Leaping from brain to mind: a critique of mirror neuron explanations of countertransference

Coping With the Emotional Impact of Working in Cancer Care: The Importance of Team Working and Collective Processing

Hospitals provide the vast majority of cancer care. A necessary focus on survival has meant that they are less well-developed in terms of supporting patients with the emotional impact of cancer; and in supporting the frontline staff who contend with this. An integration of psychotherapeutic and neurobiological findings is used to develop an understanding of the patient-staff relationship and impact of high levels of distress within it. This includes reference to Transference and Countertransference, Mirror Neurons and Poly Vagal Theory. This paper considers how patients can unconsciously "transfer" emotional distress on to healthcare practitioners; and how this evokes an emotional response from the practitioner via the mirror neuron system (MNS). This can allow the practitioner to "feel into" the patient's experience and develop a more nuanced understanding. However, it may also activate emotions connected to the practitioner's life and can leave them feeling overwhelmed. The practitioner's capacity to regulate their own emotional arousal, via the vagus nerve, has a significant impact on their ability to support the patient and themselves within emotionally distressing interactions. This dynamic often unfolds without either party having significant awareness of it. A Systemic and Process-Oriented perspective is taken to understand this within the broader context of a hospital-based structure; and consider how practitioners on frontline teams may or may not support each other in working collectively with high levels of distress. A team's level of understanding and attunement to emotional experiences as well their primary relational and communication style has significant bearing on capacity for emotion-and-relationship focused coping. A failure to work with the emotional and relational interconnection between patients and staff can contribute to isolated patients, disconnected staff, conflict within teams and an overarching system lacking in compassion. However, due to the often unconscious nature of such processes and limited understanding or training on them, they are regularly left unaddressed. Over time, this can have an accumulated effect on everyone. Group-based collective processing is considered in terms of how it can be used in supporting practitioners to integrate an emotional and relational way of working with a problem-focused approach and integrated into regular daily working.

Evolution of a "Classic" Psychoanalytic Institute: Escape From Rome

The author describes the evolution of theory and practice at the New York Psychoanalytic Society and Institute. The core concepts at the Institute have included the importance of unconscious fantasy, conflict and compromise theory, transference and countertransference, and defense analysis. In recent years, a variety of contemporary analytic theories have been incorporated into the theory and practice of the Institute. The importance of systematized research to theory development and practice is stressed.

Motherhood, evolutionary psychology and mirror neurons or: ‘Grammar is politics by other means’

Through a close analysis of socio-biologist Sarah Blaffer Hrdy’s work on motherhood and ‘mirror neurons’ it is argued that Hrdy’s claims exemplify how research that ostensibly bases itself on neuroscience, including in literary studies ‘literary Darwinism’, relies after all not on scientific, but on political assumptions, namely on underlying, unquestioned claims about the autonomous, transparent, liberal agent of consumer capitalism. These underpinning assumptions, it is further argued, involve the suppression or overlooking of an alternative, prior tradition of feminist theory, including feminist science criticism.

On neuropsychoanalytic metaphysics

Neuropsychoanalysis focuses on the neural counterparts of psychoanalytically interesting phenomena and has left the difference in the metaphysical presuppositions between neuroscience and psychoanalysis unexamined. The authors analyse the logical possibilities concerning the relation between the brain and the mental unconscious in terms of the serial, parallel, epiphenomenalist and Kantian conceptions, and conclude that none of them provides a satisfactory ground for neuropsychoanalysis. As far as psychoanalytic explanations refer to the mental unconscious, they cannot be verified with the help of neuroscience. Neither is it possible to form a picture of how a neuro-viewpoint might be of help for psychoanalytic theorizing. Neuropsychoanalysis has occasionally been seen as a reductionist affair, but the authors suggest that neuropsychoanalysts themselves lean on the hybrid conception, which combines neuroscientific and psychoanalytic viewpoints. The authors state arguments in favour of the interfield conception of neuropsychoanalysis that takes seriously the metaphysical tensions between neuroscience and psychoanalysis.

The enduring presence of Heinz Kohut: empathy and its vicissitudes

This paper expands upon and further develops the centrality of empathy in psychoanalysis as offered by Heinz Kohut. Using clinical examples, it differentiates sustained empathy as the distinctive component of psychoanalysis, and it demonstrates some of the difficulties in determining the boundaries of empathy in the practice of psychoanalysis. A further distinction is from mind reading, a purely cognitive exercise, as is intuition (Carruthers 2009). To pursue a psychoanalytic perception of empathy one must confront its limitations and go beyond the somewhat simplistic claim of its unquestioned therapeutic effect. Empathy is more than a cognitive act, and as sustained over time it can be difficult to achieve, can be misunderstood, and can at times have no therapeutic effect.

Some notes on the epistemology of empathy

The nature of the knowledge base in empathy is explored. The presumption is that empathic responses are active in both analyst and analysand. The variety of meanings of empathic experience is reviewed and aspects of its implementation discussed. Reservations regarding the accuracy, certainty, and limitations of empathy are considered. The subsequent analysis focuses on empathic affective attunement. The role of underlying mechanisms, both neurophysiological-nonconscious and psychological-unconscious, are explored. An attempt is made to integrate contributory functions of these processes in a provisional model of empathic attunement and its differentiation from countertransference responses in the analyst.

Embodied language in neuroscience and psychoanalysis

There have been relatively few discussions of systematic studies of language, including neuroscience studies, in the psychoanalytic literature. To address this dearth, a detailed review of research on embodied language in neuroscience and related disciplines is presented, after which their findings are considered in light of diverse views of language in psychoanalysis, specifically the models of the Boston Change Process Study Group, Wilma Bucci, Fonagy and Target, David Olds, and Hans Loewald. The juxtaposition of psychoanalytic models with the findings of research on embodied language shows that scientific studies can focus psychoanalytic understanding of verbal processes, and that integrations with neuroscience neither inherently threaten the traditional psychoanalytic focus on verbal meanings nor reduce the richness and complexity of psychoanalytic theory.