The unconscious being unknowable, how can the psychoanalyst be certain that the memory he recovers with the help of hypnosis is real, or that his interpretations of the patient’s free associations are correct? How, in other words, can his theories be validated? The patient’s assent or dissent cannot be trusted in this regard since the theory predicts that he or she will “resist” the unveiling of the repressed, as illustrated by the “Dora” case. The scientific controversy that is the analytic cure cannot come to a conclusion since it takes the form of an analysis of resistance to analysis, more specifically, of an analysis of patients’ positive or negative transference onto the analyst. Even a confirmation by the patient of the analyst’s interpretations is not going to settle the matter since it might be yet another ruse of transference resistance. In the end, it is the analyst who decides whether the interpretation – and the theory behind it – is correct or not. Hence the crucial importance in psychoanalytic theory of Freud’s “self-analysis,” since it – and it only – guarantees that the founder initially gained unfettered access to the unconscious.

The consultation is likely to be the first experience the patient has of a psychodynamic way of thinking and it has the potential to be an experience of being deeply heard and understood. In the consultation period the aim is for the therapist to have an experience of the internal world of the patient and the patient an experience of what the therapy will be like. A consultation over a series of meetings may even give the opportunity of developing a patient’s capacity to undertake therapeutic work. It is a complex process that often starts before the patient even enters the room. There are different approaches to the consultation process and some of these are discussed. Given that the psychodynamic consultation is an encounter which will, in all likelihood, create anxiety and a sense of vulnerability in the patient, we can expect to see defences emerging in the moment-by-moment interaction and these are considered. A tripartite structure of psychodynamic formulation is outlined as a helpful framework for picking out the relational dynamic

This chapter describes specific techniques employed in modern day psychodynamic psychotherapy. It commences with a brief outline of the core psychodynamic attitude consisting of relative restraint, ‘anonymity’, and ‘neutrality’ along with helpful tips for the psychotherapist at the start of their career. It then goes on to a section on the importance of unconscious communication which includes a brief instruction on dream interpretation. This is followed by a detailed description on the use of transference and countertransference to elicit relevant object relations; this section includes how to manage ruptures in therapy. There is a description of the spectrum of interventions and techniques used in psychodynamic psychotherapy ranging from the more supportive end of the spectrum through to the more expressive. The chapter concludes with the process of working through and managing resistance. Throughout there are suggestions for how to couch interventions when working with a patient and also clinical vignettes to illustrate key techniques.

This chapter provides an overview of current thinking regarding the supporting theory of psychodynamic psychotherapy. Rather than going through theoretical constructs in historical order of when each theory was proposed, they are presented as a composite of past and present thinking that the authors have found to be clinically relevant. It commences by describing theories on the early development of the infant and the creation of the internal world and object relations. The chapter them moves on to the issue of accommodating to the world as it is experienced by the infant, outlining circumstances leading to adaptive and less adaptive development. The chapter then outlines ‘core theory’ which covers more traditional psychodynamic concepts such as conflict, resistance, and defence mechanisms with an emphasis on projective identification. The role of this latter defence mechanism is linked with the theoretical constructs of transference and countertransference. There is a section on the narcissistic constellation in order to help the reader negotiate later sections in the book. Finally the chapter concludes with an introduction to theories as to how change is effected in psychodynamic psychotherapy.

Counseling patients through their journey to conceive can be challenging. When a therapist becomes pregnant, the therapeutic alliance alters.This chapter explores the unique dynamics between the pregnant fertility counselor and reproductive clients. Questions around the “who, what, where, when, why and how” of pregnancy disclosure are used as a tool to help think about the various elements to the therapeutic alliance. Intense feelings can be triggered for a patient who is struggling with infertility or pregnancy loss, but can also trigger emotional reactions for the fertility counselor. The transference and countertransference that arises with the self-disclosure of a pregnancy is likely to unfold complicated dynamics and emotions. The positive and negative implications that a pregnancy disclosure can have from the patient’s point of view, as well as that of the therapist, are addressed. Additionally, the postpartum experience and the return back to work after parental leave are also discussed. While this chapter focuses on the pregnant therapist, the issues raised pertain to all pregnant reproductive medical staff treating infertility patients.

In this chapter, the author sets out a unitive way of thinking about the relationship between spirituality, psychiatry and psychotherapy. An introduction to spirituality in mental health care is followed by a discussion of the meaning of ‘spirit’, ‘soul’ and ‘ego’ and how these terms may be understood with reference to ongoing developmental tasks. The poem I AM, written by the nineteenth-century poet John Clare, who suffered from enduring mental illness, is considered in depth from both psychoanalytic and Jungian approaches in order to illustrate different perspectives on Clare’s anguish and spiritual yearning. The evolution of transpersonal psychology, in which Jung’s concepts play an important part, is traced historically, with the increasing recognition of the value of spiritually orientated psychotherapy. The chapter concludes with several case studies by the author, illustrating how a range of soul-centred approaches can readily and helpfully engage with the spiritual reality of the patient.

Referencing the poem I AM by John Clare, who suffered from mental illness. Psychoanalytic and Jungian therapies are compared in order to illustrate different perspectives on Clare’s anguish and spiritual yearning. A brief history of the evolution of transpersonal theory and of spiritually oriented therapeutic approaches is provided, and the chapter concludes with case studies illustrating how soul-centred therapy can readily and helpfully engage with the spiritual reality of the patient.

While English-speaking readers were the first to have access to a complete translation of Freud’s works, problems remained: apart from deviations like rendering Trieb as ‘instinct’, the Standard Edition was marked by tone distortion, medicalization or loss of idiomaticity. Freud himself insisted that terms like Es (Id or It) were above all common language expressions. Bettelheim and Lacan posited that a critique of translation was a prerequisite before serious work could be done on the texts of psychoanalysis. However, translation had been less a problem than a method for the young Freud, whose polyglotism, quite visible in his youthful correspondence, allowed him to work creatively with the effects of the unconscious by going from transference to translation. Today, new translations of Freud are following these hints and pay more attention to both the fluidity of his vocabulary and the specificity of his concepts.

The chapter describes how to manage ruptures in the therapeutic alliance. It opens by outlining a conceptual model to understand the ruptures and proceeds to consider the ways that ruptures may manifest at different points in psychotherapy. One way to respond to some ruptures in alliance in via enhancing motivation and therefore the technique of Motivational Interviewing is described in detail; outlining the steps of expressing empathy, developing discrepancies (between actual and desired outcomes), avoiding argumentation, rolling with resistance and supporting self-efficacy. The chapter reviews ways to manage the assignment and review of homework exercises so that they are a productive element in clinical psychology practice. The chapter concludes with a close examination of psychotherapeutic process; defining what “process” is, and how to work with transference and countertransference.

This rejoinder begins with an expression of gratitude and broad agreement with the two commentaries by Kenneth Levy and Nicholas Salsman. The rejoinder considers three main issues: (1) the fact of the range of psychodynamic treatments that have been found to be effective in the treatment of personality disorder (PD); (2) the value of considering a dimensional approach to psychopathology in general and PD more specifically, particularly in the context of recent work on the general psychopathology factor; and (3), the issue of transference and different ways of approaching it across different psychodynamic treatments.

The chapter examines the Spiritual Exercises of Loyola, the foundational text for Jesuit practice, and finds there a rich psychoanalytic dynamism between satisfaction and frustration, imagination and reality, and an insistent demand for a creative, affective response to the problems it forces the exercitant to face.

The conclusion surveys the arguments made, leading to a new theory of readerly transference.

The chapter takes this Kleinian framework and uses it to read the texts and theological practices of Loyola and the Jesuit order. It illuminates the ways Loyola’s problems of reading, belief, and paranoia would have come to Joyce – more than a simple matter of ‘influence’, as most studies of religion and Joyce would have it, but as an implicit, peculiar set of problems Joyce would adapt and employ in his own work.

The chapter lays out the argument of the book: that Joyce’s texts elaborate a set of problems posed by Ignatius Loyola, working these problems into new approaches to narration, hermeneutics, and irony. It also situates this argument in wider contexts of Joyce studies, current theories of reading, negative theology, and the psychoanalytic theory of Melanie Klein.

The chapter lays the groundwork about the mind and causation. It characterizes theories about the nature of mind: physicalism, particularly non-reductive physicalism, and dualism, particularly naturalistic dualism. It then turns to causation, its relata, and counterfactual conditionals, the claims that express difference-making. Counterfactual conditionals, their general truth-conditions and logical relations are introduced, as are issues about how to evaluate them. A principle about causation in terms of counterfactual conditionals is defended that is crucial for later arguments. According to this principle, an event causes a later event if the later event would not have occurred had the first event not occurred. Although plausible, the principle needs refinement to deal with some prima facie difficulties. Assumptions need to be made about how to evaluate counterfactual conditionals like ‘If the first event had not occurred, then the second event would not have occurred’. Rival views about causation in terms of transference conflict with the counterfactual principle in so-called cases of double prevention. The conflict should be resolved in favour of the counterfactual principle.