Territories of mourning: Addressing submerged problems of grief through multidisciplinary care

Mourning and grief are natural responses to loss and can be especially complex and prolonged in the context of end-of-life care. Caregivers play a crucial role in supporting individuals through this difficult journey, often balancing their own grief with the need to provide care. This paper explores the experiences of mourning and grief in hospice settings, with a focus on the emotional challenges faced by both patients and caregivers during the grieving process. Psychological support plays a crucial role at the end of life in a multidisciplinary care approach. By addressing the complex interplay between biological disease and psychological well-being, healthcare professionals can provide more comprehensive and compassionate care. A deep understanding of mourning and elaboration of grief would improve the implementation of suitable support interventions and facilitate collaboration among family members and healthcare teams, ultimately improving the quality of end-of-life care and promoting the well-being of both patients and their families.

Earthquakes In The Analytic Field: A Post-Bionian View of Negative Therapeutic Reaction

This paper examines Negative Therapeutic Reaction (NTR) as proposed by Freud and extended by Kleinian and North American analysts before reinterpreting this well-known phenomenon through the lens of post-Bionian field theory. Employing Bion's concept of the obstructive object, the author suggests that NTR is characterized by a recognizable phenomenological sequence including impairment of the analyst's alpha function. When, as advocated by post-Bionian field theory, these reactions are understood as co-generated by the analytic group-of-two a more collaborative atmosphere develops in the analytic field. Just as pressure within the Earth produces movement of tectonic plates resulting in earthquakes of varying intensity, the author finds it metaphorical to consider NTR an emotional "earthquake" that can erupt following increasing intimacy in the analytic relationship. Clinical material illustrates how the analysand's experience changes depending on how the analyst listens to transformations occurring in the analytic field. In one case, the analyst employs a "you/me" mode of listening which hinders receptivity to communication via projective identification making NTR the dispatch of last resort. In a second, the analyst adopts a "we/us" mode of listening enabling her to employ NTR to restore a co-dreaming function as terra firma of the analytic relationship.

Same concept, different label: the effect of repressed memory and dissociative amnesia terminology on beliefs and recovered memory admissibility in court

Controversy still surrounds recovered memories, centred around replacing the term repressed memory with dissociative amnesia. This study investigated whether exposure to these terminologies impacted legal opinions. In total, 886 participants were recruited across four experiments (1a/2a, followed by 1b/2b). In experiments 1a/1b, participants were randomly allocated to one of three conditions: Repressed Memory, Dissociative Amnesia, and Control. They tested whether reading a paragraph/watching a video about one of these terms would impact their opinions on the admissibility of recovered memories in court. Experiments 2a/2b focused on dissociative amnesia's inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Participants were randomly allocated to either Dissociative Amnesia or DSM-5 Authority. Again, participants read a paragraph/watched a video corresponding to their condition, ascertaining any significant differences in opinions on recovered memory admissibility. Experiment 1a found that the Dissociative Amnesia condition was significantly more likely to support recovered memory admissibility than those in the Control condition. Experiment 1b found a significant difference between the Repressed Memory and Control condition. Experiments 2a/2b yielded no significant results. These results suggest that different terminologies affect opinions regarding recovered memory admissibility in students compared to the public (repressed memory on the public; dissociative amnesia in students).

Therapists in Wartime: Holding Others' Trauma While Contending With Your Own

OBJECTIVE

This study explores the experience of Israeli therapists who both worked with clients in emergency interventions during the third week following the Hamas attack on Israel on October 7, 2023, and were themselves exposed, to one extent or another, to the terrifying events.

METHOD

Open-ended questionnaires were completed by 201 therapists during the third week following October 7. Using thematic analysis, therapists' reports of the themes their clients raised in therapeutic sessions were compared with their reports of the hardships they themselves experienced as individuals and professionals during the same period. Drawing on the concept of shared traumatic reality, the study considers how close the themes are, and how challenging it is to cope concurrently with a traumatic reality that is experienced both directly and indirectly.

RESULTS

Seven main categories emerged from the responses to questions about both their clients and themselves: (1) uncertainty and worries about the near and more distant future; (2) overwhelming emotions; (3) physical sensations; (4) shattered meaning and loss of trust; (5) lack of routine; (6) self-preservation; and (7) shared trauma.

CONCLUSIONS

The findings shed light on early reactions to a shared traumatic reality in the period closely following the trauma itself, indicating that professionals find it hard to differentiate between the personal, professional, and national levels when exposed to a large-scale traumatic event they share with their clients.

Gender dysphoria in adolescence: examining the rapid-onset hypothesis

The sharp rise in the number of predominantly natal female adolescents experiencing gender dysphoria and seeking treatment in specialized clinics has sparked a contentious and polarized debate among both the scientific community and the public sphere. Few explanations have been offered for these recent developments. One proposal that has generated considerable attention is the notion of "rapid-onset" gender dysphoria, which is assumed to apply to a subset of adolescents and young adults. First introduced by Lisa Littman in a 2018 study of parental reports, it describes a subset of youth, primarily natal females, with no childhood indicators of gender dysphoria but with a sudden emergence of gender dysphoria symptoms during puberty or after its completion. For them, identifying as transgender is assumed to serve as a maladaptive coping mechanism for underlying mental health issues and is linked to social influences from peer groups and through social media. The purpose of this article is to analyze this theory and its associated hypotheses against the existing evidence base and to discuss its potential implications for future research and the advancement of treatment paradigms.

Trans in treatment: a mixed-method systematic review on the psychotherapeutic experiences of transgender and gender diverse people

Transgender and/or non-binary (TNB) individuals encounter a variety of attitudes from mental healthcare professionals in therapeutic contexts, ranging from microaffirmations to the reinforcement of cis- and heteronormative stereotypes and even overtly invalidating behaviors or communications. Given the scarcity of literature addressing the therapeutic experiences of TNB individuals, the current mixed-method systematic review aimed at better understanding the factors that promote or adversely impact the therapeutic experiences of TNB individuals in clinical contexts. A comprehensive search for relevant records published before August 1, 2024, was conducted across four databases (i.e., Scopus, Web of Science, PubMed, PsycInfo), following PRISMA guidelines. The inclusion criteria specified that only peer-reviewed, indexed, English-language articles addressing the therapeutic experiences of TNB individuals would be selected. A total of 20 studies (both quantitative and qualitative) met these criteria. A meta-synthesis of the selected studies identified three main themes: (1) factors influencing therapist selection and reasons for seeking psychotherapy (e.g., quality of life, gender-specific concerns); (2) factors contributing to a positive therapeutic relationship (a nurturing therapeutic alliance that, e.g., acknowledges authentic gender and addresses intersectional stigma); and (3) factors contributing to negative encounters with mental healthcare providers (e.g., micro- and/or macroaggressions, inadequate trans-specific knowledge, pathologization of TNB identities). Recommendations for future research and clinical practice addressing the needs of TNB individuals in psychotherapy are provided.

Remembering the Dead: What Community Newspaper Memorials Reveal

People will understandably continue to remember significant persons long after their deaths. One possible remembrance practice is the placement of a memorial about the deceased person in a community newspaper. It is not clear what these memorials are intended to do, how they are constructed, who places them in a public sphere for open viewing, and what purpose or purposes they serve. As these memorials could be important for grief management and other personal, family, or social purposes, an examination of memorials to the dead appearing over one year in the Edmonton Journal, the primary newspaper for a Canadian city of one million inhabitants, was conducted. This research project found memorials were uncommon (N = 567) compared to obituaries (N = 4,865), and very uncommon in relation to the number of decedents who could have been memorialized. Memorial authors were most often parents or children, with memorials usually appearing on a second year or later death anniversary. Two content themes were identified: (a) enduring love for the deceased, and (b) a continuing if not permanent remembrance of them. The findings raise many questions, but primarily how people can openly and constructively grieve long after the death of a loved one.

'Cosigning questions': patients' inquiries about the obvious

Patients often ask questions to which they already know the answer. Despite their ubiquity, little is written about understanding or handling them. The following paper uses Speech Act Theory and the concept of "cosigning" to present a theoretical understanding of patients' questions about the obvious along with three clinical vignettes to demonstrate their technical management. The unconscious intent behind such questions can be inferred by analyzing their effects on the analytic process, the analyst's moment-to-moment countertransference, and the pressure they exert on the analytic relationship. The optimal response to cosigning questions depends on the particular dynamics which necessitate their use. For patients who can mentalize their behavior, direct interpretation or observation followed by interpretation can be used. For patients whose mentalization capacity is limited, consciously playing along with the questions can serve as a preamble to offering interpretations of the motives behind them.

Novel Revolts as Crafting of a Self

The psychoanalytic field continues to struggle with the dilemmas of conceptualizing gender and the experience of gender transition, even though gender appears to be very present in its multiple and transitional forms in the realm of the psyche as it manifests through the affective situation of the transference. In this paper, I want to move to an understanding of different situations of transitions that are grounded in gender but that suggest a wider world of experience with the claim that understanding the self is a complicated matter; and while this in itself is obvious to everyone, its complexity still comes as a surprise because of the unconscious. I turn to four memoirs: P. Carl's Becoming a Man; Susan Faludi's In the Darkroom; Masha Gessen's "To Be or Not To Be"; and Jane Gallop's Sexuality, Disability and Aging: Queer Temporalities of the Phallus. Each text depicts different notions of transition that suggest a wider world of experience: physicality (age, illness, disability), generation, sexuality, and relationality. In unpacking each narrative as unique figurations of transitioning, I show how each gives us a foothold into a new way of imagining gender. I argue that by reading memoirs the analyst enters a world that is theirs and not theirs. It is a way into an imaginative realm that allows us entrance into conflicts, questions, and representations of being in the world.

The cathartic dream: Using a large language model to study a new type of functional dream in healthy and clinical populations

According to some theories of emotion regulation, dreams could modify negative emotions and ultimately reduce their intensity. We introduce here the idea of cathartic dream, a specific and separate type of emotional dream, which is characterized by a dynamic plot with emotional twists, and where negative emotions are expressed and ultimately decreased. This process would reflect psychological relief (catharsis according to the Aristotelian definition) and fulfil an emotion regulation function. We developed and validated a tool using a large language model to emotionally categorize the different dreams from dream diaries. Based on this tool, we were able to detect the prevalence of cathartic dreams in datasets of both healthy participants and patients with nightmares. Additionally, we observed the increase of cathartic dreams during 2 weeks of imagery rehearsal therapy and targeted memory reactivation during rapid eye movement sleep. We also demonstrate how the increase of cathartic dreams correlates significantly with the decrease of depression scores in patients with nightmares under therapy, thus supporting their likely functional role in well-being and their distinct nature among other emotional dreams.

Maintaining relevance in psychodynamic psychotherapy: A novel approach to discerning between effective vs. ineffective discourse correlated with better session outcomes

OBJECTIVE

Maintaining relevance in a psychodynamic dialogue is a nuanced task, requiring therapists to balance between following patients' free associations while avoiding less effective interventions. Identifying less effective sequences of talk is especially challenging given the diversity of psychodynamic approaches and methodological barriers to analyzing session discourse. This study introduces a novel approach using the MATRIX coding system, an evidence-based tool, to differentiate content correlated with better session outcomes.

METHOD

Transcripts of 367 sessions were coded using the MATRIX. Therapist Out-of-MATRIX utterances, indicating a deviation from core therapeutic focus, were examined for their predictive value. Outcome measures included the next-session alliance and patient functioning scores. Two machine-learning-based models, using the Random Forest algorithm, predicted session-by-session changes in clinical outcomes based on MATRIX codes, and interpreted using the SHapley Additive exPlanations.

RESULTS

Therapist Out-of-MATRIX utterances accurately predicted next-session changes in alliance and patient functioning scores. Our model also identified an optimal dose-effect relationship for the number of Out-of-MATRIX interventions needed for effective therapy session.

CONCLUSION

This study demonstrates the potential of using contemporary research tools to analyze therapeutic discourse, revealing how psychotherapy produces its benefits. Its scope extends beyond prediction, providing practical recommendations on how to enhance therapists' performance and outcomes.

Beyond the Narrowness of Disciplinary Borders: Biology and the Unconscious in Ferenczi's Thalassa-Primordial Phylogenetic Trauma and its Recapitulation in Ontogenesis

In this article, we present and discuss the essay Thalassa: A Theory of Genitality (1924) by Sándor Ferenczi, a pioneer and one of the greatest innovators of psychoanalysis. This essay-which Freud lauded as the most ingenious application of psychoanalysis-proposed a theory that can bridge the gap between the ontogenetic and phylogenetic development of genitality and the sexual act. Ferenczi speculatively elaborated a theory of genital development that connects two important Freudian works, namely Three Essays on Sexual Development (1905) and Beyond the Pleasure Principle (1920), with Haeckel's Fundamental Biogenetic Law, which discusses the recapitulation of phylogenesis in ontogenetic development. According to Ferenczi, coitus and sexual relations are driven by the desire to return to the mother's body, a desire that hearkens back to a period in evolution when life was entirely aquatic and life forms were ocean-dwelling. It has been claimed that the environmental catastrophes of sea recession and land emergence have had traumatic effects on animals' living conditions (resulting in the development of sexual differences) and genitality. Although the essay presented some fanciful, suggestive, and dubious theories, it remains relevant due to its epistemological and methodological implications, which are based on an utraquistic argumentative procedure (i.e., founded on the constant comparison of and recourse to isomorphisms and analogies among various disciplines, including biology, embryology, zoology, and psychoanalysis), laying the foundation for a method of bioanalysis.

Conjoining Bion's Reading of C. G. Jung's Memories, Dreams, Reflections with his Clinical Seminars in Rio de Janeiro and São Paulo

This author read W. R. Bion's (1974) unpublished, personally annotated copy of C. G. Jung's Memories, Dreams, Reflections (MDR). The interest here is to conjoin Bion's reading of Jung with his own contemporaneous work. After setting out a context for Jung and Bion's meeting one another in 1935, we look at Bion's subsequent psychoanalytic development over the decades until 1974, particularly in the area of clinical intuition. The author takes up Bion's clinical seminars in Rio de Janeiro and São Paulo in 1974. He maintains that direct correlations can be made between Bion's marginal comments in MDR and material that he directly lectured on in his 1974 clinical seminars. Bion's interest here centred on the development of clinical intuition, dreams and precocious intellectual development. Even though he never mentioned Jung by name in 1974, it seems that Jung was clearly to the back of his mind as he lectured to his Brazilian colleagues in 1974. The fields of psychoanalysis and analytical psychology can be further enhanced by exploring how Bion and Jung's ideas converge as well as diverge.

Theories on the Etiology of Deviant Sexual Interests: A Systematic Review

Not much is known about the etiology, or development, of deviant sexual interests. The aim of this systematic review was to provide a broad overview of current theories on the etiology of sexual deviance. We conducted a systematic search of the databases PubMed and APA PsycInfo (EBSCO). Studies were included when they discussed a theory regarding the etiology or development of sexual deviance. Included studies were assessed on quality criteria for good theories. Common etiological themes were extracted using thematic analysis. We included 47 theories explaining sexual deviance in general as well as various specific deviant sexual interests, such as pedophilia and sadism/masochism. Few theories (k = 7) were of acceptable quality as suggested by our systematic assessment of quality criteria for good theories (QUACGOT). These theories indicated that deviant sexual interests may develop as the result of an interplay of various factors: excitation transfer between emotions and sexual arousal, conditioning, problems with "normative" sexuality, and social learning. Neurobiological findings could not be included as no acceptable quality neurobiological theories could be retrieved. The important roles of excitation transfer and conditioning designate that dynamic, changeable processes take part in the etiology of sexual deviance. These same processes could potentially be deployed to diminish unwanted deviant sexual interests.

[Suicide prevention and assisted suicide - incompatible?]

The principles of suicide prevention and easy access to assisted suicide are not compatible. Although suicide prevention does not aim to prevent suicide at all costs, it is fundamentally geared towards supporting people in existential crises and emergency situations in developing options for a successful life. Based on empirical facts on suicide and suicidal ideation in old age as well as clinical psychodynamic theories on the understanding of suicide, the corresponding foundations of assisted suicide are presented. After a brief introduction to the basic principles of suicide prevention, the relationship between suicide prevention and assisted suicide is explained and described. Based on the empirical knowledge of specific emergencies that can lead to a request for assisted suicide, possibilities of universal, selective and indicated suicide prevention are derived for this field.

Empty Heart Disease: Teaching and Learning in China

Drawing on 15 years of experience teaching psychoanalytic theory and therapy primarily from an object relations perspective to Chinese psychotherapists onsite and online, the authors present their learning about Chinese culture, social history, and philosophy, and the Chinese way of communicating about emotional experience. Their essay is imbued with the Chinese use of metaphor and psychosomatic symbolization, particularly involving the heart. They elaborate on the Chinese concept of Empty Heart Disease, comparing and contrasting it to Western concepts from literature, sociology and psychoanalysis, namely spleen, anomie, dead mother, and schizoid, empty, false, and narcissistic self-states. They expand upon and extend the empty heart concept to various age groups and symptom presentations in China, illustrated by a vignette from individual psychoanalysis with a woman and three vignettes from applied psychoanalysis of a couple with no intimacy, a child with an obsessive psychosomatic symptom, and an adolescent school dropout who was self-harming and suicidal in response to academic pressure. Having emphasized the connection between symptom presentations and social life and times, they discuss the impact of trauma, its transgenerational transmission in China, and the impact of unprecedented economic growth and social change on individuals, couples and families.

Digital transformation of mental health therapy by integrating digitalized cognitive behavioral therapy and eye movement desensitization and reprocessing

Digital therapy has gained popularity in the mental health field because of its convenience and accessibility. One major benefit of digital therapy is its ability to address therapist shortages. Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that can develop after an individual experiences or witnesses a traumatic event. Digital therapy is an important resource for individuals with PTSD who may not have access to traditional in-person therapy. Cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are two evidence-based psychotherapies that have shown efficacy in treating PTSD. This paper examines the mechanisms and clinical symptoms of PTSD as well as the principles and applications of CBT and EMDR. Additionally, the potential of digital therapy, including internet-based CBT, video conferencing-based therapy, and exposure therapy using augmented and virtual reality, is explored. This paper also discusses the engineering techniques employed in digital psychotherapy, such as emotion detection models and text analysis, for assessing patients' emotional states. Furthermore, it addresses the challenges faced in digital therapy, including regulatory issues, hardware limitations, privacy and security concerns, and effectiveness considerations. Overall, this paper provides a comprehensive overview of the current state of digital psychotherapy for PTSD treatment and highlights the opportunities and challenges in this rapidly evolving field.

Sure It Works in Practice, but Does It Work in Theory? Appreciating Fred Pine

Fred Pine is a major contributor to contemporary Freudian analytic work. He expanded the breadth of clinical psychoanalysis by showing how the analyst could integrate ever expanding perspectives in analysis, and he expanded its depth through greater insight into how development affects psychic structure and, thereby, the context within which unconscious conflict and compromise is experienced and processed. Both of these-his expansion of potential variables implicated in the process of dynamic conflict and his developmental focus on structural deficit-have led to a way of Freudian thinking that is highly assimilative and integrative. Pine's focus on integrating disparate points of view-not different theories, but clinical observations that are featured in different overall theories-illuminates clinical possibility and nuance. Pine's work leads to questions about the relation of psychoanalytic theory to analytic practice and the definition of contemporary Freudian psychoanalysis itself.

The Dynamics of Narcissus: Exploring the Covariation of Narcissistic States in Daily Life

Advanced empirical research and clinical theory suggest that narcissistic personality states fluctuate over time. However, these fluctuations are poorly understood. To address this, we recruited 88 undergraduates to complete baseline measures and respond to smartphone prompts assessing narcissistic states and emotions in daily life seven times a day for 10 days. Narcissistic states were assessed using a state-adapted version of the Super Brief Pathological Narcissism Inventory (SB-PNI). Findings showed that within-person covariation of narcissistic states ranged from -.55 to .52 and was negatively associated with trait grandiosity, guilt, and mood activation. In addition, there was a significant quadratic relationship between narcissistic covariation and trait vulnerability and between narcissistic covariation and mean state vulnerability, self-esteem, pleasant and activated mood, and shame across 10 days. These findings suggest a potential state-based dynamic taxonomy of narcissistic presentations and highlight the importance of understanding distinctions between co-occurring, contrasting, and dissociated narcissistic states.

Redefining elective co-parenting as PACT: a systematic assessment of published concepts and definitions

BACKGROUND

There is an increase in the variation of family forms, types of parenthood roles and methods for family formation. One way of family building has most recently been referred to as 'elective co-parenting'. Yet, many other terms and somewhat diverging concept definitions have been put forward. This paper aims to establish a fundamental conceptual framework.

METHODS

We will adhere to a tailored set of guidelines for conceptual ethics organised in four stages: (i) Using a minimal scoping review of published definitions potential attributes are identified, (ii) The potential attributes are organised by theme in order to identify any necessary and sufficient or shared ones, (iii) A conceptual definition of the concept is developed, (iv) The most fitting concept label is determined.

RESULTS

Current terminology lacks comprehensiveness and often contains additional (hidden) meanings, thereby jeopardising its usability for research on contemporary family formation. We suggest a new nomenclature.

CONCLUSION

We suggest PACT (Pre-conception Agreement-based Co-parenting Together-apart) instead of 'elective co-parenting' (or equivalents) as a new concept label for this particular family type, whereby at least two parties of co-parents have agreed before the conception of a child to share parenting of this child. A party can refer either to an individual or a set of romantically involved individuals. Although there may be different types of loving relationships between some (or all) co-parents within this constellation, there is at least some 'detachment' that is recognised as being created and present by an absence of romantic love between those parties.

Transference-focused psychotherapy in an inpatient setting for borderline personality disorders: changes in symptomatology

This prospective, naturalistic, longitudinal study examined changes in borderline-specific symptoms in a six-month, manualbased transference-focused psychotherapy (TFP) inpatient treatment for patients with borderline personality disorder (BPD) in comparison to a waitlist control group. Seventy-four patients with BPD received TFP in a multi-professional inpatient setting, of whom 27 patients represented the waitlist control group. 31 patients completed six months of treatment. Borderline-specific symptoms were measured by means of the Borderline Symptom List (BSL-23) prior to treatment (waitlist control group), at the beginning, after 3 months, and at the end of it. BSL-23 scores decreased significantly from the beginning to the end of the six-month inpatient therapy program with a medium effect size of d=0.54. There was no change in symptoms for the waitlist control group. Our findings suggest that inpatient TFP is effective in terms of the reduction of borderline-specific symptoms. In terms of this, the duration of the treatment seems to be a meaningful factor. Further research will investigate changes in specific psychodynamic aspects as well as in the follow-up measurement.

Does the therapeutic alliance process explain the results of the Egokitzen post-divorce intervention program?

Objective

The objective of this study was to explain the relationship between therapeutic alliance and the changes observed in the parents' psychological symptomatology after participation in the Egokitzen program, analyzing the mediating role of emotion regulation.

Methods

The study involved 117 divorced parents and 40 therapists.

Results

It has been observed that the early development and maintenance of the therapeutic alliance influence the parents' psychological symptomatology after the intervention, through emotion regulation.

Conclusion

The study reinforce the role of the therapeutic alliance as a determining factor in the success of group interventions. This effect has turned out to be indirect through emotion regulation, highlighting the importance of emotional management.

The unconscious sibling rivalry in psychoanalytic institutions

What unconscious elements fuel the 'radioactive atmosphere' of psychoanalytic institutions - those unconscious sources of the chronic conflicts that sometimes plague the relationships among members of psychoanalytical societies and obscure the path of a constructive resolution of conflicts, creating a toxic climate that stultifies members' creativity, hindering progress and further development? An empirical research was conducted using the psychoanalytically informed research interview as an experimental situation. The main findings indicates unconscious sibling rivalry as the source of conflict in the psychoanalytic institution studied, along with narcissism of minor differences. The implications for psychoanalytic training are discussed.

The Interpretive Process

The purpose of this paper is to reformulate the concept of interpretation in a way that better reflects the interpsychic and processive dimensions of this concept as increasingly represented in psychoanalytic writings. Implicit in my redefinition is the view that, while the interpretive process is essential to therapeutic action, the notion of making interpretations is an artificial and problematic way of viewing the work of analysis. In this paper I will review an expanded definition of interpretation as developed through the writings of Hans Loewald and elaborated by more contemporary thinkers such as Sheldon Bach, Ronald Britton, and Antonino Ferro.

The Child in the Adult: Narrative and Nachträglichkeit in Henry James and Freud

At the intersection of literature and psychoanalysis, this essay draws on Freud's discovery of the infantile sexual unconscious to explore moments in the late novels of Henry James, in which an adult protagonist both recognizes and disavows the visible evidence of a sexual relationship. The essay considers Hans Holbein's 1533 painting, The Ambassadors, as a possible source for Henry James' choice of title for his 1903 novel: the painting's visual play with point of view touches on the narrative disavowal of what is there to be seen. The essay explores some narrative dimensions of Freud's writing to highlight the dynamic disclosure of the infantile within the adult. The concept of Nachträglichkeit, recognizing the deferred or belated impact of disruptive recurrences in mental life, helps to understand such moments and gives insight, more broadly, into narrative experience. Drawing on Nachträglichkeit as a principle of mental life, the essay explores the resonances of infantile sexuality, fantasy, and trauma in narrative, and more generally, as a resource in creative expression.

My Bad, You Got This: witnessing, therapist attitude and the synergy between psychedelics and inner healing intelligence in the treatment of trauma

The MAPS (Multidisciplinary Association for Psychedelic Studies) sponsored MDMA-assisted therapy protocol has had greater success in treating trauma in preliminary clinical trials than any prior psychotherapeutic, pharmacologic, or combined approach. It is predicated on a synergy between drug action and the participant's inner healing intelligence. The latter is described mainly by analogy with the body's capacity to heal itself, and the treatment is characterized as a means of activating or accessing this capacity. How is this rather mysterious-sounding process so effective? I suggest that the therapist's full commitment to, and trust in this treatment framework, along with the medication's subjective enhancement of trust, encourages individuals who have suffered trauma and have difficulty trusting others to engage the therapist as a kind of witness. I discuss parallels between the therapeutic attitude implied in the inner healing intelligence model and the way a therapist can act as witness in the resolution of dissociative enactment in relational psychoanalysis. Trusting the healing capacity of one's inner healing intelligence is dynamically equivalent to trusting the relational process. This makes trusting one's inner healing intelligence a process of feeling witnessed. In both settings, the therapist's willingness to acknowledge her technical limitations or failings, coupled with a conviction that the participant/patient's primary need in processing trauma is to feel witnessed, facilitates the integration of dissociated experience.

Evaluative Research on Psychodynamic Therapy: Foundations and Recent Advances

Psychodynamic therapy (PDT), a technical adaptation of psychoanalysis, is one of the most widely practiced forms of psychotherapy, making evaluative research on it essential. Although research on PDT has been ongoing for several decades, theoretical and practical challenges initially hindered the adoption of evidence-based medicine standards in such research, a shift that has largely taken place over the past 20 years. This article reviews the evolution of evaluative research on PDT for mental disorders in adults, with a focus on those with complex conditions. Since the first prospective evaluative studies in the 1950s, an accumulating body of knowledge-including cohort studies, randomized controlled trials, and meta-analyses-has established PDT as an evidence-based treatment for common mental disorders such as depression, anxiety, somatic symptoms and related disorders, and personality disorders, as well as complex mental disorders involving combinations of these conditions. There is also evidence supporting PDT's usefulness in treating anorexia nervosa and opioid dependence, along with some findings suggesting its potential use for schizophrenia spectrum disorders, bulimia nervosa, and posttraumatic stress disorder. Recent studies indicate that PDT can serve as a personalized treatment, promoting deep and lasting psychopathological changes in patients with severe, complex, and chronic mental disorders, involving specific technical features and mechanisms of change. These findings support the inclusion of PDT in mental health care policies and training, while ongoing research continues to explore its optimal treatment parameters.

How Psychology Can Benefit From the Academic Study of Esotericism

The paper reviews and summarizes the historical research that has been carried out in recent decades to explore the connections between esotericism and psychology while highlighting the typical historical and contemporary ways in which psychology and esotericism are linked. This examination underscores why academic research on esotericism is relevant to psychology, including why a substantive definition of esotericism made within the context of psychology is essential. Based on the sources currently at our disposal, it is asserted that the influences of esotericism have never been peripheral to psychology. The foundations and basic features of "esoteric psychology" unfolding within various theoretical frameworks are described. With this paper, the author aims to contribute to the emergence of a critical yet open and flexible discourse that recognizes the impact of esotericism on psychology and is ready to evaluate these influences in an objective way.

Understanding and Combating Misinformation: An Evolutionary Perspective

Misinformation represents an evolutionary paradox: despite its harmful impact on society, it persists and evolves, thriving in the information-rich environment of the digital age. This paradox challenges the conventional expectation that detrimental entities should diminish over time. The persistence of misinformation, despite advancements in fact-checking and verification tools, suggests that it possesses adaptive qualities that enable it to survive and propagate. This paper explores how misinformation, as a blend of truth and fiction, continues to resonate with audiences. The role of narratives in human history, particularly in the evolution of Homo narrans, underscores the enduring influence of storytelling on cultural and social cohesion. Despite the increasing ability of individuals to verify the accuracy of sources, misinformation remains a significant challenge, often spreading rapidly through digital platforms. Current behavioral research tends to treat misinformation as completely irrational, static, finite entities that can be definitively debunked, overlooking their dynamic and evolving nature. This approach limits our understanding of the behavioral and societal factors driving the transformation of misinformation over time. The persistence of misinformation can be attributed to several factors, including its role in fostering social cohesion, its perceived short-term benefits, and its use in strategic deception. Techniques such as extrapolation, intrapolation, deformation, cherry-picking, and fabrication contribute to the production and spread of misinformation. Understanding these processes and the evolutionary advantages they confer is crucial for developing effective strategies to counter misinformation. By promoting transparency, critical thinking, and accurate information, society can begin to address the root causes of misinformation and create a more resilient information environment.

Supporting autonomy in young people with gender dysphoria: psychotherapy is not conversion therapy

Opinion is divided about the certainty of the evidence base for gender-affirming medical interventions in youth. Proponents claim that these treatments are well supported, while critics claim the poor-quality evidence base warrants extreme caution. Psychotherapy is one of the only available alternatives to the gender-affirming approach. Discussion of the treatment of gender dysphoria in young people is generally framed in terms of two binary approaches: affirmation or conversion. Psychotherapy/exploratory therapy offers a treatment option that lies outside this binary, although it is mistakenly conflated with conversion therapies. Psychotherapy does not impose restrictive gender stereotypes, as is sometimes claimed, but critically examines them. It empowers young people to develop creative solutions to their difficulties and promotes agency and autonomy. Importantly, an exploratory psychotherapeutic process can help to clarify whether gender dysphoria is a carrier for other psychological or social problems that may not be immediately apparent. Psychotherapy can therefore make a significant contribution to the optimal, ethical care of gender-dysphoric young people by ensuring that patients make appropriate, informed decisions about medical interventions which carry risks of harm and have a contested evidence base.

Towards a future conceptualization of destination resilience: exploring the role of actors, agency and resilience narratives

Purpose

Despite the widespread use and application of resilience, much uncertainty about the conceptualization and operationalization in the context of tourism destinations still exists. The purpose of this paper is to provide a conceptual elaboration on destination resilience and to introduce a model for an improved understanding of the concept.

Design/methodology/approach

Taking a conceptual research approach, this paper seeks to untangle the fuzziness surrounding the destination and resilience concept by providing a new interpretation that synthesizes theories and concepts from various academic disciplines. It analyses the current debate to derive theoretic baselines and conceptual elements that subsequently inform the development of a new “Destination Resilience Model”.

Findings

The contribution advances the debate by proposing three key themes for future resilience conceptualizations: (1) the value of an actor-centered and agency-based resilience perspective; (2) the importance of the dynamic nature of resilience and the (mis)use of measurement approaches; (3) the adoption of a dualistic resilience perspective distinguishing specified and general resilience. Building on these propositions, we introduce a conceptual model that innovatively links elements central to the concepts of destination and risk and combines different narratives of resilience.

Originality/value

The contribution advances the debate surrounding destination resilience by critically examining the conceptualization and operationalization of destination resilience within previous research and by subsequently proposing a “Destination Resilience Model” that picks up central element of the three new frontiers identified in the conceptually driven review. The innovative integration strengthens the comprehension of the resilience concept at destination level and supports building future capacities to manage immediate adverse impacts as well as novel and systemic risks.

Investigating the network ties between affect, attachment, and psychopathology

OBJECTIVES

Recent years have seen an increased interest regarding theoretical and empirical associations of adult attachment security and primary affective traits concerning psychiatric disorders. In this study, network analysis technique is applied to dissect the links between both psychodynamic personality constructs and an array of psychopathological symptoms.

METHODS

A total sample of 921 (69.9 % female) participants from the general population was investigated. A regularized cross-sectional partial correlation network between attachment (Experiences in Close Relationships-Revised [ECR-RD8]), primary affective traits (Brief Affective Neuroscience Personality Scales [BANPS-GL]) and psychopathological symptoms (ICD-10-Symptom-Rating Questionnaire [ISR]) was estimated via the EBICglasso algorithm. Node centrality, predictability and bridge centrality were analyzed. To evaluate the stability of the network and evaluate the significance of differences, we employed bootstrap techniques.

RESULTS

The network was found to be stable, allowing reliable interpretations. We observed SADNESS, as well as depressive, PTSD and anxiety symptoms as the most influential nodes within the investigated network. Attachment AV and SADNESS were observed as nodes with the highest bridge centrality.

CONCLUSIONS

The results provide a data-driven in-depth look into the complex dynamics between psychopathological symptoms, attachment security and basic affective traits. Results underscore the critical interconnections between affect, attachment, and psychopathology, advocating for a psychodynamically informed systems approach in psychological research that considers the affective dimensions underlying human mental health.

Uncovering deep-rooted conflicts: the role of psychoanalytic psychotherapy in treating athletes' social media-related psychological distress

The use of social media by athletes can support them in difficult moments, but it can also become a source of negative emotions and psychological distress. This perspective critically examines psychoanalytic psychotherapy as a method for restoring athletes' psychological well-being after experiencing negative effects from social media use. The paper characterizes the key elements of psychoanalytic psychotherapy relevant to athletes, discusses the role of the psychoanalytic psychotherapist in working with athletes and describes the specifics of the psychoanalytic therapeutic process in this context. The potential advantages of psychoanalytic approaches over cognitive-behavioral methods are examined in treating the psychological impacts of problematic social media use among athletes. The analysis suggests that hate speech and negative online interactions can activate athletes' unprocessed life experiences rooted in early developmental stages. Psychoanalytic psychotherapy may offer a particularly effective method for restoring athletes' psychological wellbeing in such cases by addressing deep-rooted intrapsychic conflicts. However, a comprehensive approach integrating multiple therapeutic modalities is recommended to address the complex challenges athletes face in the digital age. This perspective acknowledges limitations in current research and suggest directions for future studies to develop and validate tailored interventions for athletes grappling with social media-related psychological distress.

"We are made of time": reverberation and the elasticity of time in psychoanalysis. Negotiating different temporalities in the session

Inspired by Dana Birksted-Breen's ideas on reverberation time, the author explores the changeability and transformation of the sensations of time and space and their connection to early embodied phantasies in the treatment of a 10-year-old boy. The experience of time changes (summarized under "time elasticity" to reflect the various forms this can take) is lived out in the transference relationship from the beginning of the therapeutic encounter. The author proposes the simultaneous development of the capacity to accept "objective" time, the establishment of a tri-dimensional space within the self and between objects and tolerating separateness and separation. The development of a capacity for symbolic thinking and depressive anxiety, as well as acceptance of the Oedipal situation and separation, has, as Dana Birksted-Breen underlined, a fundamental effect on the acceptance of objective time. This paper also discusses the difference between dealing with the difficulty of accepting objective time under the impact of fear of death and from the terror and nameless dread arising from the phantasy of the annihilation of time.

From primordial inscription to word representation

This work seeks to examine two aspects of the passage from the somato-sensory function to the psyche, in an attempt to explore in greater detail the construction of mental representations. The first aspect is the primordial inscription, which ends in the formation of a pictogram. This is an attempt to represent the "thing". The relevance of this work stems from the fact that the number of patients with difficulties in representation is increasing in clinical work. The second aspect addressed is word representation, which is necessary for the expression of meanings and for the development of a signifying chain, an essential element in the establishment of mental representations. Two questions arose during the writing of this work. The first: What enables a word to be incorporated in the psychic apparatus, with the functions of denoting, expressing and performing, thus achieving its relational and representational potential? The second and more important question: What enables words to come together and form the most varied and complex thoughts?

Communicating and not communicating with self and other. words, silence and the incommunicado self

This contribution begins from Winnicott's introduction of the incommunicado self in his paper on communication to suggest that interiority and the psyche come to constitute the infantile world through the earliest environment and through solitude. The capacity to be with others and to be alone originate in an earlier state where communication both makes no sense and yet contains the origin of the life source through the baby's bodily experience of self and world. The world beyond the baby enables this through an other's care. I link this with Bion's position on loneliness and his recognition that people may choose to live in contact with the unsynthesized and incoherent. Encouraging the unsynthesized, the formless, and the inexpressible in our patients offers ways of being an analyst that for me is the legacy of Winnicott and Bion.

Freud, bullshit, and pseudoscience

This paper critically examines the validity of Freudian psychoanalysis within the framework of Moberger's characterisation of pseudoscience as bullshit with scientific pretensions. The central question addressed is whether Freudian psychoanalysis qualifies as "bullshit," following Moberger's guideline of looking for systematic fallacies. The analysis centres on two fundamental critiques against psychoanalysis: one posited by Popper, contending that psychoanalytic interpretation is excessively flexible, and another by Glymour, asserting that Freud's interpretative method baselessly posits associations as causes. This paper argues that both criticisms rest on misunderstandings and asserts that Freudian psychoanalysis does not commit the alleged fallacies. It also offers positive evidence that Freud was not a bullshitter. The conclusion drawn is that psychoanalysis should not be regarded as bullshit, and hence does not qualify as pseudoscience on Moberger's criteria. Consequently, the paper suggests that Freudian psychoanalysis deserves a fairer hearing then many have given it.

The work of the human mind: Time and symbolization (in honour of Dana's work and thought)

In order to honour the work of Dana Birksted-Breen I will attempt to show how the reading of her work has impacted on my own thinking and changed it or modified it. I would like to begin by highlighting one of Dana's claims in The Work of Psychoanalysis. I will focus on two areas: (1) the development of symbolic capacity and its connection with temporality, and (2) the concept of reverie as a cornerstone of the psychoanalytic enterprise and that which promotes change. I will discuss these two topics following the development of some sessions of a patient. Through the clinical material I will deepen my understanding of Dana's concept of reverberation time in connection both with the progression of symbolic representation and with the use of reverie by the analyst in the inter-subjectivity of the session.

On the Logic of the Unconscious Conception of Causation Part I: The Oedipal Meta-Wish and the Sexualization of Asymmetric Time

The direction of time is often defined by describing asymmetries between past and future events, referred to as "time-arrows." Two important time-arrows are the mutability time-arrow, which specifies that the past is unalterable, while the future is not; and the causal time-arrow, which stipulates that past events may cause future events, but not vice versa. The author argues that the unconscious conception of causation expressed in both the oedipal myth and certain oedipal wishes negates the mutability and causal time-arrows. The author suggests, therefore, distinguishing between oedipal phantasies that undermine the ordinary conceptions of causation and time (such as the wish of being one's own parent), and classical content that is in line with our time perception (such as sexual and aggressive wishes toward parents). Analyzing clinical examples suggests that some patients' oedipal phantasies are combined with unconscious sexual satisfaction from the asymmetric conception of time. When this sexual satisfaction is analyzed, they might expose the oedipal phantasies founded on the symmetric conception of time.

Loss and memorialization

Drawing upon Dana Birksted-Breen's work on temporality, and the contrast which she draws between linear, developmental time, seen as a series of unchanging moments, and bidirectional, process time, which is retranscribed again and again (Birksted-Breen [2003] 2016. "Time and the Apres-Coup." In The Work of Psychoanalysis, edited by D. Birksted-Breen, 139-157. London: Routledge.), the author considers the role of unchanging elements in mental life. She argues that these elements are a form of memorialization, which defends against loss. Incorporated throughout life, they have a core of concrete, sensory experience but evoke larger scenes that are not entirely sensory. The author explores the operation of two kinds of memorial tokens: screen memories, which remain inalterable, and recurrent dreams whose unchanging structure serves as a frame in which change can take place. In analysis, both of these preserve memories of the analytic process and re-evoke the presence of the analyst. Both are particularly prominent at termination, when they function both as markers of approaching termination and as defenses against the loss of the analyst. Two brief clinical examples from patients who are nearing termination Illustrate these points.

Examining the Basic Assumption of Psychoanalytic Theory Regarding Normal and Abnormal Grief: Roles of Unfinished Businesses and Bereavement Related Guilt

To date, several theoretical models have been proposed to explain how the expected and natural grief processes turns into psychiatric disorders. Nevertheless, there is a paucity of empirical research examining the basic assumption of psychoanalytic theory regarding pre-death conflict and bereavement related guilt. Accordingly, the current study aimed to investigate the mediator role of bereavement related guilt in the relationship between the pre-death conflict and maladaptive grief process. The sample consisted of 447 bereaved adults who lost a loved one due to death in the last 5 years. The Unfinished Business in Bereavement (UBBS), Bereavement Guilt Scale (BGS), Beck Depression Inventory (BDI), and Prolonged Grief Disorder Scale (PG-13) scales were administered. The results indicated that the UBBS scores were positively correlated with both BDI and PG-13 scores, and BGS scores mediated these relationships. Obtained findings were discussed in relation to psychoanalytic theory and existing studies in the grief literature.

Nature heals: An informational entropy account of self-organization and change in field psychotherapy

This paper reviews biophysical models of psychotherapeutic change based on synergetics and the free energy principle. These models suggest that introducing sensory surprise into the patient-therapist system can lead to self-organization and the formation of new attractor states, disrupting entrenched patterns of thoughts, emotions, and behaviours. We propose that the therapist can facilitate this process by cultivating epistemic trust and modulating embodied attention to allow surprising affective states to enter shared awareness. Transient increases in free energy enable the update of generative models, expanding the range of experiences available within the patient-therapist phenomenal field. We hypothesize that patterns of disorganization at behavioural and physiological levels, indexed by increased entropy, complexity, and lower determinism, are key markers and predictors of psychotherapeutic gains. Future research should investigate how the therapist's openness to novelty shapes therapeutic outcomes.

Bion/Winnicott encounter: absence, failure and the negative in the work of Bion and Winnicott

After the death of Freud, a major thrust of the expansion of psychoanalytic theory involved the increasing recognition that the actuality of the emotional functioning of the object,-the primary objects in the infant's development, the analyst as object in the treatment process-were crucial determinants of developmental and therapeutic outcome. This recognition has been the driving force behind the evolution of various iterations of the role of interaction, inter-affectivity and intersubjectivity in two-person theories of psychic development and therapeutic action. This paper attempts to briefly trace in the work of Bion, Winnicott, Green and the Paris Psychosomatic School not only the effects of traumatic occurrences, but of their negative-i.e., the consequence of the absence of what should have been provided at crucial moments in development but was not.

[Measuring and training of therapeutic competencies]

This article provides an overview of our research concepts on therapeutic competencies with regard to three main questions. The first research question deals with therapists' competencies to succesfully handle transference and countertransference in the cotext of Alliance Ruptures. Research on the Alliance-Focused Training and on subjective countertransference is presented. The second research question deals with therapists' general interpersonal skills. The research approaches outlined here concern the construct of Facilitative Interpersonal Skills (FIS) and the measurement of these skills using the FIS-task. In further studies on this topic, we are focusing on the question of which therapist characteristics are associated with higher interpersonal skills and which linguistic and phonetic features characterise therapist responses that are rated as interpersonally competent. Another study concerns the tendency of therapists to overestimate their interpersonal skills (self-assessment bias). The third main research question deals with the competence to apply therapeutic techniques and to create helpful change processes. An instrument to assess verbal techniques (Psychodynamic Intervention List) and research approaches focusing on the description and the assessment of mediators of change are presented.