Paul Terry

Ageism and projective identification

This paper considers unconscious aspects of ageism, particularly in the underlying, reciprocal projective identifications between the ‘young’ and ‘old’ which entrench ageism and contribute to the debilitating consequences of ageing. These projections are examined in the context of care for older people, between the carer and the older person and between the therapist and the older client. Illustrations are given of how opportunities to reflect on the projective process through the counter-transference can ameliorate the effects of ageist attitudes and behaviours.

Working with Psychosis

This is the first of four papers about working with psychosis in a newly established post of psycho-analytic psychotherapist in an acute psychiatric unit in Australia. In this paper the author gives an account of some early impressions and experiences with staff and patients, particularly connected with an unacknowledged grief in the aftermath of psychosis. The author next discusses some of the psycho-analytic theory about psychosis which he found containing and helped make some sense of his experiences. He then introduces a case study of an exploratory psycho-analytic psychotherapy with a 40-year-old man suffering from a bi-polar disorder. The beginning of the therapy is described when this man revealed feelings of grief and despair about his illness. Being able to face and bear these feelings enabled him to begin to mourn what was irretrievably lost because of his illness and to contemplate what might still be possible. The author describes some of the early themes and one session in detail, and discusses how fluctuations in contact with the client reflect his retreat to a pathological organization in the mind. This psychic retreat was dominated by a psychotic process, and the retreat offered refuge from a dread of fragmentation and the pain of mourning and loss.

Working with psychosis: Part 2 – encounters with an omnipotent super-ego

This is the second in a series of four papers presenting work with a man suffering from a bipolar disorder. The present paper describes the second year of the work and my encounters with an omnipotent super-ego which made ferocious attacks on the work, especially when there were any developments. The attacks were particularly disabling because my own implacable super-ego was mobilized in the counter-transference. Consequently developments seemed to melt away as my patient and I were often reduced to mindless states. I came to understand that these omnipotent attacks were stirred by feelings of infantile helplessness and dependency, and were a means of trying to manage a dread of falling to pieces and unintegration.

Working with psychosis: Part 3 – ‘Struggling to contain madness – losing and recovering a capacity to think’

This is the penultimate paper in a series about working with a patient suffering from a psychotic disorder. The paper describes the third year of the work in which ‘John’ had four breakdowns in a period of six months. Much of the time I was unable to think. I was sitting on the edge of my chair either worrying that John was breaking down again or trying to help him recover from a breakdown. My small office became a cramped prison cell in which I felt myself a witness to a disturbing dance into and out of madness. A turning point seemed to happen as I developed a way of thinking about Johns breakdowns. I seemed then to become a less persecutory figure in Johns mind and more someone to whom John could turn for help. We found a way of thinking and talking about an infant in John. John responded by finding a way of being in my office as though he was reclining in a hammock. His breakdowns ceased. He was able to share in common humanitys concerns following September 11. Finally, I discuss thoughts about containment particularly about the paternal role in containment, drawing on Robert Capers elaboration of Bions ideas about containing psychotic aspects of experience.

Living with terror

In this paper I explore the nature of anxieties and defences underlying terror and terrorism. I suggest that the terrorists who terrorise us enact our depressive anxieties associated with an inconsolable despair about our destructiveness. This destructiveness is epitomised in the development and proliferation of nuclear weapons which threaten mass destruction of the marvellous civilisation we have created, and destruction of our personal universe. I suggest too that our terror reflects paranoid schizoid anxieties of helplessness, annihilation and fragmentation linked with the nuclear threat, but also linked with post-traumatic stress, particularly transmitted through the generations from two global conflicts in the last century. Omnipotent defences which are erected against such fears can be seen nationally in attacks on dependency cultures in institutions like the national health service or education; and internationally in the creation of a bully superpower spreading fear and disintegration. Finally, I suggest these omnipotent defences contribute to the prevalence of a cruel dictator-in-the-mind and consequently an enslavement to idealised or cruel leaders.

Working with psychosis Part 4: Therapy online – ending by email

This is the fourth and concluding paper from a series about psychotherapy with a man suffering from a psychotic illness. The paper describes the ending of the therapy which was precipitated by my decision to leave the country. News of ending was extremely disturbing for my client and stirred fears that he would again break down and need re-admission to hospital. Six weeks before the ending he stopped attending but continued to stay in contact by email. I decided to reply to his emails during the session times, and we developed what he came to call his ‘email therapy’. This online technology provided a means for my client and me to separate, to find a third perspective and to begin to mourn this ending without him losing his mind and breaking down. Following James Fishers ideas about ‘mourning in the presence of the loved object’ I understand aspects of this email ending as enabling a relinquishing of projective identification used to possess and control, a recognition of the freedom of the other and of the need to mourn omnipotence. I discuss some of the problems presented by premature ending with a vulnerable client – problems which can be seen in my difficulty of mourning and working through the ending reflected in the long time it has taken to finish writing this paper.

Fears of death and fears of dying in the counter-transference

It is commonplace for people to say they are not afraid of death but they are afraid of dying. I discuss unconscious aspects of fears of dying and fears of death which are revealed in counter-transference experiences in therapy with people suffering from terminal illnesses and with older people. Studying the counter-transference shows that fears of dying, which usually refer to lingering and disabling illnesses, unconsciously are linked with fears of dependency and the apprehension that if one becomes dependent then no-one will want to look after you. This apprehension is often a residue of failures in the early dependency relationship which can be re-enacted in adult life through projective identification when therapists and carers may be induced to abandon the caring role. Despite the ubiquitous denial, fears of death surface in the counter-transference, often obliquely but always with a particular terror for the survival of the self. This unconscious terror confirms Freud’s insight about the denial of death that what is unthinkable is the annihilation of the self. I conclude with a discussion about the importance of setting an ending date in therapy with those who are old or terminally ill.

Editorial for Psychodynamic Practice 23.3

Psychoanalysis continues to follow Freud’s footsteps in questioning, revising and refining its theory and practice. The application of psychoanalytic ideas by psychodynamic practitioners is undoubtedly influenced by this tradition. The authors of the papers in this issue demonstrate its influence in the way they explore psychoanalytic ideas to stretch the boundaries of our thinking about the context in which we conduct therapy by encouraging us to reflect about: the importance of providing therapy alongside practical support and other activities within a therapeutic community for severely traumatised young people; the therapeutic contribution of administrative and other non-therapist colleagues and the physical environment of therapy settings; how the isolation of the consulting room and the worries of taking on a client for the first time may lead trainee and beginning therapists to retreat to theory in unhelpful ways; the therapist as a container for our clients’ traumatic emotional experiences for which they have no words and which may be expressed through the body and result in addictive behaviours; processes of recovery in addiction including clients’ own stories of their recovery and the benefits gained from Alcoholics Anonymous. Sheila Melzak gave the annual talk for Psychodynamic Practice in association with the Birkbeck Counselling Association in November, last year about therapeutic work with refugees. Building seven bridges with young asylum seekers living in exile in the UK is the first of two papers based on the preparations for her talk. In this paper, Melzak describes the heroic work of the Baobab Centre which has established a non-residential therapeutic community for young refugees who have suffered shocking abuse, often having witnessed torture and murder of their parents, being enlisted as child soldiers and trafficked into slavery. Sheila Melzak discusses the impact of such trauma on memory and psychological development, and how these young people need a place where psychological and practical help is available in an holistic approach which includes individual and group therapy as well as a variety other activities such as a music workshop, philosophy group, arts and physical sports. In a moving case study, Melzak describes her work with a 21 year-old young man who tragically was in child slavery. He told her he wanted to play by which he meant ‘being free ... to cook food, ride his bicycle through the countryside’. The aim of this work is to offer ‘careful developmental help through the different phases of adolescence’. Melzak also describes ‘working in displacement’ which involves

On reading The Uncommon Reader

On first reading Alan Bennett’s The Uncommon Reader (2006), I enjoyed it as a whimsical piece of satire. Returning to it recently for the purpose of a book discussion, I came to appreciate that Bennett’s beautifully crafted work has much more to offer. On reflection, I see Bennett offering a poignant observation about the transformative potential of reading, which like therapy can bring about a shift from an omnipotent, narcissistic state of mind to one in which we can bear ambivalence, guilt and remorse, and make moves towards reparation. In choosing Queen Elizabeth II to illustrate this transformation, I believe Bennett is offering a commentary about our contemporary society with the Queen as an emblematic figure of a government in the grip of narcissism. Allow me to explain how I reached these conclusions. First a précis of the novel which opens with the Queen at a state banquet asking a reluctant French President about Jean Genet. The President is not amused, and thinks to himself he is in a ‘for a long evening’. The novel’s narrator then traces the history of the Queen’s enthusiasm for literature, beginning when she comes across a travelling library parked behind the kitchens at Buckingham Palace. Curious, she ventures in and meets the driver librarian and just one reader, Norman who works in the royal kitchens. Out of politeness, she feels obliged to borrow a book and ends up picking a book by Ivy Compton-Burnett, whom she remembers making a Dame. Thus, begins a newfound love affair with reading, initially with Norman as her guide and mentor. Norman, who is gay, is subsequently promoted as a page to the Queen. The Queen is determined to make up for what she has missed. She reads widely and prodigiously. Her majesty’s reading is not well received. Her courtiers complain she is neglecting her appearance, and worse that when she goes on walkabouts and meets her people, instead of asking the routine questions such as how they travelled there that day, for which they have been prepared and can give routine answers, she asks her subjects what they are reading and sometimes even hands out books she herself has finished. The Prime Minister becomes especially fed up when, during his regular audiences with the Queen, she starts drawing on her growing interest and study

Beware of pity which conceals envy

I was recently introduced to a novel Beware of Pity which prompted thoughts about envy and the holocaust. Stefan Zweig completed the novel in 1938 and published it in 1939. Zweig was a highly successful Jewish writer who left Austria in 1934 and went to London where he wrote this book, his only full length novel. Afraid of internment, he left London in 1939, went to the USA and then he went to Brazil. The novel begins on the cusp of the Second World War when the narrator reports a story told to him by an Austrian cavalry officer about events in his life during the period leading up to the First World War. In the latest English translation of the novel by Bell (2011), a foreword by Nicholas Lezard describes how in exile Zweig was reluctant to make any statements about the treatment of the Jews in Nazi Germany. Lezard suggests that Zweig chose to comment obliquely in the novel, which could otherwise seem somewhat nostalgic for pre-First World War Austria, but which Lezard sees as a warning to ‘not judge things by appearances’. I propose to develop this theme by discussing how Zweig’s novel unmasks what appears to be pity to reveal an envious superego which, mobilised in the Austrian cavalry officer, destroys a Jewish man and his daughter, and which mobilised in social conditions of privation and fear, contributed to the Nazi holocaust. The cavalry officer Anton’s story begins when he was aged 25 and stationed in a small garrison town on the Hungarian border. He becomes acquainted with a rich Hungarian family, a widowed father, Herr von Kekesfalva and a young woman, his disabled daughter, Edith, whom Anton presumes are aristocrats. Edith was injured in a riding accident and was subsequently unable to walk. He becomes consumed with pity for them. His pity leads him to become a regular visitor to their magnificent villa where he savours their lavish hospitality. He learns that Kekesfalva is in fact a Jew from an impoverished beginning who went on to make a fortune and bought his aristocratic title. Pity further leads Anton to give Kekesfalva and Edith false hope for their physician Dr Condor’s expectations about a new treatment to cure the paralysis of her legs. Anton is then shocked to discover that Edith has fallen in love with him. He takes flight to Dr Condor who helps him find resolve to support Edith’s attempt at the