‘Not dead … abandoned’ – a clinical case study of childhood and combat-related trauma

This clinical case study examines inter-subjective processes with a counselling client who presented with symptoms of complex trauma including severe anxiety, low mood, dissociation and suicidality. Therapy lasted 12 months and the ending was unplanned. Psychoanalytic and phenomenological hermeneutic frameworks are drawn on in theorizing the work. From this perspective, loss associated with trauma is conceptualized as relational, as traumatic states threaten psychological organization and the continuing experience of relational ties that are needed for survival. Dissociation is understood as a defensive state that changes the way that temporality is experienced. The client’s capacity for dissociation appeared to have developed in early childhood in response to physical abuse, predisposing him to further ongoing and severe trauma as an adult soldier. There will be a focus on the way that dissociation and enactment in the therapeutic relationship limited the therapist’s capacity to provide the client with inter-subjective regulation of disavowed affect. The client’s unconscious experience of unbearable affect led to a breakdown of the therapeutic relationship and the termination of therapy. Detailed session and supervision notes, and correspondence received from the client were used to evaluate theory and practice links, as well as some methodological aspects of case study research

Altruistic kidney donation : a discoure analysis, and the client's use of the body for unconscious communication

The aim of this study was to analyse how prospective altruistic kidney donors construct their decision to donate, and to explore meaning-making, subjective experience and practices that are made available to the donor and others through discourse. A genealogical approach to existing literature was taken. A multiple-case study design and biographical-narrative, semi-structured interviews aimed to produce text for analysis on two levels. These were; the social implications for subjectivity and practice, and a tentative, psychodynamic theory-driven explanation of the participants' psychological investment in the discourses they used. Six prospective altruistic kidney donors were interviewed. In-depth discourse analysis integrated Foucauldian, psycho-discursive and psychosocial approaches. Psychodynamic theory was applied to sections of the text in which participants seemed to have particular emotional investment. Discourse analysis generated three major discursive themes: other-oriented, rational and self-oriented discourses. Participants used discourses to position themselves as concerned with the needs of the recipient, to resist questioning and criticism, and to demonstrate the rationality of donating. Participants' own needs were largely rejected. Psychodynamically informed analysis suggested that altruistic donation was experienced by donors as compelling and could be theorized as unconscious communication. Results suggested that using the term "altruistic" for living, non-directed organ donation constrains available discourses, severely limiting what can be said, felt, thought and done by donors, clinicians and the public. This study demonstrated the compatibility and usefulness of counselling psychology and psychosocial methodology when it is applied to the interface between the individual, the clinic and society.EThOS - Electronic Theses Online ServiceGBUnited Kingdo