This article revisits Wilfred Bion's concept of K (the emotional link of knowing) to explore a dimension that remains undertheorized in the literature: the question of power. While Bion and his interpreters have emphasized K as a developmental drive toward emotional truth, sustained by the therapist's capacity for containment and reverie, this article considers whether power is not merely incidental to knowing in the analytic relationship but constitutive of it. Drawing on clinical work with complex trauma, the article explores how the asymmetry between therapist and patient, in which the therapist is structurally positioned as a necessary condition for the patient's capacity to think their most disturbing thoughts, creates a power differential that structures the relational field. This asymmetry manifests most clearly in what might be called the risk of being known: the patient's vulnerability in needing another mind to think their most disturbing thoughts. Building on the well-established understanding of defenses as having communicative and relational dimensions, the article considers whether defensive strategies might also be understood as assessments of power-ways of testing the therapist's capacity to hold structural authority without wielding it destructively. More radically, it asks whether such strategies might constitute a form of primitive K: the patient's way of knowing the therapist through developmentally early means that carry relational intelligence not yet available to symbolic thought. This reframing has implications for clinical practice, relational theory, and work with populations who have experienced systemic oppression or trauma.
Parents' curiosity about and attunement to their child's mental states significantly predict parenting behaviors and child outcomes. As a result, parental mentalizing is increasingly targeted as a transdiagnostic mechanism of change in evidence-based mental health interventions. In diverse clinical contexts, particularly with highly stressed and underresourced families, reducing parental nonmentalizing has emerged as a key marker of treatment effectiveness. However, effective assessment of mentalizing and nonmentalizing in real-time, high-arousal contexts remains challenging, as gold standard methods require time-consuming coding of transcripts or videos. This study introduces the Short Parental Observation Tool for Mentalizing, developed to assess both parental mentalizing and nonmentalizing during intensive home-based treatment for socially and economically marginalized families with high trauma exposure and psychopathology. The Short Parental Observation Tool for Mentalizing integrates 2 decades of conceptual and empirical findings to structure observations of parental mentalizing and nonmentalizing in both language and behavior. The results support the proposed four-factor structure, indicating that mentalizing and nonmentalizing expressed through language and behavior are related but distinct constructs. The Short Parental Observation Tool for Mentalizing demonstrated good psychometric properties, including sensitivity, internal consistency, and interrater reliability. The study discusses the tool's strengths, limitations, and implications, offering a practical, reliable method for assessing parental mentalizing in demanding clinical settings.
The Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) is a leading measure of object relations, particularly when applied to narrative responses to Thematic Apperception Test Cards. While SCORS-G provides a comprehensive view of self and object representations across eight dimensions, its reliance on aggregate ratings (i.e., composite, dimensional mean ratings) can at times obscure clinically significant variations within extreme responses. We present the Adaptive and Maladaptive Scores Grid as a methodological refinement that enhances the SCORS-G's sensitivity to clinically meaningful variations. By identifying and analyzing notable scores alongside composite ratings, the Adaptive and Maladaptive Scores Grid preserves the richness of individual narrative responses, ensuring that distinctive patterns of interpersonal and intrapsychic functioning are not overlooked. This approach enables a granular examination of object relations, offering insights into both highly adaptive and maladaptive functioning.
Narcissism is increasingly conceptualized as a dynamic, multidimensional configuration of the self encompassing both grandiose and vulnerable expressions. Whereas grandiosity reflects self-enhancement, assertiveness, and defensive distancing from self-conscious affect, vulnerability is marked by hypersensitivity, contingent self-esteem, and emotional fragility. Across psychoanalytic, developmental, and interpersonal models, shame, rather than guilt, has long been theorized as the central affective process organizing narcissistic self-regulation, yet empirical findings had not been systematically integrated. This systematic review synthesized 27 empirical studies examining associations among narcissism, shame, and guilt across nonclinical and clinical samples, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. In nonclinical populations, a consistent pattern emerged: Vulnerable narcissism showed moderate-to-strong positive associations with shame, indicating that shame constitutes its core organizing affect. Grandiose narcissism, particularly when assessed with the Narcissistic Personality Inventory, demonstrated small negative associations with shame. When grandiosity was measured with maladaptive instruments (e.g., the Pathological Narcissism Inventory), links with shame were more variable, reflecting a more affect-reactive and clinically proximal form of grandiosity. Clinical studies showed that narcissistic personality disorder showed low shame and guilt proneness but high shame aversion together with elevated implicit state shame suggesting that grandiosity co-occurs with a latent, easily activated vulnerability to shame. Clinical vulnerability was strongly linked to internalized shame, as well as depressive symptoms and suicidal ideation, underscoring shame's central role in emotional collapse and clinical risk. Overall, findings demonstrate that shame, rather than guilt, is the primary affect differentiating and regulating grandiose and vulnerable narcissistic states across the continuum from personality style to disorder.
This is the first meta-analytic review of the criterion validity of the Social Cognition and Object Relations Scale (SCORS) as applied to Thematic Apperception Test narratives, evaluating whether SCORS ratings significantly correlate with external indices of psychological and behavioral functioning. The primary hypothesis of the present study was that the overall criterion validity of the SCORS with Thematic Apperception Test narratives would yield a small to medium overall weighted effect size, with specific effects aligned with individual study hypotheses. In addition, we developed several secondary hypotheses. We hypothesized that higher SCORS ratings-indicative of more adaptive object relational functioning-would be significantly associated with a range of specific external criterion variables, including (a) membership in nonclinical versus clinical populations; (b) adaptive differences among diagnostic, clinical, and developmental groups; (c) positive psychotherapy process and outcome indicators; (d) lower levels of overall symptom severity or psychopathology; (e) higher ratings of intrapsychic functioning; (f) higher ratings of interpersonal functioning; and (g) greater performance on measures of cognitive functioning. A random effects meta-analysis was conducted on 37 articles representing 32 independent samples (N = 2,399). The primary hypothesis was supported as SCORS ratings demonstrated significant criterion validity, yielding an overall weighted effect size of r = .227 (p < .001). Heterogeneity testing showed no significant between-study variability, Q(31) = 33.210, p = .360, I-2 = 7%, suggesting consistency of validity effects across samples. In addition, when effect sizes were classified separately based on their different sources of criterion variables, each of these subgroup meta-analyses yielded significant results (p < .02) consistent with secondary hypotheses. Publication bias analyses were conducted, and two of these suggested some potential risk of bias. However, analyses conducted to correct for any potential risk of bias yielded an overall weighted effect size that remained statistically significant. Interrater reliability of SCORS coding in the original studies included in this meta-analysis was excellent, with an average intraclass correlation coefficient of .847 across 1,676 ratings. Analysis of Thematic Apperception Test card usage indicated that Cards 1, 2, 3BM, 4, and 13MF were most frequently administered (> 70%), supporting their use as a core set for standardized clinical assessment and research protocols. Findings provide robust evidence supporting the SCORS as a psychometrically sound measure of relational and affective functioning, with practical implications for clinical diagnosis, treatment planning, and tracking therapeutic change.
Adult presentations of attention-deficit/hyperactivity disorder (ADHD) increasingly arrive in psychotherapy with an established diagnosis, yet some attentional disturbances encountered in psychodynamic work appear more closely linked to schizoid dynamics and difficulties in sustaining symbolization. Drawing on a composite clinical vignette, this article explores how inattention, fragmentation, and episodic collapse of attention and reflective capacity may, in certain adults with ADHD, serve to regulate relational proximity defensively rather than reflecting difficulties that are exclusively neurocognitive. Integrating Bion's account of alpha function, the transformation of raw emotional experience into thinkable form, with Fairbairn's, Guntrip's, and McWilliams's descriptions of schizoid organization and withdrawal, I suggest that in certain cases attentional disturbance reflects a relational and symbolic organization of mind that can be obscured beneath the ADHD label. These questions have gained salience within a hypermodern diagnostic culture in which autism and autism and attention-deficit/hyperactivity disorder have become common self-descriptions in many online and clinical contexts; differentiating these presentations from schizoid phenomenology requires attention to transference and the symbolic field. Despite a rich object relations literature, schizoid organization remains underrecognized as a differential consideration in Diagnostic and Statistical Manual of Mental Disorders-shaped clinical contexts. By situating attentional collapse within a relational, symbolic, and hypermodern cultural frame, this article offers an expanded understanding of adult ADHD and autism and attention-deficit/hyperactivity disorder presentations and highlights the value of psychoanalytic treatment in restoring the conditions under which attention can begin to think.
Previous trauma can have a massive effect on current experience of exposure to a traumatic event, especially in more vulnerable periods of the life cycle, such as being a mother or a grandmother to young children/grandchildren during wartime. This study uses two modes of inquiry: first, a clinical case study illustrating how personal, intergenerational, and national traumas intertwine and impact present experiences, as revealed in therapeutic sessions with a soldier's mother; second, a qualitative study conducted through interviews with 35 mothers aged 28-73, of whom 19 shared past traumas they described as influencing their experiences following the October 7, 2023, terror attack and the subsequent Israel-Hamas war. A thematic analysis of the interviews identified three key themes capturing the mothers' experiences of the current trauma in view of previous traumas: (a) childhood trauma meets current trauma, (b) historical trauma meets current trauma, and (c) fear of children being haunted by the current trauma. The findings from these two complementary modes of inquiry shed light on the complex challenges faced by mothers during wartime, influenced by past traumas. They emphasize the interplay between their inner child and their identity as responsible parents, illustrating how their role as mothers provides them with meaning and enhances their coping abilities. Clinically, the study calls for the need for recognition and legitimacy to the different self-states and the needs that accompany them.
This phenomenological study interviewed 17 psychodynamic and psychoanalytically oriented therapists in New York City regarding their initial shift to teletherapy. The semistructured interview focused on exploring psychodynamic components of the therapeutic process-how well it is maintained, altered, lost, or added due to various changes we faced during the unprepared transition. This study points out the cocreated therapeutic setting as one of the most distinguishing differences in teletherapy. As half of our physical therapeutic environment is now managed by our patients, participants in the study reported observing a diverse curation of what our patients choose to show us beyond the walls of our therapy room. This "patient-curated therapeutic setting" or "patient-curated analytic space" can have enormous implications as an extended transference expression where the patient may convey their internal world in a more vivid way. Finally, this study highlights the importance of therapists' intuition in allowing for certain flexibility in the frame and the openness and curiosity required to actively make use of the novel information gained in teletherapy.
This article examines the psychodynamic concept of triangulation in German lesbian couples with children through sperm donation. Triangulation in psychodynamic theory often refers to a triadic relationship between mother, father, and a child and is significantly influenced by heteronormative and patriarchal family conceptions. Modern and queer family systems have not been integrated sufficiently into theoretical psychodynamic concepts, and lesbian women are underrepresented in relevant studies. With the help of a semistructured interview, the psychological experiences of lesbian mothers forming their own families in Germany are examined: Twelve lesbian couples share their perception on motherhood identity, parenthood, family roles, attachment to their children, and the role of the sperm donor. The responses were then coded and structured according to triangulation processes within the families and with the sperm donor. The findings demonstrate that mechanisms of triangulation arise from intersubjective relations, independent of parental gender, and thereby underscore the capacity of nonheteronormative families to foster healthy psychological growth and triangulation. These results should be included in the contemporary discourse of psychodynamic constructs.
