PsychAntenna

This is an attempt to clarify the confusions which, I argue, have accumulated in the uses and meanings of the term ‘projective identification’. As a remedy, I propose a return to Melanie Klein's original concept which focuses on the mental activity of the person in whose mind the projective identification takes place. I cover the early territory of Klein's definition and Bion's alteration of this, with its sole focus on PI as a communication which is dealt with in various ways by its object. Thomas Ogden followed his example. This narrowed the field opened by Klein. The confusions caused at this time persist today and render the concept less useful than it could be. I distinguish between projections and projective identifications. Further, I discuss five main types of projective identification and try to show that only one of these is evocatory; that is, only one involves a responding object.

I hope to show that the concept, as devised by Klein, has a family of uses, all of which can be grasped fairly easily if we concentrate on the state of mind of the subject ‘owning’ the projective identification. While evocatory PIs, which affect their objects and prompt certain responses, are part of the therapeutic process, other types of PI are equally important although harder to grasp.

In this paper the interplay between silence and the spoken words used by analyst and patient will be explored within the context of clinical practice. Both analyst and patient, it is argued, are engaged in a personal struggle to try to discover an integrative connection between silence, often experienced as nothingness, and speech, often experienced as suffocating or mendacious. The uses of silence in aiding speech to attain integrity will be described with reference to two clinical vignettes. Selections from psychoanalytic theory and practice will be discussed, throwing some light on silence and analytic spoken dialogue, and it will be argued that a Jungian perspective contributes a further, unique, insight through the concept of transcendent function. This is a way of seeing silence and speech as opposites, out of which new levels of meaning arise as a result of union and unconscious cooperation in the relationship between them. This union is known as coniunctio.

The importance of developing a certain consciousness in which one is present and autonomous while being intimately interconnected with larger meaning is an important dimension of a relational approach to psychotherapy. Based on the premise that both client and therapist bring something of themselves and of their respective past emotional experience to the therapeutic relationship, a relational approach to therapy is very attentive to the dynamics in the therapy room. It stresses the co-creation of the therapeutic relationship at conscious, explicit verbal levels and unconscious, implicit levels of functioning, and establishes the therapist's emotional behaviour as a significant factor in fostering change (Aron, 1996).

Therapist responsiveness to client's affective impact is discussed with emphasis on its centrality to clinical practice and its relationship to countertransference. A case study of the psychotherapeutic journey with ‘Dawn’ (previously ‘David’), a 53 year-old client who was awaiting sex-reassignment surgery, is presented which illustrates how the therapist's struggle in the countertransference represents part of a complex relational body/mind system of parallel processes, re-enactment and potential for therapeutic change.

Drawing upon Professor Higgins in George Bernard Shaw's Pygmalion as a template, and making use of clinical material, I will reflect upon the painful, poignant and self-inflicted inner loneliness of the narcissistic individual. In order to master early trauma, the narcissistic person constructs an outwardly substantial self in which he seeks to control others and the way he is perceived by others. In so doing he renounces the more emotionally vulnerable parts of himself, the very parts he needs in order to develop a more authentic self and emotionally connect with others. Sometimes a crack appears in his defensive narcissistic structure with the possibility of something more life-enhancing emerging.

Certain states of mind in a patient are difficult to remain with and tend to evoke defensive countertransference responses which, if enacted, obstruct therapeutic progress. The state of mind discussed in this paper is ‘adhesive identification’, a term that arose out of a conversation between Esther Bick and Donald Meltzer, when Bick said of certain patients: ‘They are sticky, they stick . . .’ The author presents an outline of ‘psychic skin’ defences (Bick, 1968, 1986; Briggs, A., 2002; Briggs, S., 1998; Mitrani, 2001; Turp, 2003) followed by a more detailed account of ‘adhesive identification’ (Meltzer, 1975). Cohen's (2003) work on countertransference and integrity, based on her experiences in a neonatal intensive care unit, is described. These resources are employed as a framework for thinking about countertransference enactments arising in psychoanalytic psychotherapy with an adult, adhesively attached patient. Extracts from a session with the patient, ‘Janine’, are presented and discussed. In conclusion, the author returns to the proposed links between integrity in the sense of thoughtfulness and respect and integrity in the sense of the felt experience of being in one piece within a skin boundary.

In this paper, I argue that the school counsellor occupies a liminal position in the school environment, on the boundary between the private and the public, and that this position intrinsically reflects the paradoxical nature of shame, at once hidden and viewed. I review arguments that locate the development of primitive shame in early containment failure, with shame being defended against by rage against others or the self. I argue that the school counsellor's position commonly oscillates through the three positions of the child–home–school triangle, but that this is felt particularly acutely when the dynamics projected through this triangle are those of shame and shaming. For adolescents, the paradoxical nature of shame also finds a counterpart in self-harm, a simultaneously hidden and viewed act which I see as a mapping of shame on the body. In exploring the operation of shame in self-harming students, I also argue that chance encounters between counsellor and student in the external school world render projections about intimacy, intrusion and shame particularly powerful.

Disclosures about the extent of sexual abuse within the church context and the gradual revealing of the way that the institution has responded in the past indicate underlying anxiety and associated defensive processes. It is suggested in this paper that these processes have led to secrecy and deception. Similarities between the behaviour of perpetrators and the response by the church are explored alongside current preoccupations within the church. Psychoanalytic ideas and theories of organizational dynamics are used to explore and reflect on the fantasies and explicit and implicit assumptions within the institution. It is suggested that the church has displayed institutional narcissism in its response to disclosures. Ideas are illustrated by generic situations.