Unconscious Collusion Research Articles

Can the Pain of Vystopia Help to Create a More Compassionate World?

Can the Pain of Vystopia Help to Create a More Compassionate World?

Escaping the healthcare leadership cul-de-sac

PurposeThis paper aims to propose that healthcare is dominated by a managerialist ideology, powerfully shaped by business schools and embodied in the Masters in Business Administration. It suggests that there may be unconscious collusion between universities, healthcare employers and student leaders and managers.Design/methodology/approachBased on a review of relevant literature, the paper examines critiques of managerialism generally and explores the assumptions behind leadership development. It draws upon work which suggests that leading in healthcare organisations is fundamentally different and proposes that leadership development should be more practice-based.FindingsThe way forward for higher education institutions is to include work- or practice-based approaches alongside academic approaches.Practical implicationsThe paper suggests that there is a challenge for higher education institutions to adopt and integrate practice-based development methods into their programme designs.Originality/valueThe paper provides a challenge to the future role of higher education institutions in developing leadership in healthcare.

Unconscious collusion: An interpretative phenomenological analysis of the maternity care experiences of women with obesity (BMI≥30 kg/m²)

Backgroundobstetric and midwifery literature continually emphasise incidence and consequence of obesity in pregnancy. However, they offer less consensus on how best to support women who are obese. Therefore, this study explores in depth the lived experience of women who have a Body Mass Index (BMI) ≥30kg/m². This exploration provides a bio-psycho-social understanding of the lived experience of women to identify how best to support them throughout their childbirth experience. Methodsan Interpretative Phenomenological Analysis (IPA) design was adopted for this qualitative study. Purposive sampling of participants was conducted on the postnatal wards of a maternity hospital in the Republic of Ireland. In total, 15 participants volunteered to take part in semi-structured interviews conducted at six to ten weeks postnatally. Data were analysed utilising the IPA framework. Findingsthe results indicate that participants were conscious of the problematics of communicating obesity in pregnancy. The narrative data revealed an unconscious collusion between healthcare professionals and women as they navigate obesity related conversations. The behaviours related to unconscious collusion are incorporated in the sub-ordinate themes; ‘just recorded and that's all’, ‘but what's eating healthy? ‘pussy footing around’ and ‘I hate that word obesity. Conclusions and implications for practicethe findings highlight a lack of information received by participants from healthcare professionals regarding increased BMI or weight management. The data suggests that healthcare professionals appeared to collude with women to avoid challenging discussions regarding obesity. This may be related to avoidance on participants’ part and/or may be linked with healthcare professionals’ reluctance to communicate issues relating to increased BMI. Although participants were generally unhappy with the communication skills of health professionals, they readily acknowledged the sensitive nature of obesity related communications. The findings provide healthcare professionals with an important insight into issues of effective communication and obesity related healthcare promotion from the woman's perspective in order to enhance provision of appropriate health information and maternity care to women who have an increased BMI.

The design of a Probability Bidding Mechanism in electricity auctions by considering trading constraints

In the electricity trading exchange, we need to consider electricity price, transmission costs, network congestion and technology constraints. Therefore, some electricity trading may be forced to be canceled because of limits on power transmission lines. The most challenging issue is how to make an appropriate auction bidding mechanism in electricity trading. According to the bipartite network and evolutionary game theory with the Paid-as-Bid auction mechanism as research background, we explore a Probability Bidding Mechanism (PBM). The designed mechanism could significantly disrupt the learning process and weaken the unconscious collusion behaviors of generators during the auction process. The simulation results of the proposed mechanism are compared with the High–Low Matching bidding mechanism and the comparison shows that the PBM could minimize the average transaction price and maximize the average trading quantities effectively. Further investigation reveals that the parameter, which is used to adjust trading price, has more influence on generators than purchasers. Some suggestions for reducing the generator’s offer and increasing the market trading quantities are recommended at the end of the paper.

Analysing the Dynamics in a Couple with Primitive Defences

Because of severe early trauma experienced by one member of a married couple and the unresolved oedipal issues lingering within the other, maintaining a holding environment for both and moving them from the paranoid–schizoid position toward the depressive was nearly impossible at first. Once I became aware of how both partners, using projective identification, had put split-off parts of self into the other, and that the husband was having major dissociative episodes—for example, screaming, into the air, at his wife, and nearly everywhere—I could more readily see the pair as individuals and pick up the unconscious collusion between them as a couple who relied on primitive defences.

Collusive induction in perverse relating: Perverse enactments and bastions as a camouflage for death anxiety

The author argues that one of the main functions of perverse relatedness is to induce the analyst into becoming the patient's unconscious accomplice in a “perverse pact” against the analytic work aimed at disavowing intolerable aspects of reality. The intense power of collusive induction in perverse relating leads the analyst to participate in transference‐countertransference enactments and to the crystallization of a silent and chronic unconscious collusion between the patient and analyst in the analytic field, stagnating the process (bastion; Baranger and Baranger). The author claims that analysis of perverse pathology should not be limited to interpretation of the patient's intrapsychic functioning but should also focus on the information obtained by the analyst through his participation in collusive enactments; the analyst should also take a “second look” at the analytic “field” to detect underlying bastions. The author reviews the main psychoanalytic contributions that have clarified the phenomenon of collusive induction in perverse relating and as an illustration, describes the analysis of a man with a perverse character; in this patient, one of the main functions of his perverse relatedness was to induce the analyst to become an accomplice in his disavowal of his terror of death. The author highlights the influence of death anxiety in the bastions that develop in the treatment of perverse patients.

Multi-agent based experimental analysis on bidding mechanism in electricity auction markets

Determining the best market pricing rule is a controversial issue in the design of electricity auction markets. Pay-as-bid (PAB) has been proposed to replace the market-clearing price (MCP) in deregulated electricity markets, with the expectation that it would lower market prices and reduce price volatility. A multi-agent based experiment was constructed to compare and analyze the balanced process of the two auction mechanisms. Each adaptive agent represents a generator who develops a bid price and quantity based on a reinforcement learning algorithm. In the simulation experiments, the experimental results are not as expected. Before the market reaches equilibrium, the market price with the PAB mechanism is lower than it is with the MCP mechanism. However, the market price in the PAB mechanism is higher than it is with the MCP when the market achieves a state of equilibrium. With the PAB mechanism, the volatility of volume and price of each generator is less than it is with the MCP system, as expected. The experimental results also show that unconscious collusion behaviors by generators during the game process are a key reason for producing generator market power in the two auction mechanisms.

Benign and disruptive disturbances of the supervisory field

Inspired by Baranger, Baranger and Mom’s notion of psychoanalytic bastion, we describe an unconscious collusion between analytic supervisors and supervisees. This collusion’s purpose is to avoid the anxiety inherent in the psychoanalytic field and that enters unprocessed into the supervisory field. The supervisor/supervisee dyad’s emotional experience can be fleeting, with moderate intensity, but can slow down the process. This can happen sometimes in any supervisory situation. Or it can become permanent and with greater intensity and bring the entire process to a standstill and to a disruption of the supervisory field. We call the first situation a ‘benign disturbance of the supervisory field’, the second a ‘disruptive disturbance of the supervisory field’. We illustrate both disturbances using supervisory material. Our purpose is to show how to detect these disturbances, understand them, and manage them.

What Divides the Subject? Psychoanalytic Reflections on Subjectivity, Subjection and Resistance

The paper argues that the meaning of subjectivity is controversial, even within psychoanalysis. While all schools of psychoanalysis agree that the unconscious creates a subjectivity that is divided, there is great disagreement over what divides the subject, particularly what divides it against itself. The paper examines two controversies that bear on the relation of subjectivity and subjection. The author argues that a psycho-social theory of subjectivity has to account for the effects of the social without succumbing to the reductionism of social determinism, and has to account for the idiosyncrasies of human subjectivity without removing subjectivity from its social and historical context. The author roots one relation between subjectivity, subjection, and resistance in what she calls “normative unconscious processes”: unconscious collusions with normative demands to split off and project such human attributes as dependency, emotion, and assertion. Subjects comply with such demands in order to be recognized as “properly” gendered, raced, classed, and sexed subjects, but relational repetition compulsions often express simultaneous resistance to and collusion with oppressive norms.

The patient in hospital*

The application of psychoanalytic knowledge to the care of the patient in hospital is considered in relation to two patients, one an acute surgical admission, the other psychotic. The psychological parallel is examined and defined before proceeding to where they diverge. The psychotic patient's use of splitting and projective identification, in order to avoid psychic pain felt to be incompatible with survival, is described along with the hospital staff's unconscious and empirical collusion with it. The patient's need to be ill, which is his right to be ill in hospital, is considered in relation to the psychotic's denial of his need. The inseparability of the care of the patient's body and mind, in these circumstances, is also illustrated, and argued to be equally germane to psychoanalytic thinking in this setting. It is submitted that the application of psychoanalytic knowledge catalyses and sustains relationship with these patients. The use of interpretation is briefly noted. * This article was originally published in Psychoanalytic Psychotherapy, Volume 1, Issue 1, 1985. The paper is an attempt to stimulate thought and other publications in this field, one of lasting relevance to psychoanalytic psychotherapists working in the National Health Service.

Working at the “Intimate Edge”: Intersubjective Considerations—Comments on “A Case Study of Power and the Eroticized Transference–Countertransference”

Working from the premise that as analysts we are always vulnerable to unconscious collusion and enactment, and that this has radical implications for how we conceive of the analytic process, I try to illustrate how the process of working at the “intimate edge” of the analytic relationship, and explicitly engaging what goes on intersubjectively between patient and analyst expands the analytic process and the analytic possibilities. I especially focus on how deconstructing interactive enactment can help to access unconscious aspects of what might be in play in relation to the issues of power and eroticized transference–countertransference under discussion here, and how this process itself can become the medium of the work and the focus of therapeutic action.

Acute enactment as a ‘resource’ in disclosing a collusion between the analytical dyad

The author discusses various aspects of the function of enactment in analytical practice, reviewing the concept, then describing a borderline patient with whom the analytic process seemed to be developing productively. Following a change in the setting, an intense, acute enactment took place. Understanding this led to observation of an unconscious collusion, in which a symbiotic relationship had been established between the patient, the analyst and his family, as a chronic enactment. This relationship had prevented the analyst from touching on highly destructive unconscious fantasies and archaic traumatic situations. Comprehension of the enactment enabled the collusion to be dissolved. The author suggests that, besides the resistance aspect, the collusion may have been useful in strengthening the patient's mental mechanisms and trust in the analytical work, which required some time. The acute enactment arose, unveiling the collusion, when the patient and the analyst felt able to face the terrible feelings related to the triangular situation. He speculates that both enactments may occur in the analysis of these kinds of patients, as part of the ‘natural history’ of the analytical process, and their function is to relive archaic experiences in the analysis, also with the aim of working them through. Finally, the author proposes a classification of enactments: normal, pathological, acute and chronic.

On misreading and misleading patients. Some reflections on communications, miscommunications and countertransference enactments.

This author focuses on an aspect of transference-countertransference interaction that enacted covertly is often overlooked. He argues that conflicts, needs and biases that may go undetected for lengthy periods of time are not infrequently contained within the analyst's accurate and technically correct interventions and that for defensive reasons, patients often suppress, deny or rationalise their accurate perceptions of these countertransference elements and fail to confront their analysts with them. The mistakes, miscommunications and misperceptions that arise as a consequence of the unconscious collusions that develop between patient and analyst can have a profound effect on the analytic work. Several clinical examples are presented to illustrate the operation of such covert communications in analysis and their impact on the treatment process.

On misreading and misleading patients: Some reflections on communications, miscommunications and countertransference enactments

This author focuses on an aspect of transference countertransference interaction that enacted covertly is often overlooked. He argues that conflicts, needs and biases that may go undetected for lengthy periods of time are not infrequently contained within the analyst's accurate and technically correct interventions and that for defensive reasons, patients often suppress, deny or rationalise their accurate perceptions of these countertransference elements and fail to confront their analysts with them. The mistakes, miscommunications and misperceptions that arise as a consequence of the unconscious collusions that develop between patient and analyst can have a profound effect on the analytic work. Several clinical examples are presented to illustrate the operation of such covert communications in analysis and their impact on the treatment process.

Hamlet’s Delay

This paper raises a question about Freud's understanding of Hamlet and offers a fresh psychoanalytic perspective on the play, emphasizing the psychological use made of Hamlet by the audience. It suggests Hamlet and Claudius both serve as sacrificial objects, scapegoats, for the audience, embodying, through a mechanism of both identification and disidentification, the fulfillment, punishment, and renunciation of the audience's forbidden (i.e. Oedipal) wishes. The play is thus seen to represent unconsciously a rite of sacrifice in which both Claudius and Hamlet, both the father and the son, are led, albeit circuitously, to the slaughter. The need for delay on the part of Hamlet is thus seen to arise not merely from Hamlet's psychology, whatever the audience may project onto it, but ultimately from the function (both sadistic and defensive) that the sacrificial spectacle, the play as a whole, serves for the audience. The paper also speculates somewhat on the role of tragic heroes and heroines in general, and points to the unconscious collusion that permits author and audience to make use of them. Finally, in an addendum, the paper discusses the work of René Girard, a nonpsychoanalytic thinker whose ideas nonetheless are somewhat similar to those presented here.

MEN WHO LEAVE TOO SOON: REFLECTIONS ON THE EROTIC TRANSFERENCE AND COUNTERTRANSFERENCE1

ABSTRACT It is observed that certain male patients, in psychotherapy with female therapists, end prematurely. Attention to common factors in the cases of the ‘men who leave too soon’ reveals a pattern. Some leave to avoid intimacy, others to avoid consciousness of erotic/aggressive impulses where the feminine may be alternately idealized and denigrated in the transference. Unconscious collusion in traditional gender dynamics may contribute to avoidance of consciousness of sexual feelings in the countertransference. This may sometimes result in interpretation of eros in infantile terms in denial of the adult, sexual dynamic. Vignettes from clinical practice illustrate the theoretical discussion.

Psychoanalytic Insights and the Prevention of Pseudosuccess in the Cognitive-Behavioral Treatment of Batterers

The need for psychoanalytic informedness in the currently predominant cognitive-behavioral approaches to treating male batterers is addressed against the background of the author's experiences with this population. Examined and explained are the batterer's typical defense mechanisms, the therapist's unconscious reactions to those defense mechanisms, and how confrontation consequently can be unrealizedly misused, that is, executed abusively as opposed to constructively. The ultimate unconscious collusion by therapist and client to mistakenly perceive treatment as successful is then examined, followed by an hypothesis of the collusion's effect on the batterer and his spouse.

Oedipus and the sphinx: triumph and catastrophe.

The downfall of Oedipus in Sophocles' most famous play, Oedipus Tyrannus, is the reversal of his triumphant entry into the city of Thebes 17 years earlier. The oracle at Delphi has told the Thebans that the plague will end only when the murderer of Laius is identified and punished. The unconscious collusion between Oedipus and the Thebans to ignore the unsolved murder breaks down. Told by Teiresias that he is the culprit, Oedipus begins a desperate effort to find evidence to refute this accusation. When other witnesses come forward, his cause is lost. The effect of Oedipus's collusive interaction with the Thebans is balanced in Sophocles' account by the story of the riddle of the Sphinx. The Sphinx is a goddess of discontinuity. She represents the unconscious forces at work both in Oedipus's personal fantasies and in the collective fantasies of the Thebans. The tragedy results from the interaction of these fantasies in the government of the polis. Sophocles' play thus exemplifies the intricate intertwining of the child's innate wishes and the reaction they evoke from the environment during the oedipal period. The neurotic patient's illusion of sexual triumph over his or her father or mother as a child can be best understood through the interaction of these factors.

Multiple Personality Disorder and Iatrogenesis: The Cautionary Tale of Anna O

An examination of Breuer's treatment of Anna O. illustrates some of the controversies surrounding the recent rise of case reports of multiple personality disorder. Anna O., the first patient of the cathartic method, psychoanalysis, and dynamic psychiatry, fits current criteria for multiple personality disorder. Breuer's treatment, however, may have contributed to her states of absence; the timing, type, and intensity of Breuer's interventions make it possible that he unwittingly encouraged and amplified Anna's dissociations, reified her ego fragments, and then explained Anna's symptoms with the pseudomemories and confabulations recovered from Anna while she was hypnotized. A review of Breuer's treatment highlights some of the controversial aspects of multiple personality disorder, specifically its possible vulnerability to iatrogenesis via suggestion and unconscious collusion and other factors. The current stance of some multiple personality disorder enthusiasts, opaque to their participation in interactions that may lead to certain patient productions, resembles the older psychoanalytic stance exemplified by the early Breuer and Freud. The dialectic of the therapist as a neutral observer versus as an influential participant continues to be a focus of controversy, both within psychoanalysis and psychotherapy and in the understandings of the etiology and treatment of multiple personality disorder.

Homophobia in the therapist and gay or lesbian client: Conscious and unconscious collusions in self-hate.

Homophobia in the therapist and gay or lesbian client: Conscious and unconscious collusions in self-hate.