Change in psychoanalysis: getting from A to B

Intersubjectivity: Conceptual Considerations in Meaning-Making With a Clinical Illustration

This manuscript explores intersubjectivity through a conceptual construct for meaning-making that emphasizes three major interrelated elements-meaning making in interaction, making meaning with the body as well as the mind, and meaning making within an open dynamic system. These three elements are present in the literature on intersubjectivity with a wide range of terms used to describe various theoretical formulations. One objective of this manuscript is to illustrate how such a construct can be useful to understand the meaning-making observed in psychoanalysis, such as in the treatment of a young child on the autistic spectrum. The challenges in establishing an intersubjective state with a child on the autistic spectrum serve to highlight important features of intersubjectivity. As an important background to this clinical illustration, we illustrate the construct with the scientific paradigm of the well-known face-to-face still-face.

Herding the Animals into the Barn

Initial assessments of children with psychological problems are important both to develop appropriate diagnoses and to provide the basis for productive discussions with parents on treatment alternatives. This paper develops an assessment method referred to as the Parent Consultation Model (PCM) that emphasizes the use of videotape micro-analysis and developmental theory to provide critical information to parents as well as to the clinician in this important initial stage. The paper provides a description of the PCM and an expanded example of the use of the PCM, including illustrations of how these methods can be used to organize information and engage parents in the initial consultation. The paper concludes with some observations on the role of new techniques and ideas in psychotherapy and psychoanalysis.

Exploring the diary as a recovery-oriented therapeutic tool

Diary writing is a centuries-old method of recording events, experiences, thoughts, and feelings that might offer potential as a tool that consumers and nurses could utilize in recovery-oriented practice. While the diary has been used within health disciplines to detail and communicate personal experiences to enable collaborative examination of progress, a diary can also provide a more complete picture of what life is like; not only within the confines of a health service environment, but also outside. In recent times, the diary appears to be experiencing a renewed interest in terms of health care. People experiencing a mental health challenge might use diary-based forms of communication to promote understanding between themselves and mental health workers, and ultimately the use of this form of narrative therapy might facilitate person-centred, recovery-based actions. The present study paper, therefore, explores multiple perspectives on the use of diaries in the therapeutic context. Suggesting that diaries have not yet been utilized to their fullest potential by and with consumers and clinicians, this discussion raises issues and offers clarity about diary forms and their uses in the health context. It also discusses the barriers to their use and how to engage consumers and clinicians in recovery-oriented work.

Adolescents in psychodynamic psychotherapy: changes in internal representations of relationships with parents

This study explored whether and how internal representations of adolescents' relationship with their parents--a fundamental concept in psychodynamic theory--changed in the course of a year of treatment and whether the observed changes were related to changes in symptoms. Seventy two adolescents (ages 15-18; 30 in treatment and 42 in a non-treatment "community group") underwent Relationship Anecdote Paradigm (RAP) interviews according to the Core Conflictual Relationship Theme method (CCRT; Luborsky & Crits-Christoph, 1998) and completed outcome measures at two time points. A novel data-driven approach to clustering CCRT categories was used to characterize internal representations. The potential contribution of this approach to the CCRT method is discussed. The results indicate that adolescents' internal representations of their relationships with their parents changed significantly throughout treatment, and were related to changes in symptoms.

Infancy research, infant mental health, and adult psychotherapy: Mutual influences

This article considers the influence of infant research on psychodynamic theory and practice. Infant research highlights the dramatic effects of the early caregiving relationship on development throughout the life span. It also provides important perspectives on psychotherapeutic processes. This article highlights such elements as empathy, mutual recognition and attachment, along with elaborating the intersubjective and transactional systems perspectives. In addition, it stresses the powerful role of nonverbal, implicit communication and meaning-making, which play a greater role in human relational experience-and therefore in the therapeutic process-than previously understood. In addition to clarifying these general orientations, the article describes specific therapeutic strategies based on the expanded developmental knowledge.

Changes in rigidity and symptoms among adolescents in psychodynamic psychotherapy

The present study examined changes in the rigidity of interpersonal patterns and symptoms in adolescents (ages 15-18) in a year-long psychodynamic psychotherapy. Seventy-two adolescents (30 in treatment and 42 in a non-treatment "community group") underwent Relationship Anecdote Paradigm (RAP) interviews according to the Core Conflictual Relationship Theme method (CCRT; Luborsky & Crits-Christoph, 1998), and completed outcome measures at two time points.

RESULTS

Adolescents in the treatment group became less rigid in their interpersonal patterns and improved significantly in their symptoms, whereas no such changes were observed in the community group. Levels of rigidity were not related to initial symptom distress; however, changes in rigidity were related to improvement in symptoms within the treatment group.

Infants' meaning-making and the development of mental health problems

We argue that infant meaning-making processes are a central mechanism governing both typical and pathological outcomes. Infants, as open dynamic systems, must constantly garner information to increase their complexity and coherence. They fulfill this demand by making nonverbal "meaning"-affects, movements, representations-about themselves in relation to the world and themselves into a "biopsychosocial state of consciousness," which shapes their ongoing engagement with the world. We focus on the operation of the infant-adult communication system, a dyadic, mutually regulated system that scaffolds infants' engagement with the world of people, things, and themselves, and consequently their meaning-making. We argue that infant mental health problems emerge when the meanings infants make in the moment, which increase their complexity and coherence and may be adaptive in the short run, selectively limit their subsequent engagement with the world and, in turn, the growth of their state of consciousness in the long run. When chronic and iterative, these altered meanings can interfere with infants' successful development and heighten their vulnerability to pathological outcomes. Cultural variations in meaning-making and implications for clinical practice are discussed.