Opening the closed heart: affect-focused clinical work with the victims of early trauma.

This paper begins with the understanding that early trauma leads to powerful dissociative defenses which injure the capacity to feel. It further explores ways to restore this capacity through body-centred attention to affect-in-the-moment in the psychoanalytic situation. Using the author's personal experience while in analysis as well as a case of severe early trauma, he demonstrates the consciousness-killing effect of primitive defenses and shows how body-sensitive techniques hold the promise of restoring the patient's sense of aliveness and hence, opening the unconscious to those affect-images that are the building blocks of the human imagination. A final section focuses on the neglect of feeling in Jungian psychology and suggests that the "creation of consciousness" which Jung described as his personal myth, is quintessentially a process of emotional transformation - of bringing unconscious suffering into consciousness - as feelings.

Cet article commence avec l'acceptation que le traumatisme précoce produit de puissantes défenses dissociatives qui portent atteinte à la capacité à ressentir. L'article explore ensuite des manières de restaurer cette capacité par l'utilisation d'une attention centrée sur le corps et sur l'affect-dans-le-moment-présent dans la situation psychanalytique. En s'appuyant sur son expérience personnelle durant l'analyse ainsi que sur un cas de traumatisme précoce sévère, l'auteur montre que les défenses primitives ont pour effet de tuer la conscience. Il montre aussi comment des techniques sensibles au corps contiennent la promesse de la restauration du sens de la vitalité du patient, et ainsi d'ouvrir l'inconscient aux images chargées d'affect qui sont les éléments constitutifs de l'imagination humaine. La dernière partie de l'article montre la négligence en ce qui concerne le sentiment dans la psychologie Jungienne et suggère que la « création de la conscience ¼ que Jung décrit comme étant son mythe personnel, est en quintessence un processus de transformation émotionnelle: d'amener la souffrance inconsciente à la conscience, en tant que sentiments.

El presente trabajo comienza con la comprensión de que el trauma temprano conduce a poderosas defensas disociativas las cuales dañan la capacidad de sentir. Explora formas de restaurar esta capacidad a través de una atención-centrada-en-el-cuerpo al afecto-en-el-momento, en la situación psicoanalítica. A partir, de la experiencia personal del autor durante análisis y también con un caso de trauma temprano severo, demuestra el efecto asesino de la conciencia de las defensas primitivas y muestra cómo técnicas corporales-sensitivas sostienen la promesa de restaurar en el/la paciente su sentido de vitalidad, y por lo tanto, posibilitan la apertura inconsciente a aquellas imágenes-afectivas que son las piedras fundacionales de la imaginación humana. Una sección final se focaliza en la desconsideración del sentimiento en la psicología Junguiana y sugiere que la 'creación de la consciencia', la cual Jung describe como su mito personal es quinta-esencialmente un proceso de transformación emocional, de traer el sufrimiento inconsciente a la consciencia, como sentimientos.

Trauma, innocence and the core complex of dissociation.

Trauma survivors often lament that they have lost their innocence or lost their souls and that something vulnerable and whole about themselves has been 'broken' or annihilated. Yet when the psychotherapeutic relationship begins, and symbolic material from dreams and the transference emerges, discernible patterns become apparent, indicating that a core of innocence and vitality has not been totally lost or annihilated. On the contrary, it has been 'saved' by dissociation and its system of inner objects and their protective and/or persecutory narrative 'scripts' or 'schemas'. The dissociative system splits off a wounded, orphaned 'child' in the psyche and clinging to this 'child' is a penumbra of innocence that apparently must be preserved at all costs. Unfortunately the costs of preservation are high because such encapsulated innocence becomes malignant, and the inner world turns perverse and destructive. Only when the wounded, orphaned, and innocent part of the personality is allowed to suffer experience again - this time with the promise of a new outcome - can true healing of trauma occur. How to facilitate this authentic suffering in the face of powerful resistances thrown up by the 'system', will be the focus of this paper.

Pilot Study for the Development of a Self-Care System for Type 2 Diabetes Patients Using a Personal Digital Assistant (PDA).

PURPOSE: The primary objective of the present pilot study was to investigate the feasibility and acceptability of the newly developed self-care system using personal digital assistance in patients with type 2 diabetes. The secondary objective was to investigate changes in daily calorie intake, body weight, and hemoglobin A1c after using the system for 6 months. METHOD: The participants were nine outpatients with type 2 diabetes, aged 34-72 and living in Tokyo or surrounding prefectures. They were instructed to use the electronic food diary and to review the graphs of the total energy intake to control food intake under their own target value for 6 months. After they completed the study, the feasibility indicated by adherence rate for food recording and acceptability of the system rated with 6-point Likert scale from 1 (worst) to 6 (best) by the participants were investigated. RESULTS: Seven participants out of nine completed the study protocol. The median adherence rate for food recording was 80.6 %. Regarding the acceptability, six patients rated 6 for desire to use the system while one rated 5. In addition, regarding improvement in self-care for diabetes, the median score was 5. Daily calorie intake, body weight, and HbA1c, however, did not change significantly over the 6-month period. CONCLUSION: The newly developed self-care system might be feasible and acceptable in diabetes patients, which could be applied as an ecological momentary intervention tool, although there was some room to refine it to raise adherence.

Revisioning Fordham's 'Defences of the self' in light of modern relational theory and contemporary neuroscience.

This paper explores the evolution of Michael Fordham's ideas concerning 'defences of the self', including his application of this concept to a group of 'difficult' adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a 'self-care system' in the psychological material of early trauma patients (Kalsched ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual 'enactments' between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a 'real person' to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.

La entrevista antropológica. Comprendiendo la perpectiva del actor / Anthropological interview: Understanding actor perspective

Resumen:

Objetivo: este texto tiene como objetivo reflexionar sobre el aporte de la antropología como recurso para analizar, evaluar y explicar la visión de los actores sociales/sujetos de cuidado en situación de exclusión social. Metodología: la metodología es cualitativa de tipo etnográfica, focalizada en la entrevista etnográfica. Resultados: se observa que un gesto, una mentira, una sonrisa encubren sufrimientos y relaciones de poder que se ponen en contexto, pues operan en procesos transaccionales que muchas veces pasan inadvertidos y sostienen la exclusión social en salud. De este modo, se descubren representaciones y prácticas encarnados en una mujer/madre que como sujeto de cuidado visibiliza una realidad sociocultural e histórica individual y colectiva no homogénea. Discusión: la herramienta metodológica empleada es apropiada para analizar el funcionamiento de las políticas públicas y para promover el autocuidado de los sujetos, a partir del sentido dado a las significaciones y prácticas en salud.