The aesthetic and affective matrix of pre-reflective sensemaking at the origins of the relationship between subject and world: A dialogue between Kant's Third Critique and psychoanalysis

The authors discuss the relevance of aesthetic and affective experience at the heart of the human being's capability to relate to the world and to found relations of sense. Faced with anguish that the world can be meaningless and with fear of uncertainty/chaos, trust and hope are needed for the world to be a hospitable place for existence. Such experience is aesthetic, sensitive and affective before being rational, reflective and deliberative. Through a dialogue between Kant, Winnicott and Bion, it is shown how foundation of trust is based on two essential aspects: (1) The illusion that reality was created to allow us to live in it (namely, the fictionality is a prerequisite for each possible development of psyche) and (2) this illusion is not generated by a solipsistic activity of the human mind; rather, it is made possible starting from the primordial relationship with the other, by containing anguish, nourishing trust and hope, and supporting psychic development and elaboration of progressive forms of symbolisation. The authors discuss how these points have a profound aesthetic implication through deepening the reflection on the ontogenetic development of the psyche, the complex intertwining between primary and secondary processes, and clinical implications.

Current psychopathology models emphasize very early intersubjectivity-based interventions in children to prevent later mental disorders

Current psychopathology models have evolved toward dimensional models, in which symptoms and diseases are at the extremes of dimensions. Despite these new dimensional proposals, classifications and third-person approach have shown limitations. Their extraordinary evolution nevertheless underlines the contributions of developmental and psychodynamic frameworks. Developmental contributions have made it possible to evolve from disorders centered on a first-person perspective. Complementarily to the first-person/third-person perspectives, we advocate a second-person perspective, based on intersubjectivity. This perspective reverses the intuitive trend to focus our interventions on the most specific symptoms and syndromes, and advocates instead interventions on a "p" general factor that are both generalized and highly targeted. The implications are (1) to intervene as early as possible, (2) to base the definition of our therapeutic targets on an intersubjective perspective, (3) to identify and enhance children's and parents' strengths. These empirically informed directions are not in the current mainstream of psychopathology frameworks, and need to be developed.

On the division of labor in the maintenance of intersubjectivity: insights from the study of other-initiated repair in Vietnamese

Few ideas have figured more centrally in the history of social theory than that of the division of labor. Here we ask whether conversational interaction, like other forms of social activity, exhibits a division of labor and, if so, what functions this serves and how it might be understood in relation to the theories of Marx and Durkheim. We begin by noting that, though conversational participants actively work to achieve and sustain understanding, much of the time this work is invisible and only its products are displayed in the form of sequentially fitted next turns at talk. However, in sequences of other-initiated repair, the work involved in the maintenance of intersubjectivity rises to the surface. On these occasions, we can see and thus describe what participants do to achieve and sustain what they take to be adequate understanding. In our data, which consist of video recordings of casual conversations among Vietnamese same-generation peers, participants continuously display an orientation to relations of relative seniority through the selection of terms used to accomplish interlocutor reference. This pervasive orientation is also reflected in practices of repair initiation. Specifically, seniors regularly initiate repair with so-called "open class" forms such as "huh?" and "ha?" which display a minimal grasp of the talk targeted, require little effort to produce and, at the same time, push responsibility for resolving the problem onto the trouble source speaker (i.e., the junior member of the dyad). In contrast, juniors often initiate repair of a senior participant's talk by displaying a detailed understanding of what has been said, either in the form of a repeat or a reformulation, and inviting the senior to confirm. We suggest then that this asymmetry in the distribution of initiation practices reflects a "division of intersubjective labor". We conclude with some thoughts on the theoretical implications of our findings and relate them not only to the theories of Marx and Durkheim but also to the writings of feminist sociolinguists who sought to describe the way in which women seem to be burdened more than men with what Fishman called "interactional shitwork."

Meeting Patients Where They Are: Construction And Maintenance Of Analytic Intimacy

This paper aims to describe the processes of construction and maintenance of analytic intimacy, understood as a shared state of relative internal freedom that is most permeable to preconscious and unconscious communications, which facilitate the processes of subjectivation, dreaming, and digestion of unprocessed trauma. The author illustrates the theoretical and technical features related to the concept of intimacy, highlighting the transformations of a clinical case followed in supervision. This article is presented in the form of a conversation with the supervisee, so as to evoke in the reader the dialogic and co-constructive experience of thought construction.

On Bion's Concept of Truth in an Extra-Moral Sense

The paper explores the concept of truth in Bion's theory and in the post-Bionian context of the analytic field. Truth is addressed on three levels: epistemological, metapsychological, and clinical. Bion criticizes positivism in psychoanalysis, and the same vertex when it appears in psychoanalysis itself, stating that the search for truth at all costs is similar to the arrogance and stupidity of the psychotic part of the personality. He revolutionizes the analytic concept of truth by orienting it to the function of the emotional linking between analyst and patient rather than to content. Post-Bionian analytic theory further develops these concepts. In a field or radically intersubjective perspective, the author emphasizes the shift from an "I/you" perspective to a "we" perspective. The treatment is less about the abstract search for supposed truths and more about the truth being expressed in the process of emotional and affective attunement.

The patient-practitioner interaction in post bariatric surgery consultations: an interpersonal process recall study

PURPOSE

The patient-practitioner relationship is fundamental to rehabilitation practice and patients' health and wellbeing. Dissonance between patients who have had bariatric surgery and health care practitioners about what supportive care and good outcomes are can undermine care. To address the mechanisms of this process, we conducted an Interpersonal Process Recall study.

MATERIALS AND METHODS

We interviewed patients (11), video recorded consultations (10), conducted video-assisted individual interviews with patients (10) and practitioners (11) and a dyadic data analysis.

RESULTS

We identified relational states and shifts in the clinical encounter 2-3 years post-surgery, described in themes: a) Playing by the Book - Making it Easier for Each Other, b) Down the Blind Alley - Giving up on Each Other, and c) Opposite Poles - Towards and Away from Each Other.

CONCLUSIONS

The post-surgery consultations facilitated responsibility for health and self-care but did not invite dialogues about the psychosocial burdens of living with obesity and undergoing bariatric surgery. Patients and practitioners tried to avoid creating conflict, which in turn seemed to foster distance, rather than human connection. This limits the encounter's benefit to both parties, leaving them frustrated and less willing to either meet again or take any gains into their future lives.IMPLICATIONS FOR REHABILITATIONIllness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension.Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly "notice, name and validate" emotions can promote the patient's capacity to sustain self-care, lifestyle change, weight loss and health gains.Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter.

(Why) Is Misinformation a Problem?

In the last decade there has been a proliferation of research on misinformation. One important aspect of this work that receives less attention than it should is exactly why misinformation is a problem. To adequately address this question, we must first look to its speculated causes and effects. We examined different disciplines (computer science, economics, history, information science, journalism, law, media, politics, philosophy, psychology, sociology) that investigate misinformation. The consensus view points to advancements in information technology (e.g., the Internet, social media) as a main cause of the proliferation and increasing impact of misinformation, with a variety of illustrations of the effects. We critically analyzed both issues. As to the effects, misbehaviors are not yet reliably demonstrated empirically to be the outcome of misinformation; correlation as causation may have a hand in that perception. As to the cause, advancements in information technologies enable, as well as reveal, multitudes of interactions that represent significant deviations from ground truths through people's new way of knowing (intersubjectivity). This, we argue, is illusionary when understood in light of historical epistemology. Both doubts we raise are used to consider the cost to established norms of liberal democracy that come from efforts to target the problem of misinformation.

Pain cannot (just) be whatever the person says: A critique of a dogma

McCaffery's definition of pain has proven to be one of the most consequential in nursing and healthcare more generally. She put forward this definition in response to the persistent undertreatment of pain. However, despite raising her definition to the status of a dogma, the undertreatment remains a real problem. This essay explores the contention that McCaffery's definition of pain elides critical aspects of it, aspects that demand consideration when treating pain. In section I, I set the stage. I discuss how McCaffery's definition and her understanding of pain science interrelate. In section II, I raise three problems for this understanding. In section III, I argue that these problems stem from an incoherency in her definition. Finally, in section IV, I draw from hospice nursing as well as philosophy and the social sciences to redefine 'pain' so that an intersubjective feature of it is foregrounded. I also briefly discuss one implication this redefinition has for pain management.

Abolishing the Captivity of a Tyrannized Woman: Evidence of Bion's Concept of the Contact-Barrier as Manifested in Dreams

Bion's notion of the contact-barrier formulates a semipermeable membrane responsible for preserving the distinction between the conscious and the unconscious. However, the question of how a newly established contact-barrier manifests itself in dreams remains unanswered. The author proposes that one such manifestation occurs when a patient sees themself asleep in a dream. A case of a severely traumatized woman who had difficulty thinking and being close to others is used to explore these clinical ideas. The author, in response to his reveries in a session, introduced a playful dream-like dialogue between a playwright and his reader. The nature of the communication, in functioning as a barrier, served to protect the patient from a tyrannizing reality: the therapist's sexuality. This intersubjective barrier helped the patient to contact dissociated and damaged parts of herself, and it also facilitated her ability to dream a sense of her own boundaries, femininity, and sexuality.

Focusing the Clinical Supervision on the Therapist's Developmental Trauma: A Single Case Study

The term developmental trauma (DT) refers to the impact of stressful events which occur cumulatively within the child's relevant relationships and contexts, and usually early in life. According to several authors, DT depends on the caregiver's inadequate intersubjective recognition of one or more aspects of the evolving individual's identity. In the clinical and empirical literature, the study of therapists' developmental trauma, and how it might constitute a relevant variable in the clinical exchange, seem to be underrepresented. In this paper, through the analysis of the supervision process of a clinical case, we show how the therapeutic relationship may implicitly take the form of a "dance" between the patient's and therapist's DT, that prevents the therapist from intersubjectively attuning with the patient; and how a supervision process peculiarly focused on the therapist's DT can effectively promote this attunement and a good clinical outcome.

[Meeting your baby and becoming a father]

The birth, the moment when the father physically discovers his baby, is essential in the development of fatherhood. Accompanying this encounter during the stay in the postnatal unit leads to a greater commitment to care on the part of the father over the following three months. It therefore seems essential to support him during these first moments, by offering him skin-to-skin contact, for example, or by showing him in practical terms how to provide nursing care for his newborn. Encouraging the development of the father-baby relationship is beneficial for the family alliance that is being built around the cradle.

The enigma of transference. Freud's discovery and its repercussions

This brief introduction gives an historical outline of the development of the concept of transference in the different psychoanalytic traditions. It goes back to the various meanings of the German term "Übertragung" - transference, transcription, transmission, transposition and assignment - and how they were accentuated by the different psychoanalytic schools. The paper depicts the transition from a mainly intrapsychic understanding of transference as repetition to a more bipersonal and intersubjective approach exploring the different meanings of "intersubjectivity" and the forces that operate within the analytic field. Major developments arose from a new understanding of the role of the analyst's countertransference and the detection of transference mechanisms in narcissistic, borderline and psychotic states. The exploration of different forms of splitting and projective and introjective identification deepened the understanding of the analytic communication and led to concepts like "acting in", role-responsiveness, "actualization" and "enactment". As the author tries to show, all these approaches can find a legitimization in Freud's original writings, but the main differences concern technical issues, i.e. the interpretation of transference.

They have taken out my spinal cord: an interpretative phenomenological analysis of self-boundary in psychotic experience within a sociocentric culture

INTRODUCTION

In the tradition of phenomenological psychiatry, schizophrenia is described as a disturbance of the minimal self, i.e. the most basic form of self-awareness. This disturbance of the minimal self at the individual level is assumed to precede the intersubjective disturbances such as boundary weakening. However, the role of intersubjective disturbances in the emergence and recovery of schizophrenic experience still remains an open question. This phenomenological study focuses on how encounters with others shape self-experience during from psychosis by analyzing this process from the perspective of cultural differences, which in current research is especially under-researched. While most phenomenological accounts are based on first person-accounts from Western, individualist cultures where the self is conceived and experienced as separate to others, the present study qualitatively investigates psychotic experiences of patients from Jaffna, Sri Lanka.

METHOD

Semi-structured interviews were conducted with three participants with a diagnosis of schizophrenia or first episode psychosis. The interviews were transcribed and analyzed using interpretative phenomenological analysis (IPA). Eight group experiential themes were identified across interviews.

RESULTS

The data suggest that intersubjective processes of boundary weakening such as invasiveness and hyperattunement may shape minimal self-experience and more specifically contribute to a mistrust of the own senses and to hyper-reflexivity. Interestingly, boundary weakening yields pervasive emotions and can be experienced as a threat to the whole social unit. On the one hand, the strengthening of self-other-boundary was achieved through opposition, closedness and withdrawal from others. On the other hand, this study suggests that the re-opening of self-other-boundaries in response to the crisis may help establish connectedness and may lead to recovery.

Melville's "Bartleby, the Scrivener: A Story of Wall-Street": The Vicissitudes of Treating a Difficult Patient

Taking the liberty of imagining the lawyer in Melville's "Bartleby, the Scrivener" as narrator/therapist and Bartleby as patient, this article, written with the therapist/reader in mind, traces the vicissitudes of countertransference and speculates on what constitutes a "good enough" therapeutic effort.

CULTURAL HISTORY OF PSYCHOANALYSIS IN THE AGE OF NEUROSCIENCE

In this paper I have chosen the topic of psychoanalysis in the age of neuroscience, with the aim of showing why the cultural history of psychoanalysis still matters. To make myself better understood I shall refrain from evaluating the current findings in neuroscience and limit myself to reporting briefly on them. Although I do not regard myself by any means as an expert in that field, I may be permitted to offer a few ideas about it. In this regard, there is presently a significant predominance of biological ideologies and practices regarding the treatment of mental illness, which implies an increase in the interest in etiology, nosology, definitions, and the effectivity of treatments. Even so, those psychoanalytic historians and/or analysts among us who are committed to psychoanalysis and its therapeutic implications, irrespective of what drugs might be prescribed and what the research findings might conclude, believe that patients still want to be listened to in depth and always will. For that reason, it is justified to ask why the cultural history of psychoanalysis still matters in a contemporary mental health environment that is ever more oriented towards the neurosciences.

Dialogue With Psychosis: Induced Psychotic Countertransference in Psychotherapy With Psychotically Disturbed Patients

The therapeutic encounter with psychotic patients presents therapists with moments in which they may regress, together with the patient, toward primitive and psychotic areas of experience. Within this shared psychotic world, therapists might feel persecuted, as if the ground is slipping from beneath their feet. The author suggests that the psychotic part of the personality, as argued by Bion, is inherent to all of us and may come alive in the psyche of the therapist in response to patients in psychotic states. The psychotic dialogue that emerges between patient and therapist, which involves projective identification and counter-transference mechanisms, must be worked through. Therapists' capacity to survive the psychosis forced upon them and to move through and beyond it is highly significant. By examining clinical material from therapy with a patient diagnosed with schizophrenia, the author discusses this unique countertransference phenomenon, which he terms induced psychotic countertransference.

[The therapeutic mediation device in the clinic of adolescent action]

The pathologies of the adolescent act illustrate the overflow so characteristic of the "modernity" of a world in perpetual evolution. Through compulsive bodily symptoms that are as noisy as they are enigmatic (self-mutilation, suicide attempts, addictions, fast sex, eating disorders), adolescents are always in search of transitional and containing spaces, which are indispensable for symbolizing and calming destructuring intrapsychic conflicts. Therapeutic mediations, adapted to the different singularities, offer a space through which integration and subjectivation processes are possible.

Prelinguistic intersubjective and socio-communicative skills in infants with neurodevelopmental disabilities aged 0-36 months: A new assessment and parent support tool

Background

Although children with neurodevelopmental disability (NDD) present with several deficits, they partially share developmental impairments in prelinguistic intersubjective and socio-communicative skills, which are not easily assessed by conventional tests during the first years of life.

Aim

The current paper presents a new procedure to assess the prelinguistic intersubjective and socio-communicative skills of NDD children aged 0-36 months. A specific observation form template, called the Observation of Prelinguistic Intersubjective and Socio-Communicative Skills (OPISCoS) form, has been designed to systematically detect infant skills during daily routines (e.g., mealtime, playtime, desk activities). The OPISCoS form helps speech therapists to provide parents support to better perceive and understand early communicative signals from their children, avoiding the risk of excessive or reduced social stimulation.

Methods

The OPISCoS form is composed of three sections, namely, "Pragmatics and Communication," "Decoding," and "Expression," which are useful to delineate the communication abilities of children with NDD and are not tapped by traditional batteries. Vignettes from clinical practice illustrate and provide exemplifications for using the OPISCoS form with NDD infants and their parents.

Results

The OPISCoS form was reported for two children and showed potential in detecting disrupted communicative behaviors and planning specific early interventions. Further, we observed an improvement not only in children's communicative abilities improve but also in their interactions with parents. From a clinical point of view, the OPISCoS form (1) offers an observational perspective of prelinguistic intersubjective and socio-communicative skills in infants with NDD and (2) may be useful to practitioners to enhance parents' sensitivity to their infants' communicative behavior.

Conclusion

The OPISCoS form was developed in clinical practice and is based on a very preliminary description of a new observational procedure as integration for the assessment of NDD children. The OPISCoS form appears to be a useful tool for the clinical assessment of prelinguistic intersubjective and socio-communicative skills in NDD infants as well as for promoting the quality of early parenting.

From the Enigma of Identity to "Becoming a Subject": The Transitional Double

In the field of psychopathology, "narcissistic and identity-related suffering" refers to a type of suffering characterized by a lack of being that centrally affects narcissism and identity continuity/discontinuity. Present in many clinical and psychopathological pictures, these problems in turn invite us to undertake a rereading of the modalities of structuration of subjectivity in the course of development. Elements for a model of identity construction are proposed based on the paradigm of the double. Approached from the angle of paradox, identity is thought of as a process in the service of "becoming a subject" based, essentially, on the role of the object and its reflexive function. Drawing on the concept of "transitional double," this perspective allows the foundations of subjective identity and their stages of construction to be described; these foundations underlie the creation of an internal psychic mirror, the locus of one's relationship to self. These considerations give us a better understanding of the logics of narcissistic and identity-related pathologies, which are characterized in particular by a failure of reflexive capacities, revealing the uncertainties of the dual relational dynamic in the course of early development.

The Play of Mourning

Playing is a form of responsiveness that involves a shift from more formal interpretation about defense, unconscious fantasy, or transference to one that employs humor or irony regarding the content of fantasy or poses a more direct confrontation between internal fantasy and external reality. Playing is differentiated from more formal interpretation by the analytic couple's intensity of affective expression, the idiomatic language used to express affect or ideas, or the analyst's more personally revealing reaction to the patient's recruitment of him as an internal object. Two clinical vignettes show how play emphasizes experiences of loss and waste that have been enacted in the patient's life and often in transference-countertransference engagement. Through newly discovered forms of play, these processes are occurring now in real time between patient and analyst and less through frozen memorialization of what never was.

Trusting Automation: Designing for Responsivity and Resilience

OBJECTIVE

This paper reviews recent articles related to human trust in automation to guide research and design for increasingly capable automation in complex work environments.

BACKGROUND

Two recent trends-the development of increasingly capable automation and the flattening of organizational hierarchies-suggest a reframing of trust in automation is needed.

METHOD

Many publications related to human trust and human-automation interaction were integrated in this narrative literature review.

RESULTS

Much research has focused on calibrating human trust to promote appropriate reliance on automation. This approach neglects relational aspects of increasingly capable automation and system-level outcomes, such as cooperation and resilience. To address these limitations, we adopt a relational framing of trust based on the decision situation, semiotics, interaction sequence, and strategy. This relational framework stresses that the goal is not to maximize trust, or to even calibrate trust, but to support a process of trusting through automation responsivity.

CONCLUSION

This framing clarifies why future work on trust in automation should consider not just individual characteristics and how automation influences people, but also how people can influence automation and how interdependent interactions affect trusting automation. In these new technological and organizational contexts that shift human operators to co-operators of automation, automation responsivity and the ability to resolve conflicting goals may be more relevant than reliability and reliance for advancing system design.

APPLICATION

A conceptual model comprising four concepts-situation, semiotics, strategy, and sequence-can guide future trust research and design for automation responsivity and more resilient human-automation systems.

Psychoanalysis of young children with autism spectrum disorders. An adaptation of technique in the approach to three cases

At present, the therapeutic approach for young children with autism spectrum disorder is a major challenge for child psychoanalysis. These patients place us in a special clinical and metapsychological terrain with its own characteristics and call our technique into question. What tools do we have for working in situations where speech has not yet acquired a communicative value? How can we intervene when an experiential subject has still not been constituted? How can psychoanalysis benefit these patients? The purpose of this paper is to show an adaptation of technique in the treatment of three children who came to my practice between the ages of two and three with a diagnosis of autism spectrum disorder. In this context, there were certain elements that in the affective proximity of the transference bond which encouraged the child's openness to representational world and a progressive psychic structuring and subjectivation. These elements were the analyst's active search for an encounter with the child, the non-verbal exchanges between analyst and patient, and the characteristics of the interpretations.

Negotiating intersubjectivity by interpersonal and appraisal shifts in Chinese-English government press conference interpreting

This study investigates how interpreting shifts of interpersonal and appraisal resources facilitated the successful negotiation of intersubjectivity at China's premier press conferences (PPCs) from 2016 to 2021. This study conducts a corpus-based critical discourse analysis of interpersonal shifts at the PPCs as defined by systematic functional linguistics. Quantitative results show that the interpreter is strongly inclined to utilize appraisal shifts which enhance (or soften) the positive (or negative) evaluations of the Chinese government in interpreting the journalists' questions and uses shifts to first-person plurals and inclinational modal verbs in interpreting the Chinese Premier's answers. Qualitative results show these shifts facilitate the direct or indirect reproduction of the government's official ideology (especially the notions of solidarity, change, resolution, and people's wellbeing) and the existing power relations between the government, media, and Chinese people (both authority and solidarity). It is concluded that the interpreter displays a strong tendency to use interpersonal shifts to ensure successful negotiation of intersubjectivity at the PPCs by ultimately reproducing the social status quo.

Exploring agency and entrainment in joint music-making through the reported experiences of students and teachers

This qualitative interview-based study draws on the reported experiences of students and teachers to explore how agency and entrainment resource and constrain each other in joint music-making. The participants were 23 students of Grades 6 and 11 music teachers from different primary schools. The qualitative content analysis of the 11 student pair interviews and 11 one-to-one teacher interviews indicated that experiences of music-related interpersonal entrainment intertwine with different dimensions of agency. In the analysis, four themes were identified as follows: presence, belonging, safety, and continuity. These findings provide insights into the relationship between agency and entrainment in classroom-based joint music-making and provide a novel lens through which to examine the complementary experiences of students and teachers. This study builds bridges between the concepts of agency and entrainment in the context of music education, offering theoretical clarification as to how and why joint music-making can be considered an intersubjective activity that fosters group cohesion and social interaction. The findings further present a view of the constitutive nature of the relationship among agency, entrainment, and intersubjectivity in joint music-making. The findings offer educators concrete grounds for using joint music-making as a platform for an agency.

Philosophical underpinnings of intersubjectivity and its significance to phenomenological research: A discussion paper

Intersubjectivity is the proposition that human experience occurs in a world of shared and embodied understandings, mediated by culture and language. Nursing is fundamentally relational, and nursing research stems from an exchange between participants and researchers and indeed around the transaction of the patient and the nurse in the intersubjective space of clinical settings. Through the philosophical standpoints of Husserl, Merleau-Ponty, Heidegger, and Gadamer we examine these differing philosophical constructs of intersubjectivity and the contribution of these positions to phenomenological nursing inquiry. Particular framings of intersubjectivity should influence the way researchers interact with their participants and data so that the chosen philosophy sits coherently within a research plan and methodology. This exploration of philosophical standpoints is extended through examples of, and reflections upon, the authors' experiences of intersubjectivity in our published phenomenological nursing studies and through dynamic interactions that characterise interpretive activities within a research team.

Mingled bodies and voices: Maternal reflections on caregiver expertise and intellectual disability

The risk of viral infection during the COVID-19 pandemic has caused many hospitals to prohibit all patient visitors, including family caregivers for people with intellectual disabilities. Drawing on a postmodern, intersubjective view of the body, as well as my experience as the mother of a young adult with profound disabilities, I argue that caregiver knowledge while unconventional within the medical paradigm must be viewed as essential expertise. People with profound intellectual disabilities often have concurrent, complex medical issues that are complicated by their inability to self-advocate. Optimal care rests upon the ongoing presence and expertise of their primary caregiver. Medical professionals risk patient care by excluding the essential expertise of family caregivers at any time, and specifically during COVID-19.

"Day's Residues": One Vertex Among Many

The post-Bionian paradigm in psychoanalysis invites us to listen to the session as a waking-dream-thought where unconscious-thinking-in progress is continuous. The hypothesis put forward here and illustrated using clinical material is that we can use the notion of day's residues as a metaphor to refer to the incoming narrative of the patient. Whatever the patient brings to the session can be conceived as "day's residues" in that they are potential instigators of waking-dream-thought in the session. This metaphor helps the analyst place brackets around the outside of the session, deconcretizing what apparently are hard facts, so that immediate contact is made to create a shared perspective, possibly producing in this session "food" for the mind. To create the waking-dream-thought of the session, the analyst may consider listening to the incoming narrative as a metaphor. This is not a new or different concept but a particular kind of elaboration on the metaphoric stance taken by psychoanalysts of all stripes; it is an elaboration that expands the ways we can describe the session and narrow the gap between talking about the session and the experience of the session itself.

Bion at the Crossroads: A Contrarian Reading of "on Arrogance"

In "On Arrogance," Wilfred Bion made a remarkable claim: "the analyst who is treating an apparently neurotic patient must regard a negative therapeutic response together with the appearance of scattered, unrelated references to curiosity, arrogance, and stupidity as evidence that he is in the presence of a psychological catastrophe with which he will have to deal." However Bion came to believe this, he sought grounds for it in a reading of Oedipus that seriously distorts that tragedy. Since the clinical outcome in "On Arrogance" appears to be impasse, perhaps even iatrogenic injury, the text's value is perhaps best consolidated by historicizing its construction through a psychoanalytic lens. Thus, while "On Arrogance" has been canonized as prescriptive for the treatment of difficult patients, it can instead be read as the illuminating trace of a grievously difficult intrapsychic struggle, a personal reckoning that resulted in Bion's 1958 return to the battlefield at Amiens where he had "died" in the hell of combat forty years earlier. "On Arrogance" thus reflects a prodigious episode of sublimation that proved essential to Bion's lifelong development as a psychoanalytic writer and thinker.

"Call Me by Your Name": The Wrong Action: From Ferenczi to Enactment as a Process

It is always hard for psychoanalysis to connect free associations and action. With Freud, action could be interpreted only when it referred to the transference; otherwise, action was a resistance to the possibility of free association. Unlike Freud, Ferenczi recognized the importance of the analyst's acting-out as the patient's unconscious request for experiences of trauma to be mobilized. By presenting a clinical case, the author offers the analyst's error as the mobilization of a traumatic block. The error activates a "Process of enactment," whereas if the error is not considered positively, it is simply a mistake, or the loss of a creative opportunity.

The Only Fag Around: Twinship Needs In Gay Childhood

A number of contemporary psychoanalytic writers have characterized gay childhood as a profoundly isolating experience. Within a developmentally informed self psychological framework, the loneliness of gay childhood is theorized here as a deficit in requisite twinship experience in early life. A detailed clinical example illustrates how these thwarted twinship needs may reemerge in the transference to the analyst, and how patients may escalate their acting out when the analyst misattunes to, or altogether misses, manifestations of twinship longings in the transference. A bridge between Freud's theory of the repetition compulsion and Kohut's theory of selfobject transferences suggests how specific moments of thwarted twinship needs may be repeated within the analytic relationship in an attempt to master the earlier experience. The experience of the analyst being pulled into the patient's attempts at mastery is detailed. A broader theoretical trend is hypothesized whereby psychoanalytic theories may have a pull toward twinship between each other.

Intersubjectivity and the Emergence of Words

Intersubjectivity refers to two non-verbal intersubjective relations infants experience during their first year that are precursors to the emergence of words. Trevarthen, a pioneer in the study of intersubjectivity, referred to those relations as primary and secondary intersubjectivity. The former, a dyadic coordination between the infant and her caregiver, begins at birth. The latter, a triadic coordination that develops around 9 months, allows the infant and a caregiver to share attention to particular features of the environment. Secondary intersubjectivity is crucial for an infant’s ability to begin to produce words, at around 12 months. Much research on the social and cognitive origins of language has focused on secondary intersubjectivity. That is unfortunate because it neglects the fact that secondary intersubjectivity and the emergence of words are built on a foundation of primary intersubjectivity. It also ignores the evolutionary origins of intersubjectivity and its uniquely human status. That unique status explains why only humans learn words. This article seeks to address these issues by relating the literature on primary intersubjectivity, particularly research on bi-directional and contingent communication between infants and mothers, to joint attention and ultimately to words. In that context, we also discuss Hrdy’s hypothesis about the influence of alloparents on the evolution of intersubjectivity.

Tales of COVID-19: Fear of Contagion and Need for Infection

The pandemic has been such a dramatic experience that it has newly illuminated the factors that can transform Hegel's necessary "infection"-a permeability to the other and the intersubjective foundation of the ego-into a contagion that alienates the subject. The dialectic between these two kinds of otherness represents what is truly at stake in any encounter-i.e., mutual recognition. Therefore, despite the terrible load of concreteness and suffering that bears directly on psychoanalysis, the theater of analysis still stands, so that the "tales of COVID-19" should also be listened to as fictional, that is, as unconscious communications in the here and now.

Implicit Causality and Pronoun Resolution in Intersubjective Discourse Relations

Interpersonal verbs like disappoint and praise in Lucy disappointed/praised Mary because she… bias the potential cause of the event to one of the antecedent noun phrases (henceforth NPs) (e.g., Lucy for disappoint whereas Mary for praise). Using Chinese as its materials, this study investigated how verb-based implicit causality affects online pronoun resolution in backward concession (e.g., Lucy disappointed/praised Mary although she…), an intersubjective discourse relation where the subordinate although-clause forms an indirect relationship with the preceding main clause. Experiment 1 was a baseline experiment with the typical structure where implicit causality is found to be effective, i.e., backward causality. Results showed a clear modulation effect of implicit causality on pronoun resolution such that as verb bias strength decreases, participants were faster in processing sentences that disambiguate the pronoun to the verb-inconsistent NP. However, this modulation effect was not observed in Experiment 2 where we used the same verbs but replaced because with although. There was no preference for the pronoun to be disambiguated toward the verb-consistent NP or the verb-inconsistent NP in backward concession. The results of Experiments 1 and 2 were replicated in Experiment 3 where we directly compared causal and concessive relations. We suggest that the absent effect of verb-based implicit causality in backward concession could be attributed to the intersubjective nature of the concessive relation. Discourse devices such as although indicate speakers' subjective perspective and comprehenders are able to quickly accommodate the speaker's point of view during online discourse processing.

Dialogic Book-Sharing as a Privileged Intersubjective Space

Parental reading to young children is well-established as being positively associated with child cognitive development, particularly their language development. Research indicates that a particular, "intersubjective," form of using books with children, "Dialogic Book-sharing" (DBS), is especially beneficial to infants and pre-school aged children, particularly when using picture books. The work on DBS to date has paid little attention to the theoretical and empirical underpinnings of the approach. Here, we address the question of what processes taking place during DBS confer benefits to child development, and why these processes are beneficial. In a novel integration of evidence, ranging from non-human primate communication through iconic gestures and pointing, archaeological data on Pre-hominid and early human art, to experimental and naturalistic studies of infant attention, cognitive processing, and language, we argue that DBS entails core characteristics that make it a privileged intersubjective space for the promotion of child cognitive and language development. This analysis, together with the findings of DBS intervention studies, provides a powerful intellectual basis for the wide-scale promotion of DBS, especially in disadvantaged populations.

The institution, mental disability and the psychoanalyst: Prospects presented by a revival of intersubjective receptivity in groups

This presentation aims at giving an account of a novel group project, conducted with adults with mental and/or psychic disabilities. The evolution of post-war psychiatry in France is marked by several important changes. The development of psychotherapy in institutions asserts the role of psychoanalysis in the institutional sphere. We then will describe the environmental contexts for the reception and support of the mentally disabled subject as it currently exists in France, highlighting their effects on psychic disability. This novel project takes place in a medico-social institution, a residential home in which live eight adults with disabilities, women and men, aged 19 to 55, and at a particular moment in institutional history. Sustained by several mediations, it is first through the support of a jigsaw puzzle project that the experience is initiated. Then a writing workshop will be organised, whereby residues of proceedings will find a form in which to be recorded. The objective will be the implementation of intersubjective space, despite the impediment identified at the level of individual subjective psyches. The effectiveness of the methods used can be detected in the intersubjective connections, allowing the renewal of symbolization and creativity.

The Psychological Structure of Loneliness

Despite the current surge of interest in loneliness, its health consequences, and possible remedies, the concept itself remains poorly understood. This paper seeks to contribute to a more fully worked out account of what loneliness consists in. It does this by stressing that loneliness always has an experiential component and by introducing a simple psychological structure to analyze the experience. On this basis, it suggests that we can distinguish between three ways of thinking about the phenomenal dimension of loneliness. There are objectivist views that seek to understand loneliness by a description of its intentional object, subjectivist views that consider its holistic relation to other aspects of the sufferer’s psyche, and embodied and enacted views that focus on the relation between the lonely person’s mental life and her social environment. The aim is not to adjudicate between these views or to suggest that they are mutually exclusive. Rather, this paper recommends a pluralistic framework on which all three approaches have something to contribute to a fuller understanding of the condition and may be of use in devising measures aimed at improving sufferers’ health.

Intersubjectivity: Conceptual Considerations in Meaning-Making With a Clinical Illustration

This manuscript explores intersubjectivity through a conceptual construct for meaning-making that emphasizes three major interrelated elements-meaning making in interaction, making meaning with the body as well as the mind, and meaning making within an open dynamic system. These three elements are present in the literature on intersubjectivity with a wide range of terms used to describe various theoretical formulations. One objective of this manuscript is to illustrate how such a construct can be useful to understand the meaning-making observed in psychoanalysis, such as in the treatment of a young child on the autistic spectrum. The challenges in establishing an intersubjective state with a child on the autistic spectrum serve to highlight important features of intersubjectivity. As an important background to this clinical illustration, we illustrate the construct with the scientific paradigm of the well-known face-to-face still-face.

Knowing and being known: Psychedelic-assisted psychotherapy and the sense of authenticity

Participants in MDMA- and psychedelic-assisted psychotherapy often emerge from these treatments with new beliefs about themselves and the world. Studies have linked changed beliefs with mystical experiences reported by some participants during drug sessions. While there has been some debate about the epistemic value of drug-induced mystical experiences, and about the need for consent to treatments that may alter metaphysical beliefs, less attention has been given to the sense of authenticity that attends these experiences. In this paper, I consider the intersubjective context in which these changed beliefs arise. I suggest that the sense of authenticity people experience with MDMA- and psychedelic-assisted psychotherapy derives from a simultaneous feeling of knowing and being known. The medications used in these treatments reduce the defensive barriers which ordinarily prevent powerful feelings from being intersubjectively shared, allowing the subject to experience knowing and being known with the therapist and/or internalized or imagined others. In explaining this thesis, I discuss Ratcliffe's "existential feeling;" ipseity in incipient psychosis and psychedelic states; Winnicott's notions of the True Self, omnipotence, creativity, and transitional phenomena; implicit relational knowing and moments of meeting; infant-mother dyad research; predictive processing and the relaxed beliefs model of psychedelic action; the role of the "partner in thought" in knowing and feeling known. I propose that a "transitional space" model of MDMA- and psychedelic-assisted psychotherapy is well-suited for working through "not-me" or dissociated experience.

Case Report: Psychotherapy of a 10-year-old Afghani refugee with post-traumatic stress disorder and dissociative absences

Violence-related post-traumatic stress disorder (PTSD) in the context of war and terrorism has become an increasingly pressing public health issue relevant to refugee children and families. PTSD and related psychopathology in children can adversely affect all domains of development and, in particular, interfere with learning and socialization. When the experience of violent trauma and related loss is shared with the entire family, resulting impairment and distress may prevent caregivers from being psychologically available to process their traumatized children's emotional communication and otherwise meet their children's developmental needs. When children suffer from PTSD, it may be impossible to put their experience and related thoughts and feelings into words, let alone a coherent narrative. The latter difficulty can be even more pronounced when the child displays dissociative symptoms, possibly signaling a dissociative subtype of PTSD. Thus, the narrative within the child's play during psychotherapy becomes all the more important as an indicator of the child's internal world. This case report is an example both of evaluation and of psychotherapy that is both psychodynamic and trauma-informed with a 10-year-old Afghani boy who suffered the violent loss of his father at age of 3 years, leading to his immigration to Switzerland. This paper addresses the question of how the psychotherapist can accompany the child through the elaboration of his trauma and how the therapist can contribute to the co-construction of a coherent narrative of the child's experience and to the restoration of an intersubjective connection between the traumatized child and caregiver.

An attachment-based framework for disordered personality development: Implications for intersubjective psychodynamic psychotherapy

Infant-caregiver dyads show high heterogeneity in terms of compatibility. Several lines of evidence indicate that the modalities by which areas of good and poor fit were emotionally recognized and managed by caregivers influence the infant's personality development, the integration of their personality traits, the overall sense of authenticity, as well as the modalities of transference that typically manifest during psychodynamic psychotherapy. Within an intersubjective framework, the relationship between patient and psychotherapist will inevitably recreate compatibility issues, although the specific areas of incompatibility will likely differ from the scenarios present in the caregiver relationship. In other words, emotional friction may originate from personality traits that were not problematic in the first place. The author hypothesizes that disclosure of the challenges associated with the management of areas of incompatibility will not only promote emotional honesty within the dyad, but also offer an excellent opportunity for introjection. Such disclosures are not at risk of being interpreted as an attempt to build an intersubjective experience, but represent a window into authenticity, which in turn enables patients to develop awareness of their personality and relational traits, along with the challenges and vulnerabilities that occur when such traits interface with otherness.

Errare Humanum Est (To Err Is Human): A Mentalizing Breakdown in the Therapeutic Work With an Adolescent

The therapeutic stance in therapies conceptualized by the two-person psychology (Wachtel, 2010) binds the therapist to genuine self-scrutiny. The concepts of transference and countertransference are viewed as jointly constructed endeavors between therapist and client, wherein the therapist needs to be aware of her contribution to difficulties arising in the therapeutic dyad. Different conceptualizations of this therapeutic technique have been eloquently described elsewhere throughout the years in terms of intersubjectivity (Stern, 2005; Aron, 2006), mentalizing (Fonagy and Bateman, 2006), mindfulness-in-action (Safran et al., 2001), rupture and repair (Newhill et al., 2003), and epistemic trust (Fonagy and Allison, 2014). These concepts will be presented interchangeably with a clinical vignette delineating a rupture in the therapeutic work with an adolescent. Finally, the article concludes with a discussion of identifying non-mentalizing modes (Allen et al., 2008) within the therapist to get back on track and restore epistemic trust (Fonagy et al., 2014) in the therapeutic relationship.

Mimetic Self-Reflexivity and Intersubjectivity in Complementary and Alternative Medicine Practices: The Mirror Neuron System in Breast Cancer Survivorship

This study examines complementary and alternative medicine (CAM) providers' practices in the treatment of their breast cancer survivor (BCS) clients and interprets these practices within the context of existing neuroscientific research on the mirror neuron system (MNS). Purposive and snowball sampling was conducted to recruit CAM providers (N = 15) treating BCSs from integrative medicine centers, educational institutions, private practices, and professional medical associations across the United States. In-depth semi-structured interviewing (N = 252 single-spaced pages) and inductive qualitative content analysis reveal CAM therapeutic practices emphasize a diachronic form of mimetic self-reflexivity and a serendipitous form of mimetic intersubjectivity in BCS pain management to allow the providers to tune-in to their clients' internal states over time and experience themselves as an embodied subject in an imaginative, shared space. By employing imagination and an intentional vulnerability in their embodied simulation of the others' internal states, CAM providers co-create experiences of pain while recognizing what about the other remains an unknown. Although MNs provide the mechanism for imitation and simulation underlying empathy through a neuronally wired grasp of the other's intentionality, the study suggests that examining mimetic self-reflexivity and intersubjectivity in the therapeutic space may allow for a shared simulation of participants' subjective experiences of pain and potentially inform research on self-recognition and self-other discrimination as an index of self-awareness which implicates the MNS in embodied social cognition in imaginative ways.

Comparison of Japanese and Scottish Mother-Infant Intersubjectivity: Resonance of Timing, Anticipation, and Empathy During Feeding

Feeding involves communication between mothers and infants and requires precise synchrony in a special triadic relationship with the food. It is deeply related to their intersubjectivity. This study compared the development of mother-infant intersubjectivity through interactional synchrony in feeding between 11 Japanese and 10 Scottish mother-infant dyads, observed at 6 and 9 months by video. Japanese mothers were more deliberate in feeding at an earlier age, whereas Scottish mothers were significantly more coercive than Japanese mothers at an earlier age. Japanese mothers brought the spoon to infants with a pause to adjust the timing of insertion to match their infants' readiness, whereas this pause was not observed in Scottish mothers. Isomorphic mouth opening between mothers and infants was observed. This empathic maternal display is an important element of intersubjectivity in infant feeding that differed between Scottish and Japanese mothers. Scottish mothers' mouth opening always followed their infants' mouth opening, but about half of Japanese mothers preceded their infants. Further, the mouths of Scottish infants and mothers opened almost at the same time as spoon insertion. In contrast, Japanese mothers' mouth opening did not co-occur with the insertion but was close to spoon arrival, a subtle but important difference that allows for greater infant autonomy. The time structure of Scottish mother-infant interactions was simpler and more predictable at 9 months than in Japan, where the structure was more variable, likely due to a stronger regulation by Scottish mothers. In conclusion, Scottish mother-infant intersubjectivity is characterized as more maternally reactive and mother-centered, whereas Japanese mother-infant intersubjectivity is characterized as more maternally empathetic and infant-centered. Cultural differences in intersubjectivity during feeding between Japan and Scotland are further discussed in relation to triadic relationships and parenting styles.

Social Dysfunction in Psychosis Is More Than a Matter of Misperception: Advances From the Study of Metacognition

Many with psychosis experience substantial difficulties forming and maintaining social bonds leading to persistent social alienation and a lack of a sense of membership in a larger community. While it is clear that social impairments in psychosis cannot be fully explained by symptoms or other traditional features of psychosis, the antecedents of disturbances in social function remain poorly understood. One recent model has proposed that deficits in social cognition may be a root cause of social dysfunction. In this model social relationships become untenable among persons diagnosed with psychosis when deficits in social cognition result in inaccurate ideas of what others feel, think or desire. While there is evidence to support the influence of social cognition upon social function, there are substantial limitations to this point of view. Many with psychosis have social impairments but not significant deficits in social cognition. First person and clinical accounts of the phenomenology of psychosis also do not suggest that persons with psychosis commonly experience making mistakes when trying to understand others. They report instead that intersubjectivity, or the formation of an intimate shared understanding of thoughts and emotions with others, has become extraordinarily difficult. In this paper we explore how research in metacognition in psychosis can transcend these limitations and address some of the ways in which intersubjectivity and more broadly social function is compromised in psychosis. Specifically, research will be reviewed on the relationship between social cognitive abilities and social function in psychosis, including measurement strategies and limits to its explanatory power, in particular with regard to challenges to intersubjectivity. Next, we present research on the integrated model of metacognition in psychosis and its relation to social function. We then discuss how this model might go beyond social cognitive models of social dysfunction in psychosis by describing how compromises in intersubjectivity occur as metacognitive deficits leave persons without an integrated sense of others' purposes, relative positions in the world, possibilities and personal complexities. We suggest that while social cognitive deficits may leave persons with inaccurate ideas about others, metacognitive deficits leave persons ill equipped to make broader sense of the situations in which people interact and this is what leaves them without a holistic sense of the other and what makes it difficult to know others, share experiences, and sustain relationships. The potential of developing clinical interventions focused on metacognition for promoting social recovery will finally be explored.

Intersubjectivity And Analytic Field Theory

Intersubjectivity is the central concept of the relational paradigm, the most widely employed in contemporary psychoanalysis. Yet we do not have a clear definition of it. Usually it is synonymous with "the interpersonal" and thus indicates the interaction that takes place between two already constituted subjects. In this sense it has little to do with the radical social theory of subjectivation suggested by the term, at least originally, in Husserl's philosophy. In the original meaning of intersubjectivity, as handed down by Husserl and later developed by Merleau-Ponty, the binary opposition between subjectivity and intersubjectivity is dissolved and transformed into a dialectic relationship. To formulate a clear and distinct, but above all specific, definition of intersubjectivity, we need to reclaim this intuition and translate it into coherent principles of technique. It is also essential to verify whether the models of psychoanalysis proffered as intersubjective actually satisfy this parameter. On the basis of these two simple principles, the variants of psychoanalysis that are labeled intersubjective can be placed along a continuum. Examples are given of "weak" and "strong" intersubjectivity. Paradigmatic of the latter pole is the post-Bionian theory of the analytic field.

Emerging psychotherapeutic approaches to addressing self-experience in schizophrenia spectrum disorders

Growing awareness that many who are diagnosed with schizophrenia recover has spurred the development of new psychosocial approaches to treatment. These new approaches include forms of individual and group psychotherapy whose focus extends beyond reducing symptoms and improving skills to subjective outcomes related to sense of self. This paper introduces an issue of In Session which presents six case reports which illustrating these approaches in differing international contexts. First, we explore the larger issues of subjective outcomes from schizophrenia. We then discuss each of the papers separately along with implications of these papers as a group for how treatment might promote the recapturing of a sense of self or place in the world.

How Intersubjectivity Can Contribute to Understanding and Implementation of Child Rights in Early Childhood

Children's participation and involvement has increasingly been on the agenda for the last few decades. The right for children to participate was established in the United Nations Convention on the Rights of the Child (UNCRC). However, even though the UNCRC gives the right to participate to all children, national policy and practice seems to draw a line on verbal language and exclude pre-verbal infants from participation. The spur of this paper is to challenge the exclusion of infants, to describe how pre-linguistic children communicate their intentions, and to show how an understanding of children's participation grounded in intersubjectivity, can inform and reframe the participation of all children as being fundamentally about close relationships with sensitive and containing adults who look within themselves for the voice of the child. The infant's proto-conversational narrative communicates interests and feelings through sympathetic rhythms of what infant researchers have named "communicative musicality," and it can surface in the mother's narrative about the child and their relationship. Intersubjectivity oppose the monadic view of man as separate and left only to imitate others and claims that humans from the very start are intertwined in a fundamental thirdness of co-created reality. Infants are powerful communicators who actively engage in intersubjective relationships with their caretakers only days after birth, and newborns actively influence and even control the mental process of those who communicate with them. Early childhood participation then, would be to find within ourselves the voice of the child. A research project building on the theories and ideas described in the first part of the article, is presented.