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.

Postcholecystectomy syndrome, dynamics of ideas, diagnostics, treatment

This article provides an overview of the data on postcholecystectomy syndrome (PCES). The entire period of study of this frequent complication (up to 40%) can be divided into 2 periods: surgical and therapeutic. Surgical complications of cholecystectomy accounted for 10% and were studied by surgeons. This study led to the correction of surgical treatment, formulated the examination program and reduced and minimized surgical complications. The second part of the complications is made up of functional disorders of the sphincter of Oddi, which today are the leading ones and, apparently, remain so. The article gives an idea of PCES as a dynamic disorder of the sphincter of Oddi, gives the last definition of PCES given by the IV Roman Concensus, suggests an algorithm for diagnosis and treatment. As a clinical illustration, the authors present their own data on the diagnosis and treatment of 60 patients with PCES, which confirmed the point of view proposed by the international gastroenterological community. The authors separated two types of postcholecystectomy syndrome: one with a predominance of sphincter of Oddi (SO) spasm and another with a predominance of sphincter of Oddi hypotension. The drug of choice in the spastic type is the selective antispasmodic gimecromone, in which case a dose is of the essence. In case of a hypotonic type of postcholecystectomy syndrome, motor regulators to increase the SO tone should be used. The therapy should be stepwise with an assessment of the effect and correction of the next step of treatment. This treatment option for patients with postcholecystectomy syndrome we see today as the leading one. The features of treatment associated with the developing syndrome of bacterial overgrowth (SIBO) and chronic biliary insufficiency (CBI), which require constant monitoring (diagnosis) and permanent treatment, are considered.

Between the Therapist’s Vulnerability and the Client’s Vulnerability: Building a Therapeutic Intervention Through the Regressive Regions of the Mind

The article expands Winnicott ,Balint and other theoretical conceptions in order to describe what happens in a therapist‘s mind so that an intervention can take place. It stresses not only the need to identify the psycho-developmental region where the patient operates, but also how intervention arises in the therapist’s mental regions and engages the relevant mental regions of the patient. It explains the process in which the therapist’s subjective communication with his own mental regions helps the patient establish an initial connection with his regressive areas and even gradually draw closer to them symbolically. The article offers an analysis based on a detailed clinical illustration.

A Firefighter Saving Virtual Addictions

Virtual addiction is, like all addictions, first and foremost an attempt to find a SOLUTION by a patient, faced with a problem in their relationship to the world, to others or to themselves. This attempt at a solution, not being the best, becomes a PROBLEM in a second step.Very often, the solution can emerge from the problem if it is well identified, via systemic modelling (modelling of the relationship between the individual and the relational system that surrounds him). So, the questioning techniques specific to systemists and so-called “brief” therapists and hypnotic techniques (including HTSMA, EMDR) are an excellent means by which a therapist can help treat his patient.We see in the clinical illustration above that starting from the external screen to which the child is addicted and repatriating it inside oneself, and making it a "psychic working screen", will be able to quickly improve the symptoms.

A ‘complementarist’ approach to the group as matrix and as psychic apparatus

This article presents an epistemological reflection on two models of the group: S.H. Foulkes’ matrix model and René Kaës’ less well-known group psychic apparatus model. These two models are viewed as complementary, in the sense of George Devereux’s ‘complementarist’ approach, provided that each is conceived of as constituting a ‘vertex’, as Bion used this term. After showing that the two models are neither in competition nor coextensive, we explore their complementarity. The concepts of the ‘internal group’ and ‘unconscious alliances’ proposed by Kaës provide a way to understand how communication networks emerge and are structured in the matrix. Conversely, the concept of the network of communication can also be thought of as a metaphor for the psychic spaces of the group psychic apparatus. A clinical illustration involving a group supervision session is presented in support of these proposals.