Showing papers in "International Forum of Psychoanalysis in 2022"

On survival

Abstract: or undergo postnatal changes in Langerhans cells and alveolar macrophages. Genes encoding some tissue-specific factors are expressed as early as embryonic day 10.26 in tissue macrophages ( Sall1 and Sall3 ) or are expressed in erythro-myeloid progenitors or pre-macrophages ( Id1 and Sall3 ) before their expression becomes restricted to a certain macrophage subset. The transcription factor Id3 emerges as being important for the development and maintenance of Kupffer cells.

Probing the impact of psychoanalytic therapy for bipolar disorders: A scoping review

Abstract: No systematic review has been conducted to provide an overview of the effectiveness of psychoanalysis for treatment outcomes in bipolar depression and mania. The present study undertakes a scoping review of the effectiveness of psychoanalysis for bipolar disorder (BD), provides a summary of the evidence base, and identifies issues for future research in this area. A thorough search of journal articles in MEDLINE, PEP-Web, PsycINFO, Scopus, and the Web of Science was carried out to obtain available studies on psychoanalytic treatment for BD published from 1990 to 2021. We searched for either quantitative or single-case studies. Twenty-six single-case reports from 21 articles and no quantitative studies met the inclusion criteria. A qualitative analysis suggests efficacy and cost-effectiveness but thus far there is no scientific evidence in support of psychoanalysis. Although these pilot findings suggest that psychoanalysis may impact symptoms and global functioning in individuals with BD, the underlying evidence is poor and should be confirmed by experimental studies.

When patients probe the analyst: Manifestations of patient testing and its complexity – An in-depth exploration of case examples of extant research

Abstract: Patients probe the analyst with the goal of challenging pathogenic adaptations to early experiences. As the core concept of control mastery theory (CMT), testing is contextualized within psychoanalytic theory. The current work examines 29 articles illustrating therapies performed or analyzed using the CMT approach for the occurrence of testing, which takes place through interaction, self-presentation, narratives, or the use of the setting. The various manifestations of testing and their potential meanings are described. An in-depth analysis of selected testing examples is performed to compare tests within patients and across studies. The results show that patients differ in their testing strategies, shift testing strategy during the process of treatment, combine tests, and test multiple conflictual themes within a single test. Therefore, the importance of applying a case-specific approach, based on a thorough understanding of a patient, becomes evident. Recommendations concerning psychoanalytic technique, including the role of interpretation, as illustrated in case vignettes, are introduced.

One life heals another: Beginnings, maturity, outcomes of a vocation

Abstract: must run twice as fast as that” (Carroll, 1865; reprint 1993, p. 79). On the other hand, it is clear in psychoanalysis there is little consensus: when discussing analytic techniques Charles Brenner wrote: “All are agreed that an analyst listens while the patient talks and then intervenes at what is considered to be an appropriate time, but there agreement ends” (Brenner, 2007, p. 49). However, there are also some surprises. Stefana makes a continuous and constant crosslink between the theoretical positions of the various scholars. This allows the reader to “fly” from one continent to another, following the clinical and theoretical manifestations of the concept of countertransference. Thus we can appreciate authors who remain adherent to the clinic and the therapeutic encounter with the patient, and others who slide towards theories that can appear decidedly abstract. In fact, by reading these pages over and over, new things can be found. Sometimes we pause to reflect on a sentence; other times we are induced to explore other books and correspondence. Sometimes, the reader can take notes to follow up their curiosity of wanting to know more: for example, to gain more knowledge on the Scottish psychoanalyst Denis V. Carpy, or on Otto Gross’s (mutual) analysis with Jung. Stefana closes his work with a chapter called “Some non-conclusive considerations”. Wisely, he writes:

When patients probe the analyst: Manifestations of patient testing and its complexity – An in-depth exploration of case examples of extant research

Abstract: Abstract Patients probe the analyst with the goal of challenging pathogenic adaptations to early experiences. As the core concept of control mastery theory (CMT), testing is contextualized within psychoanalytic theory. The current work examines 29 articles illustrating therapies performed or analyzed using the CMT approach for the occurrence of testing, which takes place through interaction, self-presentation, narratives, or the use of the setting. The various manifestations of testing and their potential meanings are described. An in-depth analysis of selected testing examples is performed to compare tests within patients and across studies. The results show that patients differ in their testing strategies, shift testing strategy during the process of treatment, combine tests, and test multiple conflictual themes within a single test. Therefore, the importance of applying a case-specific approach, based on a thorough understanding of a patient, becomes evident. Recommendations concerning psychoanalytic technique, including the role of interpretation, as illustrated in case vignettes, are introduced.

Hezbollah: Lebanon’s identified patient?

Abstract: Abstract In this article, I interpret Hezbollah’s birth and role in Lebanon’s sociopolitical life from a group and family psychoanalytic perspective. In particular, I examine whether Hezbollah, as one of Lebanon’s “children,” can be seen as the “designated patient” and “symptom” of its large family, nation-state “incestual” dynamics and complicated separation and individuation process. As a designated patient, Hezbollah performs the double-sided function of gluing its fragmented nation-state together while carrying the weight of being its breaking force. In this logic, Hezbollah’s paradoxical role in the Lebanese nation-state family would be similar to that of a “scapegoat/Messiah,” who carries both the family’s incestual dynamics and internal tensions and its hope for a solid and cohesive nation-state identity. To build a cohesive nation-state identity, Hezbollah’s ideology acts as a prosthesis for Lebanon’s narcissistic fragility, which replenishes the narcissistic hemorrhage of its perforated bodily and psychic envelopes. I also reflect on whether a national mediation process informed by a group psychoanalytic approach could help Lebanon constitute a more functional ego-nation-state and thus renounce the need for a designated patient. Hezbollah would be better capable of giving up its pathological ideological position.

Sanity and madness within the therapeutic setting: A case study

Abstract: This article analyses a particular case of sanity and madness within the therapeutic setting as an expression of psychosis. It describes the story of a boy named Pedro who, between the ages of 12 and 16 years, struggled with mental balance – oscillating between lucidity, within a broken mind, and the madness required to stay healthy. The psychotherapeutic path was marked by a set of characters – real and fictional – that revealed his split functioning. In the plots Pedro created, he used the evil characters of any given movie saga in order to express himself. Like a dream, these narratives functioned as metaphors and metonyms, where the condensed forces of evil took over the symptom – which brings us to psychosis – while the good side, represented by an isolated and unprotected figure with which Pedro identified, revealed the displaced material of his unconscious desire. Although the psychotic parts of Pedro’s personality had been rehabilitated and integrated, his mental functioning remained marked by dissociation with reality, linked to the psychotic dysfunctionality. Therefore, even if his psychotic parts were contained and masked by clever humor, they were an indelible trace of his mental life.

Hezbollah: Lebanon’s identified patient?

Abstract: In this article, I interpret Hezbollah’s birth and role in Lebanon’s sociopolitical life from a group and family psychoanalytic perspective. In particular, I examine whether Hezbollah, as one of Lebanon’s “children,” can be seen as the “designated patient” and “symptom” of its large family, nation-state “incestual” dynamics and complicated separation and individuation process. As a designated patient, Hezbollah performs the double-sided function of gluing its fragmented nation-state together while carrying the weight of being its breaking force. In this logic, Hezbollah’s paradoxical role in the Lebanese nation-state family would be similar to that of a “scapegoat/Messiah,” who carries both the family’s incestual dynamics and internal tensions and its hope for a solid and cohesive nation-state identity. To build a cohesive nation-state identity, Hezbollah’s ideology acts as a prosthesis for Lebanon’s narcissistic fragility, which replenishes the narcissistic hemorrhage of its perforated bodily and psychic envelopes. I also reflect on whether a national mediation process informed by a group psychoanalytic approach could help Lebanon constitute a more functional ego-nation-state and thus renounce the need for a designated patient. Hezbollah would be better capable of giving up its pathological ideological position.

Psychoanalysis and political economy

Abstract: The authors examine the influence that psychoanalysts’ economic situation has on the current state of psychoanalysis, particularly focusing on the situation in Germany and employing a perspective afforded by Marxian commodity analysis. Their analysis brings them to conclude that, in psychoanalysis, the suspension of truth value, the tolerance shown towards contradictory concepts, the lack of conceptual criticism, and the exclusion of sociocritical issues seem to be effects of psychoanalysts’ interest in realizing the exchange value of their psychoanalytic treatment and their accompanying lesser interest towards its use value.

“Being myself as the analyst I have become:” An interview with Jay B. Frankel

Abstract: In 2015, during the IPA Congress in Boston, Jay Frankel, Gabriele Cassullo, and I started editing a book about Sandor Ferenczi (Dimitrijevic,́ Cassullo, and Frankel, 2018). In the following couple of years, we met regularly online, for the most part once a week, and gathered in Berlin, where Jay gave a lecture at the International Psychoanalytic University, in Florence, in Paris, where we interviewed Judith Dupont (Dimitrijevic,́ in press), in New Jersey, and in Washington D.C., where all three of us presented at a conference about the “Lines of Development” book series. This collaboration – successful despite many challenges – led to a personal friendship and new joint projects (see Frankel, 2020, 2022). I had the privilege of talking to Jay about his interpretations, impressions, and plans, and about his reminiscences and contacts. I felt he had lived at the epicenter of contemporary American psychoanalysis, but I also felt that my image was only fragmentary. When my interview with Professor Michael B. Buchholz was published in the International Forum of Psychoanalysis (Dimitrijevic, 2021), a detailed conversation about Jay’s contributions, development, and experiences seemed like a most natural continuation. Recordings of our four meetings, held over April and May of 2020, were kindly transcribed by Ms. Gamze Farz, MA, edited by myself, and corrected and approved by Jay Frankel. This text is a slightly condensed version of the transcript, kindly accepted by Dr. Marco Conci and Dr. Grigoris Maniadakis, the Coeditors-in-Chief of the International Forum of Psychoanalysis, without significant cuts, as this Bildungsroman deserves.

Psychoanalysis and political economy

Abstract: Abstract The authors examine the influence that psychoanalysts’ economic situation has on the current state of psychoanalysis, particularly focusing on the situation in Germany and employing a perspective afforded by Marxian commodity analysis. Their analysis brings them to conclude that, in psychoanalysis, the suspension of truth value, the tolerance shown towards contradictory concepts, the lack of conceptual criticism, and the exclusion of sociocritical issues seem to be effects of psychoanalysts’ interest in realizing the exchange value of their psychoanalytic treatment and their accompanying lesser interest towards its use value.

Mentalization promotion and affect mobilization in clinical work

Abstract: The author presents a model of clinical intervention based on patients’ mentalization, or mind reading, that is, the function of the mind to understand the mind. The action of mind reading means a type of thought, mostly not conscious, implicit, often not even encoded in words, that expresses the meaning “I think that you think that I think.” Thoughts about the analyst’s states of mind crowd the minds of patients, taking shape in these questions: “What do you think I have in mind?” and so “How do you plan to act towards me?” If the analyst does not capture and does not disambiguate the doubts, the patient’s perplexity and insecurity can intensify and produce emotions of anxiety, fear, fright, but also anger towards a silent interlocutor. Conversely, the analyst who mentalizes the state of mind of the patient and verbalizes it heteroregulates the patient’s fears and anxiety level. Mentalization and affect regulation are also related to the analyst’s recognition of the patient’s metacognition process. At the conclusion of the theoretical section, a clinical sketch shows examples, and highlights in therapeutic work the abovementioned theoretical issues.

Psychoanalytic encounter: Conflict and change – Papers from the XXIst IFPS Forum, February 2020, Lisbon

Abstract: The papers we have put together in this issue represent the selection that our Editorial Board made of the many papers presented at the XXIst IFPS Forum held in Lisbon on February 5–8, 2020, about which one of us wrote the report published in No. 2 of Vol. 29 of this journal (Conci, 2020). Writing now, with the pandemics not fully behind us and the war in the Ukraine accompanying our daily life, we can only hope to be lucky enough to be able to meet next October 19–22 in Madrid, for the XXIInd IFPS Forum, organized by the Centro Psicoanalìtico deMadrid under the title “Psychoanalytic Theories and Techniques: Dialogue, Difficulties and Future. 60 Anniversary of the IFPS.” Of the eight papers of this issue, three come from Portugal, three from the USA, Brazil and Italy, and the last two –which were not presented in Lisbon – from Iran and from Israel. One of the best and most appreciated papers given in Lisbon was Sandra Buechler’s paper “King Lear and the challenge of retirement,” dealing as it does with a question that most of us experience as rather embarrassing, problematic, if not wholly impossible to deal with. But Sandra was courageous enough to be able to draw a line and retire from working with patients, on May 31, 2019 – the day before she turned 73. This allowed her to formulate a series of thoughtful considerations on how such a decision impacts our personal identity, and on how we can survive living without the structuring – and reassuring – routine of our analytic work. Of course, Sandra was helped in such a difficult transition by her passion for writing, which allowed her to publish her seventh book, Poetic dialogues, in the fall of 2021 (Buechler, 2021). Her first book, Clinical values: Emotions that guide psychoanalytic treatment (Buechler, 2004), was reviewed by one of us in this journal (Conci, 2006). Sandra Buechler is not only one of the most productive colleagues of the W.A. White Institute of her generation, but also the one who has most actively participated in the life of our Federation since the time in which Gerard Chrzanowski and Buechler’s own analyst, Rose Spiegel, contributed so greatly in linking their society to the IFPS (see Conci, 2021). A similar function has also been played by Jô Gondar, a Brazilian colleague and a member of the Circulo Psicoanalitico de Rio de Janeiro, a member society of the IFPS since 1980; for many years it was represented on the Executive Committee by Edson Lannes – who had trained in the 1960s with Katrin Kemper, a German pioneer of the Brazilian IPA and IFPS psychoanalysis. In her paper “‘To hear with eyes’: Gestures, expressions, rhythms,” the author borrows a Shakespearean expression used by Masud Kahn in The privacy of the self (1974), to show how his eyes could detect inscribed in the body of a patient lying on his couch different things from the ones he was hearing from the patient. Referring also to Sándor Ferenczi’s Clinical diary (Ferenczi, 1988), Jô Gondar shows how important it is to pay attention to the nonverbal aspects and to the rhythm of each patient, a dimension of our work that becomes particularly important when we work with patients suffering from traumatic experiences beyond verbal formulation. In such a case – and here the author refers also to Haag, Maiello, and Roussilion – we can even speak of psychic suffering as “a rhythmic disturbance, a dysrhythmia.” The chair of the organizing committee of the 2018 IFPS Forum, Anna Maria Loiacono, presented in Lisbon her own clinical work with a female patient through the paper “Countertransference and Oedipal love.” This is centered around the famous paper that Harold Searles wrote on this subject (Searles, 1959) and around Thomas Ogden’s revisitation of it (Ogden, 2007). The “mature relatedness” that Searles offers as a model of treatment consists in accepting the paradoxical character of the Oedipal dimension in the treatment, that is, its being at the same time both real and imaginary. In the light of her treatment of Mrs. K., the author shows how “there exists a direct proportional relationship

Unresolved shadows: German encounters in the consulting room

Abstract: The reunification of Germany took place in 1990. As an analyst brought up in the former West Germany, but practicing in Berlin, I have observed over and over again that patients who come from what used to be East Germany (German Democratic Republic) – even those born after 1990 – have a strong need to distinguish between East Germans and West Germans. In their minds, Germany seems still to be a divided country. A split identity appears to have been internalized, producing “West German” and “East German” racists who despise, in the “other” kind of German, a devalued aspect of what being German means. I have tried for many years to understand the hidden meanings of this defensive maneuver for the analytic couple, and beyond this for the relation between the East and West German societies. Here I discuss these unresolved shadows in German identity. Analyses in Germany may be dominated by the splits they provoke, which interfere with patients’ capacities to think. Patients may relate instead to a “German” object that is impersonal, nonempathic, and rejects the idea of an independent internal world. The defensive use of this object in the transference has to be continually worked through in the analysis.

Paul Williams’ portrayal of the psychological growth of the narrator in The fifth principle and Scum, part 2*

Abstract: Abstract In this paper, I explore the nature of Paul Williams’ portrayal of the psychological growth of the narrator in The fifth principle and Scum. Growing up in an impoverished environment, both as a child and as an adolescent, the narrator experienced forms of neglect and abuse, which, together with the fantasies that he created, left him traumatized and close to being totally shattered. This is conveyed quite graphically through the use of various stylistic devices that include shifts in the method of narration in both books as well as the innovative use of language in Scum. Through extensive introspection as well as the help provided by others, the narrator suggests that he became sufficiently psychologically independent as well as capable of feeling connected to others in sustained ways.

Evolution of Freudian psychoanalytic thought in the twentieth-century USA: The influence of the European émigrés

Abstract: This paper briefly reviews major theoretical and clinical changes in American psychoanalysis since its beginning in the early twentieth century. The immigration of European analysts in the 1930s and 40s was of major significance. Infant development research promoted a shift towards the importance of object relations, reducing the importance of the Oedipus complex. The increasing focus on narcissism and borderline personalities is discussed, as well as the applications to dynamic psychotherapy. Dogma dissipated with increasing latitude in theory and clinical work within “classical” psychoanalysis.

Paul Williams’ portrayal of the psychological growth of the narrator in The fifth principle and Scum, part 1

Abstract: Abstract In this paper, I explore the nature of Paul Williams’ portrayal of the psychological growth of the narrator in The fifth principle and Scum. Growing up in an impoverished environment, both as a child and as an adolescent, the narrator experienced forms of neglect and abuse, which, together with the fantasies that he created, left him traumatized and close to being totally shattered. This is conveyed quite graphically through the use of various stylistic devices that include shifts in the method of narration in both books as well as the innovative use of language in Scum. Through extensive introspection as well as the help provided by others, the narrator suggests that he became sufficiently psychologically independent as well as capable of feeling connected to others in sustained ways.

Sense of self and psychosis, part 2: A single case study on amniotic therapy

Abstract: Abstract Some people diagnosed with schizophrenia show an alteration of the sense of self. From a psychodynamic perspective, it has been hypothesized they have disorders of the integration of self/other identification/differentiation processes. From a neuroscientific view some with this diagnosis present dysfunctions in neural correlates of representation of self from other (the implicit sensorimotor-based bodily self), and self united with other. In “Sense of self and psychosis, part 1” we discussed scientific literature offering empirical evidence for the psychodynamic clinical observations that patients with diagnoses of psychoses didn't receive adequate early infancy parental care and sufficient affective-sensorial/tactile interactions. Introducing parental care/cutaneous interactions seemed relevant in the analytic treatment of psychoses, as the pioneers of the psychoanalytic approach to psychosis suggested. From this theoretical basis we developed amniotic therapy, which reproduces the affective-tactile interactions of early infancy, insufficient in cases of psychosis, and aims at integrating the processes of differentiation and identification. We present a single case study of an experimental intervention plan including amniotic therapy. Results showed increases in interoception and global functioning, with significant decreases in positive symptoms suggesting that amniotic therapy contributes to increasing the protective strength of self-boundaries and integration of identification/differentiation processes.

Unresolved shadows: German encounters in the consulting room

Abstract: Abstract The reunification of Germany took place in 1990. As an analyst brought up in the former West Germany, but practicing in Berlin, I have observed over and over again that patients who come from what used to be East Germany (German Democratic Republic) – even those born after 1990 – have a strong need to distinguish between East Germans and West Germans. In their minds, Germany seems still to be a divided country. A split identity appears to have been internalized, producing “West German” and “East German” racists who despise, in the “other” kind of German, a devalued aspect of what being German means. I have tried for many years to understand the hidden meanings of this defensive maneuver for the analytic couple, and beyond this for the relation between the East and West German societies. Here I discuss these unresolved shadows in German identity. Analyses in Germany may be dominated by the splits they provoke, which interfere with patients’ capacities to think. Patients may relate instead to a “German” object that is impersonal, nonempathic, and rejects the idea of an independent internal world. The defensive use of this object in the transference has to be continually worked through in the analysis.

Paul Williams’ portrayal of the psychological growth of the narrator in <i>The fifth principle</i> and <i>Scum,</i> part 1

Abstract: In this paper, I explore the nature of Paul Williams’ portrayal of the psychological growth of the narrator in The fifth principle and Scum. Growing up in an impoverished environment, both as a child and as an adolescent, the narrator experienced forms of neglect and abuse, which, together with the fantasies that he created, left him traumatized and close to being totally shattered. This is conveyed quite graphically through the use of various stylistic devices that include shifts in the method of narration in both books as well as the innovative use of language in Scum. Through extensive introspection as well as the help provided by others, the narrator suggests that he became sufficiently psychologically independent as well as capable of feeling connected to others in sustained ways.

Gender dysphoria – A therapeutic model for working with children, adolescents and young adults

Abstract: "Gender dysphoria – A therapeutic model for working with children, adolescents and young adults." International Forum of Psychoanalysis, ahead-of-print(ahead-of-print), pp. 1–2

Mentalization promotion and affect mobilization in clinical work

Abstract: Abstract The author presents a model of clinical intervention based on patients’ mentalization, or mind reading, that is, the function of the mind to understand the mind. The action of mind reading means a type of thought, mostly not conscious, implicit, often not even encoded in words, that expresses the meaning “I think that you think that I think.” Thoughts about the analyst’s states of mind crowd the minds of patients, taking shape in these questions: “What do you think I have in mind?” and so “How do you plan to act towards me?” If the analyst does not capture and does not disambiguate the doubts, the patient’s perplexity and insecurity can intensify and produce emotions of anxiety, fear, fright, but also anger towards a silent interlocutor. Conversely, the analyst who mentalizes the state of mind of the patient and verbalizes it heteroregulates the patient’s fears and anxiety level. Mentalization and affect regulation are also related to the analyst’s recognition of the patient’s metacognition process. At the conclusion of the theoretical section, a clinical sketch shows examples, and highlights in therapeutic work the abovementioned theoretical issues.

Paul Williams’ portrayal of the psychological growth of the narrator in <i>The fifth principle</i> and <i>Scum,</i> part 2*

Abstract: In this paper, I explore the nature of Paul Williams’ portrayal of the psychological growth of the narrator in The fifth principle and Scum. Growing up in an impoverished environment, both as a child and as an adolescent, the narrator experienced forms of neglect and abuse, which, together with the fantasies that he created, left him traumatized and close to being totally shattered. This is conveyed quite graphically through the use of various stylistic devices that include shifts in the method of narration in both books as well as the innovative use of language in Scum. Through extensive introspection as well as the help provided by others, the narrator suggests that he became sufficiently psychologically independent as well as capable of feeling connected to others in sustained ways.

Sense of self and psychosis, part 1: Identification, differentiation and the body; A theoretical basis for amniotic therapy

Abstract: Abstract We will describe in two articles (“Sense of self and psychosis”, 1 and 2) the theoretical basis and the methodology of a new therapeutic group approach called amniotic therapy, which aims to improve the sense of self of psychotic patients. In this first article we explore the role of the surface of the body and its early sensorimotor interactions in the processes of self/other identification and differentiation. We propose that these processes have common origins, the body surface and its interactions, but different destinies, depending on where the body’s surface is projected. When it is projected intrapsychically we have differentiation, and when it is projected externally onto the body’s surface of the other, we have identification. Identification is a reciprocal process, in which the self’s and the other’s surfaces mutually contain each other and co-create a shared field. The neural correlates of identification and differentiation are discussed. The second article, which follows, describes amniotic therapy and explores a single case study.

Reflections on dying patients, hospices, assisted suicide, and euthanasia

Abstract: Abstract My parents’ death struggle, my clinical work with dying patients, the euthanasia of Freud, and a fear of dementia form the background to my reflections on dying patients, hospices, assisted suicide, and euthanasia. The change in public opinion has resulted in a displacement from Nazi crimes to the present focus on the right to self-determination. Consequently, a law allowing assisted suicide or euthanasia has been adopted in several locations, such as Oregon in the USA, the Benelux countries, Switzerland, and Canada. The fear of suffering, hopelessness, and inability are strong arguments to allow euthanasia and aided suicide. A compelling case against it is its negative social consequences, the infringement into the private sphere when the sick person and their family must decide if they are willing to accept assisted suicide or euthanasia. Although the “right to death” provides freedom to some, for others it is a forced choice that interferes with the dying process. I conclude by highlighting the palliative model, wherein death is perceived as a part of an individual’s life and as a normal process, although this task is hard for the family to contain, especially when the dying person is in pain and agony. Dying is not merely an individual process. It affects the whole family as well as the future generations’ views on reciprocity and responsibility.