Reciprocal movement as a platform for mental well-being:  A relational research method that explores the quality of movement between patient’s and therapist’s self-states in psychodynamic psychotherapy

Dr. Nechama HaCohen, Kinneret Shapira Sheda, Prof. Rivka Tovel Messia

The current study was born out of a gradually expanding contemporary movement, that strives to bridge the gap between clinical practice and empirical research. In this article, we will demonstrate the TPA scale utility (Two-Person-APES) when conducting psychotherapy process research. The TPA scale explores the quality of movement between patient’s and therapist’s self-states and enables the identification and rating of progression of tension between multiple self-states; in a continuum from dissociation to dialectic. Therefore, this new method assesses patient and therapist in-session intra-personal and inter-personal processes, and their relation to treatment outcome. A good and a poor outcome cases were sampled and analyzed for both the patient and the therapist using the TPA. Findings revealed that the therapist of the good outcome case was more responsive to the patient and followed her quality of movement in a way that enabled the patient to explore, face and come to terms with her self-states. These findings emphasize the importance of surrendering to vague and dissociative mental discourse in therapy, which enables the renewal of the intra-psychic and inter-personal movement of the patient. Allowing gaps to exist between the two members of the dyad could make it difficult for a good developmental conflict or dialectic to evolve, as well as for achieving a better treatment outcome. These findings have theoretical and clinical implications for understanding within-session changes as processes occurring in the context of a dyadic relationship.

Keywords: psychodynamic psychotherapy; relational theory; psychotherapy process research, conflict, dialectic

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Psychoanalytic Thoughts on Loneliness: A Study of Samuel Beckett’s Rockaby

Dr. Tsiky Cohen

In its discussions of the phenomenon of loneliness, psychoanalytic literature focused mainly on the etiological perspective. The present article seeks to offer a phenomenological perspective on loneliness, that is, to describe the feelings, emotions, and experiences of the lonely person. It uses the play Rockaby by Samuel Beckett, to demonstrate how the experience of loneliness has an effective quality of 'nameless dread', and of 'unthinkable anxiety'. The article claims that from a phenomenological and psychoanalytic point of view, the experience of loneliness is not a static event but a persistent struggle between life and death Instincts, a continuous process of withdrawal, depletion, calcification, and finally mental annihilation.

Keywords: Loneliness; Solitude, Isolation, Aloneness, Samuel Beckett

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Clinical supervision as an act of love - The emergence of the therapist’s self through the perspective of the Kleinian theory

Keren Or-Mor

The article's title echoes the elusive character through which love manifests in the context of clinical supervision. This phenomena might become intrusive, limiting and frightening, while at the same time, might become a space of continued, emerging creativity, offering the supervisor, as well as the supervisee, an opportunity for expansion and growth. Supervisees in the early stages of their careers, undergoing clinical supervision within institutional frameworks like the Israeli Defense Forces Mental Health Department (MHD), often find themselves encountering meaningful yet painful experiences through deep and introspective process. In addition to those difficulties, an institutional factor emerges, akin to an Oedipal third, as it sets forth the rules and guidelines of the supervision process. The collision between the external reality and the anxieties that act in the internal world is inevitable, and becomes a fertile ground for the formation of projections, splits, and the emergence of archaic fantasies that are characteristic of the infantile schizophrenic state. A basic premise rooted in the heart of Kleinian thinking is the desire to know the truth. The engagement with interpretations of inner reality involves struggle and pain. The willingness to come into contact with complex truths, without distorting them according to our needs, is perceived as integral to the drives of life; and forms the basis for processing the depressive position. In this paper, I will explore the process of the therapist's self-formation within the context of institutional clinical supervision, employing the comprehensive perspective of the Kleinian theory. I will argue that the supervisor's willingness to engage with complex truths transforms clinical supervision into an act of love, driving the integration of the self, facilitating transformative change, and supporting the therapist's self-formation. To illustrate this, I will present case studies of supervision processes conducted within the MHD.

Keywords: supervision, Melanie Klein, love, positions

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Sexuality peeking into the therapy room - The clinical manifestation of the sexual state of mind 'delayed adaptation to mature sexuality' among women who grew up in Ultra-Orthodox society

Rachel Forges

This article proposes recognizing a unique sexual state of mind, to be added to those described by Meltzer. 'Delayed adaptation to mature sexuality' is a state common among women who were raised and matured in Ultra-Orthodox (Haredi) society, occurring for the most part in the age-developmental stage of the transition from adolescence to marriage, and in the course of marriage. Such women, regardless of their current lifestyles and beliefs, were raised in a culture characterized by abstinence from sexual contact until marriage, by taboo on sexuality, by an absence of education and knowledge on the subject, and by a sharp transition from total abstention of any sexual contact to full sexual relations. A theoretical and clinical lacuna exist in understanding their mental organization as adults when facing sexuality, and in identifying the nature of the anxiety, defenses and unconscious fantasies that are expressions of this organization, which come to the fore in therapy. Psychodynamic therapists have a hard time cuing into the inner world of these women and identifying the dynamics of the therapeutic situation when the content the patient raises relates to her sexuality, both due to the difficulty of these women themselves to understand their sexuality in the absence of explicit language and a clear conceptual framework in the dialogue on sexuality, and due to the lacuna in existing theoretical models that lack the conceptual framework that would allow understanding and thinking about the dynamics taking place with inclusion of sexuality in these women’s identity and externalization of it in their world.

Acquaintance with the characteristics of this sexual state of mind could assist the dynamic therapist to understand, through transference and countertransference relations, the challenges in the inner world of these patients. 

Keywords: Sexuality, Taboo, Women, Ultra-Orthodox Society, Transference and Countertransference

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Aspects of playing and reality in group therapy of children

Netanel Zingboim

This article describes some of the qualities of group therapy, which sustains the tension between playing and reality and provides an environment that facilitates growth. In my work at `Friends – group therapy`, I meet children whose social world is damaged. The reasons for this damaged are varied, and touch a whole range of neuroses. In other words, these patients are impaired in their ability to be in a relationship, due to having impaired object-relations. The therapeutic environment and the development of the ability to play are two of the main factors in group therapy. These are central to the therapeutic processes since they contain additional treatment factors, and because of them being an intersection that allows the connection between imagination and reality. Maintaining the tension between them enable a transitional space. Nonetheless, little has been written about their heightened significance in groups of children. The purpose of the article is to present some of the aspects of playing and reality that occur in the therapy of children's groups. I will demonstrate the theoretical writing through a case study from a group therapy of children. I will also emphasize the `good-enough` environment provided by the group setting and the playing space that is possible in it – in a children group interventionsl.

Keywords: group psychotherapy, play, environment, transitional space

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