Claudia Lament

Transformational processes and therapeutic action: what David knew.

The often neglected nonlinear dimension of the developmental process is described and its usefulness in the consulting room will be highlighted by a clinical example of the psychoanalytic treatment of an adolescent. The concept of transformation and its linkage with nonlinearity and discontinuity are also outlined.

Conceptualizing transformations in child and adult psychoanalysis.

A study group on Conceptualizing Transformation in Child and Adult Analysis focused on a particular kind of change in analysis, that of transformational change, a change in organization that could not be predicted from what came before. We found that, based on careful presentations of four analytic cases, transformational or pre-transformational change did take place. A central intervening variable was the patients development of a sense of agency. We tried to articulate the nature of the interventions leading to agency and ultimately to transformation. We added other new dimensions: an emphasis on construction in addition to reconstruction and a focus on the future.

Transformation into adolescence.

A transformational process from latency to adolescence is tracked in this essay of a disturbed boy who required an innovative therapeutic action that did not rely on the standard technique of interpretation of defense and conflict. The de-stabilization of the patients mind-set as a victim was leveraged by the analysts taking an extreme stance in keeping her own reflections to herself and, instead, assisting the boys capacity to experience himself as an agent in his own right as he took us both on his journey towards self-discovery. This technical strategy also facilitated the shoring up of fragile self and object boundaries, provided a necessary fillip in the boys capacity for affect differentiation and integration, and helped to create linkages between self and object representations in the present with hoped-for images of self and other in the future.

Inventing the Future: Narrativity, Agency, and Dynamic Systems Theory

ABSTRACT The Association for Child Psychoanalysis, founded by Marianne Kris, celebrates its fiftieth anniversary in this lecture. Kris’s own paper, “The Use of Prediction in a Longitudinal Study” (Kris 1957), is the cornerstone of this lecture, and signals the importance for child analysts to contemplate the time zone of the future as children mature, despite the unreliability of prediction. Inspired by a host of postmodern historians, devotees of the perilous problems inherent in foresight, I modified a methodology they developed to consider these issues from a psychoanalytic practitioner’s perspective. Creating a series of futuristic stories that could happen—each containing the elements of plausibility, surprise, and unpredictability—mirrors Kris’s emphasis on keeping one eye cocked toward the unanticipated unspooling of the developmental process. One important by-product of this work is one’s awareness of how the child analyst conceptualizes his or her child patient’s history. Consciously or preconsciously, how the analyst narrativizes his or her patient’s past and present will influence the kind of future portraits the patients will paint for themselves.

Transgender Children: Conundrums and Controversies--A Introduction to the Section.

This paper introduces the readership of The Psychoanalytic Study of the Child to the topic of transgender children, which will be investigated in the papers that follow. A flashpoint in the recent discourse that escorts children who self-describe as gender nonconforming is whether or not to support the practice of the medical suspension of puberty of these children by the administration of hormonal treatment. Relevant up-to-date research findings on this subject will be reviewed here. Despite those advocates and opponents who swarm around both poles, any reliable conclusions as to the long-term safety and psychological effects of puberty suppressants will remain provisional untilfuture studies proffer more definitive answers. While we await further study, the journal sees the necessity to press for dialogue concerning this conundrum. Anchoring this section is a clinical paper by Diane Ehrensaft, Ph.D., which documents the psychotherapeutic treatment of a transgender child who was prescribed puberty suppressants. The commentaries that follow and that are briefly summarized in this introduction will accent the psychoanalytic developmental point of view. This will provide the principal framework for the study of this controversy, which underscores the complementary dimensions of linear and nonlinear progressive hierarchical growth. In this context, features such as the developmentally normative fluidity of self-structures, including gender role identity, and the evolution of concrete thinking toward metaphoricity and figurative meaning-making in middle childhood and adolescence will be examined and applied to the clinical data. In addition, the argument that the use of puberty suppressants exacts a premature foreclosure on the reorganizing potential of developmental growth, and the proposed efftcts of the crosscurrents of the sociocultural body politic on these children and on the decision to opt for the suspension of pubertal growth will be explored.

The many dimensions of group process. A discussion of the treatment of Sandy.

What is presented is a summary of the study groups discussion of Dr. Oleskers work with her patient Sandy. A spotlight was thrown on the group process with an emphasis on the organic nature of how this group of psychoanalysts came to grips with the nature of Sandys inner world. One central issue which challenged the group was how to conceptualize the structure of her mind: Was she a child whose mental life could best be described as compromised by a fundamental biological frailty so that a primary emptiness or inchoate quality of mental contents reigned? If so, technical interventions which turned on narrative building were viewed as the principal therapeutic action. On the other hand, if her difficulties were perceived as stemming primarily from primitive psychological anxieties of annihilation and separateness, a dynamic approach was agreed upon as the preferred mode of treatment. Other issues regarding the transformational potentialities in the developmental process and the use of the analyst as a transformational object were also highlighted. Lastly, I offered my own perspective as to what I imagined occurred between Dr. Olesker and Sandy over the course of her treatment which enabled Sandy to change.

The consultation process with an adult: a child analyst's perspective.

A close examination of a consultation is presented. Such a face-to-face encounter with an adult patient can suggest a parallel with another type of treatment: child analysis. It is argued that certain ways of working with children in analysis—the gliding between the interpersonal and the intrapsychic—were especially useful in bringing this adult patient to engage in analysis. Also highlighted in this account are interventions that function not as interpretations per se but as protointerpretations aimed at arousing preconscious affect states for the purpose of bringing them into conscious experience.

Technical issues in adolescent analysis : A Jamesian view

When adolescent patients come to analysis with an intermingling of neurotic and developmental disturbances, the analysts technique cannot rely solely on interpretive methods. I use two examples to illustrate alternate interventive approaches: the first is taken from the dialogue of a fictional relationship between two characters in Henry Jamess novel The Ambassadors, and the second is selected from excerpts of an analysis with an adolescent boy. The strategies suggested aim to destabilize anachronistic mental percepts, connect representations of the self in the present with wished-for images of the self in the future, and join split-off affects and representations of self and others.