior members. Qualitative data analysis from voluntary member interviews details the damage that spread throughout the institute, demonstrating that a violation of one is a violation of many. Members at all levels reported feeling disturbed in ways that affected their emotional equilibrium, their thinking processes, and their social and professional relationships. The aggregated interview data were reported to the institute community in large and small group meetings designed to reverse the “disease of silence” and to allow members to talk with each other. Outside consultation helped with this emotionally arduous process. The authors offer hypotheses concerning the nature of group anxieties during ethics crises. We assert that both sexual and non-sexual boundary violations break the incest taboo, as they breach the generational protection required of professional interactions. Ethical violations attack the group’s foundational ethos of care, unleashing primitive anxieties and defences that interfere with capacities for thinking, containment, collaboration, and integration. Since the full reality of what happened is unknowable, hybrid truths emerge, causing conflict and disturbances that inhibit thoughtful group discourse.

Exploring the Role of Blame in Couple Relationships within the Triangular Setting of Couple Psychotherapy

This paper describes the process of couple therapy with two couples that used blame as the currency of exchange in their relationship. Both couples struggled with managing three‐person relationships. The triangular setting of couple psychotherapy provoked and triggered primitive anxieties around exclusion, rejection and abandonment in both cases. I draw upon clinical work with two such couples to illustrate how one repeatedly collapsed the triangular space whereas the other gradually became more able to bear it. I refer to scientific evidence of the brain's ability to continue to change in response to new learning by forming fresh neural connections throughout life. I suggest that the repetitive occurrence of new experiences within couple psychotherapy can generate new neural pathways thereby biologically influencing new ways of how partners might respond to each other. I conclude by highlighting the therapeutic potential of the framework within which couple psychotherapy takes place, a triangular configuration which offers a developmental opportunity for navigating primitive anxieties related to triangular relationships.

Primitive Anxieties, Gender Madness, and Perversions of Agency in Eating Disordered Patients: Commentary on Paper by Tom Wooldridge

The following is a discussion of Tom Wooldridge’s (this issue) paper on primitive anxieties in anorexia and his metaphor of the “entropic body” as a false self “body-state” (Petrucelli, 2014) that functions to omnipotently deny dependency. The focus here is on how, for the eating disordered patient, primitive anxieties related to dependency and containment intertwine with the challenges of rapprochement, in which separation, agency, and awareness of sex difference emerge in a traumatic field. This response emphasizes the clinical utility of conceptualizing eating disorders as disorders of a gendered, agentic self. Wooldridge’s clinical material is discussed with a focus on (a) the salience of gendered enactments in work with eating disordered patients and (b) the relationship between experiences of “entropy” in the clinical dyad and the mutual disavowal of gender-inflected identifications and desires.

Many Selves in One Body: Discussion of “The Entropic Body”

The discussion of Wooldridge’s paper (this issue) offers two theoretical ideas to conceptualize the psychodynamics and treatment of individuals with severe eating disorders. Multiple self-states posited by Philip Bromberg and others allows for an understanding of the often contradictory nature of eating disorder symptomatology. Pathological organizations and primitive anxieties, elaborated by Paul Williams, suggests that the deep psychotic layer of the personality must be reckoned with in order to help the patient. Wooldridge’s patient Sara is discussed from these two perspectives, and technical considerations are offered.

The Entropic Body: Primitive Anxieties and Secondary Skin Formation in Anorexia Nervosa

This paper develops a metapsychological view of anorexia nervosa, including not only its symptomatic presentation but also its etiology and characteristic psychic and relational styles. Because patients with anorexia are understood as not having internalized maternal comforting functions in the period of separation-individuation, they are unable to digest trauma experiences of infancy. I argue that the anorexic patient’s disturbed relationship with food reflects distortions in transitional object usage. Lacking the ability to contain intense anxieties about disintegration and falling apart, patients with anorexia must find other ways to hold themselves together. The fear of getting fat expressed by these patients is one way that this fear of disintegration is expressed. Furthermore, the almost addictive experience of emaciation holds the personality together. Elaborating this idea, I develop the notion of the entropic body, a particular version of the false body (Goldberg, 2004) employed by patients with anorexia nervosa in an attempt to compensate for absent maternal comforting functions. This body-state (Petrucelli, 2014), which develops against a background of profound early trauma, eschews hunger and dependence in favor of omnipotently controlled protection.

From Night kitchen to Wolves in the walls: a brief psychoanalytic look at children’s picture books

This article uses psychoanalytic theory to look at a range of contemporary picture books, and argues that picture books allow child readers an opportunity to engage with their own primitive anxieties. It begins with a brief look at the history of children’s literature, arguing that the genre has developed to allow for increasingly complex representations of children’s internal worlds. Alongside this, it considers the value and application of psychoanalytic theory to literary criticism in order to contextualise its own approach to the books it later looks at. The article focuses in on picture books as a specific genre within children’s literature and uses Maurice Sendak’s picture book In the night kitchen to outline some of the key characteristics that make picture books especially suited to the articulation of primitive anxieties in ways that child readers can engage with and take ownership of. The second part of the article examines a number of contemporary picture books, analysing them in terms of their unconscious content in order to demonstrate the ways in which psychoanalytic ideas can be usefully applied to such texts.

In the mind of the reader: On some aspects of relating to a psychoanalytic text

The aim of this paper is to explore certain aspects of reading as a psychic activity, focussing on editorial reading of psychoanalytic texts. The author puts stress on container–contained aspects of the reader–text–author relationship. The efficiency (or failure) of a text as container is more or less to be sought in its form and its “readability.” Concerning psychoanalytic texts, the editorial reader has to function as a container for the author's primitive and/or Oedipal anxieties, a process necessary for the evaluation and/or the potential transformation of a text; moreover, the psychoanalytic journal as a whole, through the linking processes it establishes between readers and authors, in the psychoanalytic community, can be regarded as the third object of a commensal container–contained relationship.