Is there still a place for the concept of therapeutic regression in psychoanalysis?

The author uses his own failure to find a place for the idea of therapeutic regression in his clinical thinking or practice as the basis for an investigation into its meaning and usefulness. He makes a distinction between three ways the term ‘regression’ is used in psychoanalytic discourse: as a way of evoking a primitive level of experience; as a reminder in some clinical situations of the value of non-intervention on the part of the analyst; and as a description of a phase of an analytic treatment with some patients where the analyst needs to put aside normal analytic technique in order to foster a regression in the patient. It is this third meaning, which the author terms “therapeutic regression” that this paper examines, principally by means of an extended discussion of two clinical examples of a patient making a so-called therapeutic regression, one given by Winnicott and the other by Masud Khan. The author argues that in these examples the introduction of the concept of therapeutic regression obscures rather than clarifies the clinical process. He concludes that, as a substantial clinical concept, the idea of therapeutic regression has outlived its usefulness. However he also notes that many psychoanalytic writers continue to find a use for the more generic concept of regression, and that the very engagement with the more particular idea of therapeutic regression has value in provoking questions as to what is truly therapeutic in psychoanalytic treatment

FDA-approved disulfiram as a novel treatment for aggressive leukemia

Acute leukemia continues to be a major cause of death from disease worldwide and current chemotherapeutic agents are associated with significant morbidity in survivors. While better and safer treatments for acute leukemia are urgently needed, standard drug development pipelines are lengthy and drug repurposing therefore provides a promising approach. Our previous evaluation of FDA-approved drugs for their antileukemic activity identified disulfiram, used for the treatment of alcoholism, as a candidate hit compound. This study assessed the biological effects of disulfiram on leukemia cells and evaluated its potential as a treatment strategy. We found that disulfiram inhibits the viability of a diverse panel of acute lymphoblastic and myeloid leukemia cell lines (n = 16) and patient-derived xenograft cells from patients with poor outcome and treatment-resistant disease (n = 15). The drug induced oxidative stress and apoptosis in leukemia cells within hours of treatment and was able to potentiate the effects of daunorubicin, etoposide, topotecan, cytarabine, and mitoxantrone chemotherapy. Upon combining disulfiram with auranofin, a drug approved for the treatment of rheumatoid arthritis that was previously shown to exert antileukemic effects, strong and consistent synergy was observed across a diverse panel of acute leukemia cell lines, the mechanism of which was based on enhanced ROS induction. Acute leukemia cells were more sensitive to the cytotoxic activity of disulfiram than solid cancer cell lines and non-malignant cells. While disulfiram is currently under investigation in clinical trials for solid cancers, this study provides evidence for the potential of disulfiram for acute leukemia treatment

At the coalface and the cutting edge: general practitioners’ accounts of the rewards of engaging with HIV medicine

The interviews we conducted with GPs suggest that an engagement with HIV medicine enables clinicians to develop strong and long-term relationships with and expertise about the care needs of people living with HIV ‘at the coalface’, while also feeling connected with a broader network of medical practitioners and other professionals concerned with and contributing to the ever-changing world of science: ‘the cutting edge’. The general practice HIV prescriber is being modelled here as the interface between these two worlds, offering a rewarding opportunity for general practitioners to feel intimately connected to both community needs and scientific change

Can there be an analytic practice of a non-analytic therapy?

This paper explores the dilemma faced by many current analytic practitioners, particularly in the National Health Service. With the elevation of the idea of 'evidence-based practice' as the increasingly dominant mode of discourse, is it better to try to preserve one's analytic identity and practice by keeping to the psychodynamic model, or is there a case for seeking accommodation with other therapies, even if they are non-analytic? This paper describes the author's experience in pursuing the latter course, in learning a form of therapy called Interpersonal Psychotherapy. The author describes a piece of work using Interpersonal Psychotherapy, and then attempts to give a psychoanalytically informed reading of the same material. The aim is to suggest that although a perfectly adequate account can be given of this clinical work in terms of Interpersonal Psychotherapy, the therapeutic process can also be understood in terms of movements in the transference and in the patient's intra-psychic world. It is finally suggested that adding a psychoanalytic dimension to such a non-analytic therapy may enrich one's practice not only of these other therapies but also of analytic therapy itself

'Characters' in psychoanalytic and interpersonal therapy: a comparison

In this paper the author considers how the therapist might listen to the characters talked about by his or her patients. In psychoanalytic therapy the emphasis is on listening to the patient’s characters as though they are located in psychic reality and as representatives of the transference relationship, whereas in interpersonal therapy (IPT) the patient’s characters are taken as inhabiting the realm of external reality. It is argued that clinical thinking in IPT would be enhanced by taking more account of psychic reality, which will make clearer the quality of external reality in which the patient’s characters are located. It is also argued that both therapies share an interest in enabling the patient to find characters which can serve as holograms of previously unexpressed affective experience

An introduction to psychodynamic counselling

Book synopsis: This new edition of Laurence Spurling's highly regarded introduction to psychodynamic counselling gives readers a detailed understanding of the aims and principles of psychodynamic therapy. From basic concepts to advice on more complex cases, the book examines a range of issues that challenge therapists at all levels. Spurling draws on his wide experience as a psychotherapist to offer practical guidance across a variety of settings and illustrates this with a wealth of vivid case examples. In particular, this second edition ■ provides a solid grounding in the basics of a theoretical approach; ■ offers an important new chapter on the different phases of the therapeutic relationship; ■ discusses organizational settings in order to give insight into managing the demands of your institution; ■ explores the challenges of working with clients with more severe emotional and psychological problems. This authoritative, engaging and practical text continues to be an essential guide both for trainees and practitioners in counselling or psychotherapy, as well as for those working in related psychological and mental health professions

The psychoanalytic craft: how to develop as a psychoanalytic practitioner

Book synopsis: Why is developing as a psychoanalytic practitioner so often laden with anxiety? A simple answer is that psychoanalytic work is intrinsically complex and difficult. But Laurence Spurling argues traditional accounts of practice make these difficulties even worse for students and practitioners: he shows that case descriptions and examples in psychoanalytic textbooks often give a misleading picture of practice, because they explore what practitioners ought to do rather than what they actually do. The Psychoanalytic Craft uniquely identifies and explores what is missing in these accounts of therapy, namely the 'craft' aspects of skilled psychoanalytic work: how theories and models are actually used in practice, what kind of reasoning is employed in conducting a session, how interventions are composed and evaluated. The book draws on recent research, as well as the wider craft literature to show how these features of clinical thinking, which normally operate below the level of awareness, can be identified and explored in clinical practice, in supervision and in teaching. This book has been written specifically for those students and practitioners moving beyond beginner level towards skilled and resourceful practice

On psychoanalytic figures as transference objects

One of the tasks that analysts and therapists face at a certain stage in their career is how to develop a way of psychoanalytic thinking and practising of their own. To do this involves modifying or overcoming the transferences established during their training or early career. These transferences are to one's teachers or training analyst, investing them with authority and infallibility, and to received theory, which is treated as though it were dogma. The need to free oneself from such transferences has been discussed in the literature. There is, however, another kind of transference that the developing therapist also needs to resolve, which has received little attention. This is the transference made on to a key figure in the psychoanalytic tradition. Such a psychoanalytic figure will be seen as the originator of or embodiment of those theoretical ideas to which one becomes attached, and/or as standing behind one's training analyst or seminal teachers who become a representative of that figure. The value of an investigation of one's relationship to a psychoanalytic figure is that it is an excellent medium for revealing one's transference, as the figure in question is not a real person but only exists through his/her writings. The body of the paper consists of an extended example of such an analysis, that of my own transference on to the figure of Winnicott. In this example I illustrate how my evaluation of Winnicott's ideas changed from seeing them as providing answers to all my clinical questions to no longer satisfying me in some areas of my work. This change in my relationship to Winnicott's theory went hand in hand with a modification in my transference on to the figure of Winnicott, from seeing him as endowed with authority and goodness to an appreciation of him as a still sustaining figure but now with limits and flaws. In the final part of the paper several questions arising out of my analysis are posed. Can the pull of writing such an account in terms of dramatic rupture rather than gradual and partial change be avoided? Should my account be regarded purely as a form of self-analysis or does it have anything to say about Winnicott himself and his theory? And do some psychoanalytic figures attract more intense or sticky transferences than others