The environmental crisis and the film First Reformed: Paths to paralysis and change.

The natural world has always been integral to our existence; currently, we are compelled to reckon with our assumptions about this connection with mounting urgency. Individual reactions to the environment are influenced not only by the sociocultural surround, but also by one's internal world, particularly whether one's internal objects are felt to have been irreparably damaged or are potentially salvageable. Excessive guilt about destructive impulses can limit one's ability to recognize individual responsibility for the current situation without catastrophizing the weight of one's ecological footprint. Delusional solutions may be adopted, valorizing extreme forms of engagement. The film First Reformed illustrates what appear to be divergent approaches to the planet: ruthless exploitation by an industrialist versus an impassioned objection to destruction of the environment for economic gain. In this narrative, both are underpinned by a paranoid-schizoid mindset. We investigate the dynamics of this psychic state, which results in a constricted perception and an absence of constructive agency with respect to the environmental crisis. We present an alternative conceptualization of the natural world's place within a person's psychic equilibrium. We emphasize that a more integrated relationship with the environment can facilitate concerned, preservative action on behalf of the natural world and ourselves.

Annotated Bibliography for Supervising Psychiatry Residents in Psychodynamic Psychotherapy.

OBJECTIVE: This paper sought to compile an annotated bibliography for the outpatient year of adult psychiatry residents, providing resources for a foundation in psychodynamic theory which can be utilized in supervision to aid in ongoing psychotherapeutic work. METHODS: In selecting the readings, the ACGME Milestones sub-competencies considered were (i) empathy and process, (ii) boundaries, (iii) alliance and provision of psychotherapies, (iv) seeking and providing supervision, and (v) knowledge of psychotherapy (theories, practice, and evidence base). Once the readings were selected, two authors independently reviewed the articles to determine which key sub-competencies each article addressed. Chance corrected agreement between the reviewers was assessed using the Cohen kappa statistic. The kappa for interrater agreement was 0.83. RESULTS: A list of 32 readings was compiled sequentially, allowing for theoretical concepts to be progressively built upon. The content of the papers aligned well with multiple sub-competencies in the medical knowledge (MK) and patient care (PC) domains. The bibliography allows for close examination of therapeutic frame; active listening and reflecting on the meaning of the therapist's interventions; transference and the use of countertransference as a diagnostic/therapeutic tool; defense mechanisms; patient pressures towards reenactment; theoretical viewpoints on therapeutic action (e.g., ego psychology, self-psychology, relational therapy, object relations, classical/modern Kleinian); and meaning of lateness, treatment breaks, and termination. CONCLUSIONS: This list serves as an ancillary resource which can augment discussions in therapy supervision, while also aiding in standardizing the minimal knowledge base achieved in psychodynamic theory.

Words and transitional phenomena in psychotherapy.

In analytic psychotherapy, language provides form for the patient's conscious and unconscious material. Therefore, language creates a space for patient expression and a medium for therapeutic work. The space of language in analytic therapy is comparable to Winnicott's transitional space. The transitional space of language is independent of the number of languages the patient uses in therapy but transitional space of language is made particularly manifest during the moments of language switch Paying close attention to language switch during therapy may reveal the transitional space of language, the special words with transitional object qualities and, finally, the symbolic functions of language.

The experience of borderline phenomena through cinema: Guentin Tarantino's Reservoir dogs, true romance, and pulp fiction.

The experience of many patients with borderline personality is intense and kaleidoscopic. These qualities may be represented in film in ways that reflect and convey their essential features that are less readily captured in words. Quentin Tarantino has produced a trilogy of films that bring to light and to life the borderline experience. We use these movies to illustrate and discuss five key borderline themes: the fluid nature of drive derivatives, the discontinuous experience of time and space, the coniflicted search for an idealized parent, antisocial distortions of the superego, and the organizing and stabilizing function of a central romantic fantasy.

Complementary dreams: a window to the subconscious processes of countertransference and subjectivity.

The British psychoanalysts were the first to be interested in reciprocal and interpersonal interactions of psychotherapy. The Freudian mirror model was progressively questioned in the 1940s and 1950s. Throughout the 1950s, positions and terms were created that either defended or attacked the use of subjectivity and countertransference in psychodynamic psychotherapy. The objective of this article is to discuss the participation of the therapist's subconscious mind, as it is involved in communication with the patient's subconscious mind during psychodynamic treatment. Specifically, this takes the form of complementary dreams, a clinical phenomenon that I will describe as secondary to the therapist identification with the patient infantile object relations. Complementary dreams will be discussed as a helpful therapeutic tool used to understand the subjective communication that happened between patient and therapist in two separate cases. Complementary dreams will be presented as a helpful therapeutic instrument in containing countertransference enactment.