The dissertation concerns a person's subjective perception of responsibility in the clinical setting: its developmental origins, various aspects of it, and its intra- and interpersonal implications. The motivation behind this project was work in a therapeutic community and the role of work activity which demanded a definition of responsibility as a clinically relevant concept. It is a concept that has been largely overlooked - most of mainstream psychological interventions today focus on changing symptoms, rather than on developing a client's sense of responsibility. I considered different meanings of the term, representing a number of theoretical perspectives: ethical, developmental, legal, socio-psychologicakajid" psychodynamic. I linked Melanie Klein's theory of object relations with common understandings of responsibility, and discovered that a Kleinian approach integrates them into single maturational process. A Kleinian formulation also provides with ideas on how to facilitate the transformation from less mature 'modes' of responsibility into more mature ones, particularly through the process called reparation and through inducing hope. Two main aims of the dissertation are: a) to operationalize the notion of responsibility; and b) to develop a practical way of assessing its dynamics systematically. The dissertation therefore consists of two parts: theoretical - suggesting an integrative model of respon- sibility based on Kleinian theory (I call it the structure of responsibility), and empirical - a proposal and assessment of an instrument measuring three identified dimensions of responsibility: locus, valence and time orientation.

The application of psychoanalytic understanding to organizations has been a rich field of research and development, with a vast number of studies and a history spanning several decades (Anderson and Vlhite 2002, Miller 1990, Irist and Murray 1990). One of the most fertile concepts arising from this work has been Social Defence Systems, first put forward by Elliott Jaques (Jaques 1953;). More recently containment (Bion 1962b) appeared as pan of the psychoanalytic approach to organizations, thougl:l the interconnections between these two concepts are not easy to pinpoint. In fact, organizational life is sometimes seen as ranging from defensive to containing and these concepts appear as opposites along the same continuum, probably partially due to the same dichotomy being present in the clinical setting. This thesis addresses the relation between Social Defence Systems and containment in organisations, using Bion's (1965) notion of Vertices in order to bridge the two concepts. Thus empirical research was conducted in a mental health institution using the method observing organizations (Hinshelwood and Skogstad 2000), and criteria for both concepts were devised from the data. A series of 56 vignettes depicting the interactions between staff and patients were analysed using both sets of criteria. The data show that Social Defences were not activated in the cases where flexible containment was observed. However, in the cases where rigid containment was observed, Social Defences were activated and it could be said that the two concepts overlap. In the vignettes where fragmented containment was observed, the initial moment of interaction, was followed by a second moment of defence. Thus Social Defence Systems and Mal Adaptative Containment can be seen as two different perspectives stemming from two different vertices.

I investigate consciousness as an emergent state coming from the interaction of brain, mind and environment. 1 start with the constellation of autonomous feeling-toned complexes because of their disruptive effect on consciousness. I then apply my findings to the normal functioning of the ego-complex and to the constellation of archetypes. I contend that these three phenomena constitute three bridges to consciousness. I use the methodology of dynamical systems modelling to deepen understanding of the relationship between the psychological space of a constellated complex and the physical space of the brain based on resea rch in neuroscience. Drawing on complexity theory, I conceptualise the complex as an attractor whose macroscopic patterns (thoughts and behaviour) are determined by an order parameter: evaluation-interpretation-meaning, and control parameters: emotion, memory, and perception. This suggests that it is the distinct meaning in the life of the individual. experienced through feelings and building on previous experience, which enslaves the psyche resulting in the sudden change in psychic state characteristic of the feeling-toned complex. Consciousness arises as a completely natural phenomenon based on internal constraints arising from neurochemistry, neurobiology, as well as external interactions with the environment. However, I argue that, as an emergent property, it engenders more than these components. It is characteristic of a self-organising system that the observable, initial physical properties are no longer manifest, so that the resu lting system exhibits completely different properties_ Thus I contend that the global functioning of the brain as a dynamic system generates consciousness as an emergent phenomenon. I further propose that an attractor of this system is the complex, and consequently it is through the bodily experience of the complex, whether an autonomous complex or the ego-complex, that consciousness emerges. Finally, I develop some novel visual representations of the foregoing models .

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This dissertation presents the development and findings of a long-term follow-up study of adults who received psychoanalytic treatment in childhood and adolescence at the Anna Freud Centre in London. It reviews the existing literature on outcome research of child psychotherapeutic interventions, highlighting the advances that have taken place in the last fifteen years, alongside a host of methodological challenges that continue to confront researchers in the field. Particular emphasis is given to the relative lack of outcome studies focusing on psychodynamic interventions, despite their wide usage in clinical practice, and the dearth of follow-up studies which investigate post-treatment gains beyond termination. Given the impact of developmental changes on the long-term sequelae of childhood disturbances, the need for follow-up assessments across the life span is emphasized. In addition, the dissertation discusses the limitations of outcome measures that focus solely on the symptomatology, recommending multi-level assessment procedures that incorporate a more diverse and comprehensive approach to the assessment of functioning and treatment outcome. This approach recommends the inclusion of both disturbance and functioning, and the importance of both risk and protective factors. The development of a comprehensive adult assessment interview protocol is described and the thirty-four treated subjects that comprise the study's sample are presented. Childhood variables assessed retrospectively on the basis of subjects' case files are described along with current adult demographic data. The Adult Functioning Index, based on five individual assessment measures, is presented and the relationship between childhood variables and adult functioning is analyzed. The findings highlight the importance of pre-treatment global functioning level in childhood as the best predictor of adult outcome, followed by the number of psychiatric diagnoses at the conclusion of treatment in childhood. The study's results highlight the relationship between security of attachment and adult functioning, suggesting that a secure attachment status may play a pivotal role in overcoming a poor long-term prognosis. The potential impact of treatment in childhood on security of attachment and subsequent development is discussed. The contributions and limitations of the study are outlined and recommendations for future prospective studies are described.

This study adopted a social constructionist framework to explore how clients and therapists construct their experiences of termination from long-term psychoanalytic psychotherapy. To this end, six psychoanalytic therapists and three clients were interviewed and their accounts were analysed qualitatively using a discourse analysis approach. Prominent therapist discourses elaborated termination as a loss experience. Clients also constructed termination in terms of available discourses of loss, however, additional client narratives were generated which storied termination in a variety of other ways, such as conveying hopes for a new beginning. Analysis revealed certain contradictions between the discourses deployed by therapists and those of clients, for example, whilst therapists constructed termination as a typically mutual process, clients storied termination as a time during which they had felt powerless. Discourses of termination were thus examined with reference to the institutions and ideologies they support and the power relations they reproduce. Analysis revealed that the within-therapy focus that still persists in more traditional approaches to analytic psychotherapy reproduces specific power relations and reinforces a view of clients as in need of expert help. Therefore, the ways in which power is enacted within the therapeutic relationship tends either not to be seen or is not explicitly addressed within certain approaches to psychoanalytic therapy, specifically, within a local NHS psychotherapy service. As such, this study argues for the adoption by therapists of a critical, reflexive approach to the ways in which therapy is enacted within specific settings. Further, it calls for the issue of power to be explicitly addressed within the practice of therapy in order to make clients more powerful. In practice, as with recent feminist and post-structuralist developments within psychoanalytic theory and practice, this would mean acknowledging the lived realities of clients and connecting with the structural inequalities that position them within society.

The thesis entitled 'Developing an early therapeutic alliance with the transferred client' explores how the early alliance develops within client-therapist dyads and the impact that a transfer of care can have on developing a new alliance. Section One presents a systematic review of 14 empirical studies, considering how client and therapist intra- and interpersonal variables impact upon the other person's perception of the early therapeutic alliance. The review provides a comprehensive and critical account of the current state of knowledge, indicating that client interpersonal difficulties consistently cause therapists to rate the alliance negatively. In addition, shared expectations within the dyad create a positive alliance, whilst therapeutic ruptures foster negative alliances for both parties. Section Two presents a research study exploring how clinical psychologists experience working with transferred clients. Nine participants were interviewed and the data analysed using interpretative phenomenological analysis (IPA). Four major themes emerged from the transcripts: Developing a boundaried and transparent alliance; Abandonment and raised expectations: the lasting influence of the previous therapist; Following on where somebody else left off: using or not using previous therapeutic work; and Working within the transfer culture. The themes describe the difficulty and frustration experienced within the transfer process, as clinical psychologists attempt to establish a new therapeutic alliance to promote positive change in clients. Section Three provides a critical review of the research study, specifically focusing on reflexivity. The author reflects on the experience of conducting interviews whilst having a dual-role, placing them on 'the inside' of participant accounts. In addition post-hoc reflexivity was used to provide practice guidelines for trainee clinical psychologists managing transfers of care. It is anticipated that the findings presented here will encourage clinical psychologists and associated professionals to consider the 'importance of establishing a solid therapeutic alliance, whilst also recognising the consequences of breaking this bond.

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