The evolution of couple psychoanalysis in the United Kingdom is historically rooted in, and currently supported by, what might be called the Tavistock tradition, which principally derives from the ...work of Tavistock Relationships, a London-based organization combining clinical practice, training, and research. Practitioners working within this tradition draw on a range of psychoanalytic theories and differ in the ways they are applied in clinical practice and with different client groups, but they are united by their focus on relationship dynamics and how these can be affected by unconscious processes. This article charts how the main ideas and practices associated with the Tavistock tradition of couple psychoanalysis came into being, describes the conceptual building blocks that provide the platform for current training and practice, and identifies nodal points that might indicate directions of growth in the future.
The couple relationship is at the centre of this book. The complex nature of the couple attachment is emphasised, drawing both on psychoanalytic concepts and on attachment theory. The chapters aim to ...integrate theory with practice and can be seen, both separately and together, as offering new insights into the intricate web of psychic fantasies, shared unconscious anxieties and external realities that shape the attachment between the couple.
The authors outline the development in the United Kingdom of a service commissioned by the Department for Education from the Tavistock Centre for Couple Relationships. The purpose was to develop and ...evaluate a well-being service for couples. The service offered a brief therapeutic intervention of four sessions and was primarily aimed at younger couples in the early stages of parenthood presenting with a focused concern. The authors examine the contextual factors that lead to the development of the service; namely, the importance of prevention and the need for early intervention in regard to securing children's emotional and psychological well-being. Particular emphasis was placed on the couple relationship as a foundational factor. The authors also explore the purpose and effectiveness of the brief therapeutic approach and the theoretical underpinnings that informed their work. Case studies are presented to illustrate the application of the four-session model. In addition, a set of DVDs was specifically commissioned to enhance the brief intervention and their impact is examined and assessed. The report concludes with an evaluation of the service.
High-conflict relationship dissolution has been shown to cause substantial emotional risk and psychological harm to children's developmental outcomes. Parents in chronic post separation conflict who ...repeatedly use the courts to address their disputes are by nature difficult to engage in therapeutic services. This paper describes the theoretical and practical key elements of a mentalisation-based therapeutic intervention, Mentalization-Based Therapy for Parental Conflict - Parenting Together (MBT-PT), that has been developed in order to address some of the unique challenges that these parents and the professionals working with them are facing. Specifically, the intervention aims to reduce anger and hostile conflicts between parents and mitigate the damaging effects of inter-parental conflict on children. The implementation procedure of the MBT-PT intervention among parents in entrenched conflict over their children, in the context of a random allocation pilot study, is briefly described. Next, the MBT-PT intervention is exemplified using clinical examples, followed by potential implications concerning practice and policy for professionals working with this population of parents.
This chapter explores the important couples in the film, to see how Alexander Bergman's screen characters enact the process of passing unresolved oedipal phantasies and anxieties down the ...generational line. It suggests that Bergman's portrayal of Alexander is of a boy re-enacting his parents' unresolved oedipal feelings in his struggle to find a "third position", from which he may find greater freedom to witness rather than repeat the pattern. The chapter refers to some of Bergman's published autobiographical material and considers what Alexander's character may tell us about Bergman's personal history. It reflects on the character of Alexander, who can be seen, in a sense, to represent Bergman himself. The chapter also explores some of the oedipal themes in Fanny and Alexander. Fanny and Alexander is a magnificent, multi-faceted work of art, which cannot be reduced to any one theme within its complex narrative.
This chapter suggests that when the "detached" narcissist and "adherent" narcissist form a partnership, it creates an unconscious "couple fit", which becomes a defensive and pathological mental ...organization. This "fit" is characterized by a particular power imbalance where the detached and adherent aspects act as poles meant to repel the other and its defensive purpose is to prevent intimacy. The "fit" also allows for understanding a shared dread as a catastrophe that would happen if two separate minds were to be brought together. Within this "fit", the "thin-skinned" narcissist is able to project his or her detached needs into the "thick-skinned" partner, and vice versa. This brings about a defensive and polarized "fit" based on each partner carrying the split-off parts of the other. As Anton felt able to begin to know about his own fear of madness, it seemed that he took flight from this knowledge by leaving therapy.
The aim of the study was to determine risk factors for lymphedema of the lower limbs, assessed by four methods, 1 year after surgery for endometrial cancer.
A prospective longitudinal multicenter ...study was conducted in 14 Swedish hospitals. 235 women with endometrial cancer were included; 116 underwent surgery including lymphadenectomy, and 119 had surgery without lymphadenectomy. Lymphedema was assessed preoperatively and 1 year postoperatively objectively by systematic circumferential measurements of the legs, enabling volume estimation addressed as (1) crude volume and (2) body mass index-standardized volume, or (3) clinical grading, and (4) subjectively by patient-reported perception of leg swelling. In volume estimation, lymphedema was defined as a volume increase ≥10%. Risk factors were analyzed using forward stepwise logistic regression models and presented as adjusted odds ratio (aOR) and 95% confidence interval (95% CI).
Risk factors varied substantially, depending on the method of determining lymphedema. Lymphadenectomy was a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 14.42, 95% CI 3.49 to 59.62), clinical grading (aOR 2.11, 95% CI 1.04 to 4.29), and patient-perceived swelling (aOR 2.51, 95% CI 1.33 to 4.73), but not when evaluated by crude volume. Adjuvant radiotherapy was only a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 15.02, 95% CI 2.34 to 96.57). Aging was a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 1.07, 95% CI 1.00 to 1.15) and patient-perceived swelling (aOR 1.06, 95% CI 1.02 to 1.10), but not when assessed by crude volume or clinical grading. Increase in body mass index was a risk factor for lymphedema when estimated by crude volume (aOR 1.92, 95% CI 1.36 to 2.71) and patient-perceived swelling (aOR 1.36, 95% CI 1.11 to 1.66), but not by body mass index-standardized volume or clinical grading. The extent of lymphadenectomy was strongly predictive for the development of lymphedema when assessed by body mass index-standardized volume and patient-perceived swelling, but not by crude volume or clinical grading.
Apparent risk factors for lymphedema differed considerably depending on the method used to determine lymphedema. This highlights the need for a 'gold standard' method when addressing lymphedema for determining risk factors.
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