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The process of psychotherapy opens the door to many paradoxes which cannot always be easily resolved by recourse to psychoanalytic theory, which itself may obscure the complexity of the psychological paradox. A model of psychotherapeutic practice is proposed which emphasizes the validity of the patient's own images while de-emphasizing theory. The metaphor of the therapist as the 'editor' of the patient's narrative helps to bring out clearly the many paradoxes entailed by therapy. In this model, the therapist is advised to suspend disbelief in the patient's 'fictions'; to look for elements in the patient's story that may reveal new stories; and to look for hidden themes in the patient's interactions with the therapist. Emphasizing the imagery in the patient's stories contributes to understanding and empathy. more...

One hundred and twenty couples applying for DI or involved in the procedure were seen in consultation or therapy at various stages. The clinical findings provide evidence that both partners experience conflict in two areas. The discovery of infertility generates transient impotence, loss of self-esteem and withdrawal in husbands, and anger, guilt and a wish to make reparations in wives. The DI procedure itself evokes oedipal conflicts. Clinical vignettes have been presented to illustrate these patterns and to provide evidence for the view that couples should recognize, discuss and come to terms with the conflicts generated by the discovery of infertility before tackling DI and the conflicts this procedure evokes.Although secrecy is advocated by most DI couples and physicians, a questionnaire study of 76 couples in our unit disclosed that many individuals consider it psychologically useful to discuss their infertility problems with others. Although secrecy may be useful, it may also, through the indirect sanction of denial and negation, interfere with the couple's acknowledging and discussing their problems. One useful purpose of a psychiatric assessment is that it can promote such acknowledgement and discussion. Conflict needs to be distinguished from psychopathology which may be the outcome of unresolved conflict. more...

This presentation examines the effect of the discovery of the REM state on the role of the psychotherapist. A clinical illustration serves as the point of departure. A dream fragment which might be explained in terms of the activation-synthesis hypothesis is shown to connect with conflicts in a way that this hypothesis cannot encompass. Freudian theory requires modification in its explanation of what instigates dreams and in its explanations of energy and drive. The therapist's interventions, to the extent that they imply causation to the dream or an energy transformation, also require modification. At the same time psychoanalytic theory does provide a unique understanding of sequential clinical events. The pitfalls of focusing solely on dreams are discussed. Finally, the tentative findings from the REM laboratory concerning the function of dreams are shown to fit nicely with the use to which dreams have been put by psychoanalytic therapists. more...

This paper focuses on the adaptive capacity of survivors, and, by reframing the psychodynamics of the “survivor syndrome”, employing Object Relations theory and Self Psychology, attempts to shed light on the recovery process and the subsequent regressive responses in later life. Historically, an understanding of the survivor syndrome was impeded by the severity and uniqueness of the trauma. Survivors demonstrated symptoms that were not always congruent with the established diagnosis “traumatic neurosis”, and conventional psychoanalytic psychotherapy which aimed at lifting the repression of the persecution often failed. Despite reports of “late” physiologic sequelae, recent work has focused on the survivor's capacity to recover. Survival during the persecution entailed maintaining perceptual defences, maintaining an attachment to the world and the objects in it, and despite the fragmenting effect of these two sets of mechanisms, maintaining an integrated sense of self. Three clinical vignettes are presented to demonstrate that during the-recovery process a degree of reversal of the survival mechanisms was necessary. This required taking into oneself or acknowledging the anger evoked by the persecution, which, associated with the fragmenting effect of the persecution on the sense of self, often resulted in guilt and self-loathing, and affected the vicissitudes of the survivor's personal story. Often the self-self object function required bolstering by particular relationships. The triggers for later regression responses in survivors are events that evoke rage or serve as a symbolic bridge to memories of the persecution, and life changes that generate altered relationships that had served a self-selfobject function. Attending to the state of internalized objects as well as the self-cohesive contribution of relationships may benefit survivors. more...

The psychiatrist consulting to an infertility clinic is confronted with a variety of clinical issues and problems. The couple arrives with anxiety, for a work-up that in itself will be traumatic. The psychiatrist’s role is to weed out distortions and issues that are unreal. more...

This survey of the psychological literature on Artificial Insemination by Donor (AID) pays particular attention to the secrecy. Studies of couples beforehand do not arrive at criteria for choosing psychologically suitable couples. Follow-up questionnaires are superficial and cannot inform us which couples and what percentage of couples encounter psychological difficulties. Case reports of couples who encountered difficulties are too few to permit generalization and cannot specify AID's role in generating symptoms. A second look at the data suggests that, although overlooked, the secrecy surrounding AID may create psychological difficulties, a view supported by the findings at our clinic. A plea is made with specific recommendations to create an ambience in which openness is possible, and which will allow in-depth research of the psychological aspects of AID. more...

The process of learning in groups, as exemplified by the author's experience in a multidiscipline conference on a surgical ward of a general hospital has been examined. A sequence of six developmental stages has been identified: initial ambivalence; passive-receptivity; resistance; task orientation; the work group; and consolidation. These findings have been compared with those of other studies dealing with sequential stages in group development. The psychiatric consultant's role in expediting these phases and some of the difficulties encountered have been mentioned. more...

The concept of empathy has become a central issue in the debate between classical psychoanalysts and self psychologists. If one recognizes that dilemma is central to the human condition and that the two competing schools of psychoanalysis emphasize opposite sides of several parameters that are fraught with dilemma, it is possible to view them both as empathic. Three levels of empathy are discussed: empathizing with the patient's story as it stands; discovering new themes hidden away in the patient's narrative; and discovering significant patterns in the patient-therapist relationship itself. The concept of therapy as a self-correcting process that approaches but never quite attains objective accuracy is emphasized. more...