Showing papers in "Psychoanalytic Inquiry in 2002"
TL;DR: In this paper, a reformulation of attachment theory constructs in terms of the quality of interpersonal interpretive functioning and the interpersonal strategies adopted by individuals to maintain optimal psychological distance between themselves and others, given their particular level of interpretive capacity.
Abstract: Self-regulation is the key mediator between genetic predisposition, early experience, and adult functioning. This paper argues that all the key mechanisms underpinning the enduring effects of early relationship experiences interface with individuals' capacity to control (a) their reaction to stress, (b) their capacity to maintain focused attention, and (c) their capacity to interpret mental states in themselves and others. These three mechanisms together function to assist the individual to work closely and collaboratively with other minds. The paper proposes a reformulation of attachment theory constructs in terms of the quality of interpersonal interpretive functioning and the interpersonal strategies adopted by individuals to maintain optimal psychological distance between themselves and others, given their particular level of interpretive capacity.
284 citations
TL;DR: The Analysis of the Self as mentioned in this paper is a detailed exposition of the central role of the self in human existence, focusing on the development, structuralization, psychopathogenesis, and psychotherapy of disorders of self.
Abstract: In 1971, Heinz Kohut, trained in neurology and then psychoanalysis, published The Analysis of the Self, a detailed exposition of the central role of the self in human existence. This classic volume of both twentieth century psychoanalysis and psychology was more than a collection of various clinical observations—rather it represented an overarching integrated theory of the development, structuralization, psychopathogenesis, and psychotherapy of disorders of the self. Although some of these ideas were elaborations of previous psychoanalytic principles, a large number of his concepts, including an emphasis on self rather than ego, signified an innovative departure from mainstream psychoanalysis and yet a truly creative addition to Freud's theory.
196 citations
TL;DR: The concept of multiple code theory and the referential process are examined in relation to levels of awareness and the sense of self as characterized in recent work in neuropsychology by Damasio as discussed by the authors.
Abstract: The concepts of multiple code theory and the referential process are examined in relation to levels of awareness and the sense of self as characterized in recent work in neuropsychology by Damasio. The juxtaposition of subsymbolic and symbolic systems in working memory, as this operates in the referential process, is central to both consciousness and the sense of self. The roots of pathology lie in dissociation within emotion schemas; this applies at different levels for all forms of neurosis. The goal of psychoanalytic treatment is integration of dissociated schemas; this requires activation of subsymbolic, including bodily experience, in the session itself, in relation to symbolic representations of present and past experience. Implications concerning repression, resistance, the primary process, the role of language in therapeutic change, and other psychoanalytic concepts are discussed.
121 citations
TL;DR: In this paper, a contextualist, complexity theory perspective in conceptualizing the organization of personal, subjective experience and the therapeutic process is presented, emphasizing that one's personal, lived experience originates and continues to evolve from within a relational matrix, with affect as its primary currency.
Abstract: This article underscores and expands on a contextualist, complexity theory perspective in conceptualizing the organization of personal, subjective experience and the therapeutic process. It emphasizes that one's personal, lived experience originates and continues to evolve from within a relational matrix, with affect as its primary currency, and reevaluates what, exactly, is being analyzed and potentially transformed in the clinical setting. An extension of intersubjective systems theory, this article focuses on two complementary themes: the concept of the interpenetration of multiple worlds of experience and the idea of systemically derived organizing principles. These ideas enhance our understanding of the positive transformation of subjective experience and expand our perspectives about therapeutic change in psychoanalysis.
93 citations
TL;DR: The diagnosis of AD/HD is often discounted by psychoanalysts because it is purely descriptive and behavioral, but it can be understood in psychoanally terms as a disturbance in ego functioning, namely in the synthetic, integrative function.
Abstract: The author suggests that a multifaceted approach is optimal in the assessment of children who meet criteria for AD/HD. The diagnosis of AD/HD is often discounted by psychoanalysts because it is purely descriptive and behavioral, but it can be understood in psychoanalytic terms as a disturbance in ego functioning, namely in the synthetic, integrative function. The impact of this disturbance on development and its reverberation with dynamics, both intra-psychic and familial, create complex and highly individualized clinical presentations that evolve as development proceeds. Psychoanalytically informed evaluation and treatment recommendations are optimal, because enlightened psychoanalysts can integrate the multiple contributions to the clinical picture and craft an appropriate and balanced approach to help the child and the family toward progressive development. Such an approach may include medication, parent counseling, remediation, and psychoanalytic psychotherapy or psychoanalysis. There is an incongruit...
34 citations
TL;DR: In this article, the authors examine classical psychoanalytic theory on the female oedipal complex in order to shed light on same-sex object choice and suggest that the obscuring of female desire has to do centrally with the fate of eroticism in the early mother-daughter relationship.
Abstract: In this paper, I closely examine classical psychoanalytic theory on the female oedipal complex in order to shed light on same-sex object choice. Given that the mother is the first love object for the girl as well as for the boy, the girl's object relational constellation centrally involves the experience of homoeroticism as well as heteroeroticism. Yet, it remains a question as to whether a mother can see her daughter as a sexual subject; can mother–daughter homoerotic desire be experienced and validated by the mother? That a girl desires her mother is generally not seen or registered by the mother; it remains an unrecognized desire. I suggest that the obscuring of female desire has to do centrally with the fate of eroticism in the early mother–daughter relationship. I propose relabeling the “negative oedipal complex” in girls as “the primary maternal oedipal situation.” Issues involving invisibility or stigmatization of one's erotic desire likely pose a significant challenge to the self–esteem of many le...
30 citations
TL;DR: In this paper, a brief overview of the metatheory of integral constructivism is presented, highlighting important convergences among constructivist, dynamic systems, integral, object relations, self-psychology, and intersubjective approaches to the practice of psychotherapy.
Abstract: This article presents a brief overview of the metatheory of integral constructivism, highlighting important convergences among constructivist, dynamic systems, integral, object relations, self-psychology, and intersubjective approaches to the practice of psychotherapy. The roles of relationships, emotionality, and perturbations in the client-therapist bond are emphasized. Complex nonlinear dynamics are inherent to life organization and to therapeutic process.
29 citations
TL;DR: In this article, the authors argue for a radical relational perspective that explicitly challenges the notion of the intrapsychic and the related Cartesian assumptions of representationalism, and propose a new ontology of experience.
Abstract: This paper argues for a radical relational perspective that explicitly challenges the notion of the intrapsychic and the related Cartesian assumptions of representationalism. Conceptual tools derived from the school of embodied cognition provide an alternative theoretical language that depicts a new understanding of experience as an emergent and distributed phenomenon of a dialogic communicative system. Clinical vignettes illustrate how this new ontology of experience promotes a therapeutic ambience that dissolves the barriers to empathic contact imposed by the retention of representational modes of thought.
27 citations
TL;DR: In this article, the authors argue that the shift in psychoanalytic thinking from the primacy of drive to the importance of affectivity moves psychoanalysis toward a phenomenological contextualism and a central focus on dynamic intersubjective systems.
Abstract: It is the thesis of this article that the shift in psychoanalytic thinking from the primacy of drive to the primacy of affectivity moves psychoanalysis toward a phenomenological contextualism and a central focus on dynamic intersubjective systems. Unlike drives, which originate deep within the interior of a Cartesian isolated mind, affect—that is, subjective emotional experience—is something that from birth onward is regulated, or misregulated, within ongoing relational systems. Therefore, locating affect at the center automatically entails a radical contextualization of virtually all aspects of human psychological life.
26 citations
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TL;DR: Learning from Life as discussed by the authors is full of psychoanalytic wisdom about how to be with a traumatised patient and how to think about a patient who does not attend, how to make trial identifications with patients to support and inform internal supervision.
Abstract: “This book is full of psychoanalytic wisdom about how to be with a traumatised patient, how to think about a patient who does not attend, how to make trial identifications with patients to support and inform internal supervision, and much more. I recommend Learning from Life to anyone who values the link between the exploration of themselves and their work with patients and clients.” Donald Campbell, British Psychoanalytical Society
23 citations
TL;DR: In this paper, the author relates aspects of his own personal history and professional development in an effort to explain the changes in his way of thinking and working as an analyst that have evolved over the past thirty years.
Abstract: The author relates aspects of his own personal history and professional development in an effort to explain the changes in his way of thinking and working as an analyst that have evolved over the past thirty years. He also includes some of his current thinking on the questions of countertransference, the uses of memory, and contemporary analytic technique.
TL;DR: A neuropsychoanalytic sketch of attention deficit disorder (ADD) is presented in this article, which is defined in terms of its core symptoms, and discussed from the perspective of etiology, pathogenesis, diagnosis, differential diagnosis, and treatment.
Abstract: A neuropsychoanalytic sketch of attention deficit disorder (ADD) is presented. The syndrome is defined in terms of its core symptoms, and discussed from the perspective of etiology, pathogenesis, diagnosis, differential diagnosis, and treatment. Also unique is the effort to describe the patient's inner experiences and begin to map these onto the external perspective of what is happening psychologically and neurologically, that is, inside the patient's brain (chemically, anatomically, and neurophysiologically). A number of speculations are thus created regarding the role of the executive control network (ECN), particularly, that of the basal ganglia, cerebellum, anterior cingulate, and those parts of the ECN that are responsible for such things as cognitive shifting between low-level routine information processing modes and those used for high-level processing applicable for sensitive or complex analysis. The effects of trauma on the tagging of memories are also considered. In this manner the research of S...
TL;DR: A review of my development from psychology intern and research assistant to the psychoanalytic tester and theoretician David Rapaport at the Menninger Clinic in the 1940s, through my career in psychological testing, my psychodynamic training in the Western New England Institute, and my working successively at the Austen Riggs Center, Yale Department of Psychiatry, Yale Student Mental Health Center, Cornell Department of psychiatry, and eventually private practice in New York City can be found in this article.
Abstract: This paper is a review of my development from psychology intern and research assistant to the psychoanalytic tester and theoretician David Rapaport at the Menninger Clinic in the 1940s, through my career in psychological testing, my psychoanalytic training in the Western New England Institute, and my working successively at the Austen Riggs Center, Yale Department of Psychiatry, Yale Student Mental Health Center, Cornell Department of Psychiatry, and eventually private practice in New York City. During this period, I rose to the academic rank of Professor and the analytic position of Training Analyst. I have written extensively: first on testing, then more or less in turn on psychoanalytic ego psychology, action language for psychoanalysis, feminist issues, narrative in psychoanalysis, and the contemporary Kleinians of London. This memoir traces the intellectual continuity that characterizes these writings and my continuing development as a psycho-analyst—my first ambition and great love.
TL;DR: In this paper, a psychoanalytic treatment of an Attention Deficit/Hyperactivity Disorder (AD/HD) patient is presented, taking account of the development of self-regulation in terms of interactive social exchanges, as well as neurobiologically based factors.
Abstract: Attention Deficit/Hyperactivity Disorder (AD/HD), only recently diagnosed in adults, usually is treated by medication and coaching. This article presents a psychoanalytic treatment of an AD/HD patient, taking account of the development of self-regulation in terms of interactive social exchanges, as well as neurobiologically based factors. The patient's gains in cognition and affect management opened the way for development of empathic capacity after the therapist began integrating ideas and methods from the AD/HD theoretical literature with Beebe and Lachmann's (1994, 1998) model of self-and mutual regulation. The key idea from the AD/HD research (Barkley, 1997b) is that the disorder is at root a deficit in the capacity to inhibit response to internal and external stimuli long enough to allow time for reflection, affect management, planning, and other executive functions that neuroscience links with the prefrontal cortex and other areas of the brain.
TL;DR: The patient's internal experience of states of distractibility, impulsivity, and hyperactivity, their incorporation in unconscious fantasies, and their employment in the service of both self-punitive urges and defenses against the "unpleasure" associated with psychic conflicts are explored in this article.
Abstract: AD/HD may be overlooked as well as too zealously and concretely overdiagnosed. When this condition is properly identified, it is most fruitfully understood in a balanced manner that is integrated with an appreciation of its inevitable shaping influence on the patient's perceptions, self-experience, and psychodynamic constellation, including central unconscious fantasies. This exploration is necessarily multifaceted: the patient's internal experience of states of distractibility, impulsivity, and hyperactivity, their incorporation in unconscious fantasies, and their employment in the service of both self-punitive urges and defenses against the “unpleasure” (Brenner, 1982) associated with psychic conflicts. Psychoanalysts are in a unique position to grasp these complex relationships. Familiarity with diagnostic issues, the developmental impact of AD/HD, common difficulties such patients present in treatment, and typical countertransference responses will enrich their psychoanalytic work. Interrelationships ...
TL;DR: The responses to the challenges of developmental milestones are particularly interesting for female therapists, whom I have studied extensively since 1983, as will be alluded to subsequently, and from whose work I draw a clinical example for this paper as mentioned in this paper.
Abstract: LIFE IS NOT STATIC, NOR ARE WE. THROUGH DIFFERING DEVELOPMENTAL stages, we analysts may experience poignant self-awakenings precipitated by internal and external changes, some of which may originate in our work with particular patients. Our directions in life often shift as external events and internal modifications cause us to bring new insights and perspectives into the analytic treatment milieu. Through life and treatment processes, then, many psychoanalysts may manifest these shifts and changes by altering their approaches and treatment directions with their patients in the analytic situation. In doing so, analysts may also bring innovative new ideas and revitalizing approaches to the body of knowledge in the mental health field. The responses to the challenges of developmental milestones are particularly interesting for female therapists, whom I have studied extensively since 1983, as will be alluded to subsequently, and from whose work I draw a clinical example for this paper. Issues of separation anxiety and loss, movement into middle age and advanced maturity, all reverberate in a particular way for women in our society and culture. The female analyst’s response to her own life stage can have profound implications
TL;DR: Research findings and review articles in the neurosciences relevant to AD/HD are surveyed in this article, with a focus on the areas of attention and executive control, learning, and neural plasticity and memory.
Abstract: Research findings and review articles in the neurosciences relevant to AD/HD are surveyed. Summaries of results in the areas of attention and executive control, learning, and neural plasticity and memory suggest that, as hypothesized, AD/HD is an apt field for the interdigitation of psychoanalysis, neuroscience, and cognitive psychology. Two case reports of adult AD/HD patients demonstrate the intricacy of the clinical picture.
TL;DR: One of the major advances in PSYCHOANALYTIC Theory and Practice during the last two decades has been the broadening of our understanding and use of the concept of countertransference as discussed by the authors.
Abstract: ONE OF THE MAJOR ADVANCES IN PSYCHOANALYTIC THEORY AND PRACTICE during the last two decades has been the broadening of our understanding and use of the concept of countertransference. From Freud’s (1920) original position that “the countertransference arises in the analyst as a result of the patient’s influence on his unconscious feelings, and we are almost inclined to insist that he shall recognize the countertransference in himself and overcome it” (pp. 144–145), current practitioners tend to view countertransference as including “all of the emotional reactions at work” (Abend, 1989, p. 374). Rather than being experienced solely as an obstacle to be overcome, countertransference is now regarded by most clinicians as “all those reactions of the analyst to the patient that may help or hinder treatment” (Slakter, 1987, p. 3). Although Freud’s model of the cold, dispassionate clinician who unemotionally performs his work diligently and objectively has been part of most analysts’ professional superegos during at least some part of their careers, this idealized image has been consistently challenged. Freud himself, as we know, did not always practice what he preached. He loaned money to his patients, fed some, hugged others, gave advice to many and went on vacation with a few (Jones, 1953). In his inner circle, although his adherents constantly reiterated Freud’s notion of
TL;DR: In this paper, three moments of spontaneity and surprise from the analysis of a man with a rigid character structure are presented and discussed, and the authors discuss the potential for change to occur through perturbations in the analyst-analysand system.
Abstract: Moments of spontaneity and surprise create opportunities for change to occur through perturbations in the analyst-analysand system. These moments of authentic person-to-person contact violate anticipated patterns of intersubjective engagement. Mutative potential arises from the coconstruction of new relational configurations and the resultant modifications in the procedural memory system of both members of the analytic dyad. Three moments of spontaneity and surprise from the analysis of a man with a rigid character structure are presented and discussed.
TL;DR: In this article, an attempt is made to elaborate an analytic event consisting of a dream dreamt by the analyst and a corresponding memory told for the first time the next morning by the patient, both of which reflect the same content.
Abstract: An attempt is made to elaborate an analytic event consisting of a dream dreamt by the analyst and a corresponding memory told for the first time the next morning by the patient, both of which reflect the same content. The question that is addressed is, how did these same ideas occur simultaneously to both patient and analyst? The analytic dyad is envisioned as an integrated system, and connectionism is used to formulate the concept of an empathic network, with the assumption that the symbolic content (e.g., imagery, dreams, accounts of memories) emerges from an integrated system having both individual and personal representations and systemic and parallel distributed representations.
TL;DR: Gerald Edelman's theory of neuronal group selection (1987, 1989, 1992) describes how we appraise, organize, and reorganize our subjective experience of the world as mentioned in this paper. But it is not a theory that is applicable to the clinical domain.
Abstract: Gerald Edelman's theory of neuronal group selection (1987, 1989, 1992) describes how we appraise, organize, and reorganize our subjective experience of the world. Edelman's theory and the intrinsic principles of selection and self-organization are explicated. A clinical case illustrates the psychoanalytic implications of both Edelman's theory and a dynamic systems approach to development and change (Thelen and Smith, 1994) in which deeply ingrained traumatic experience is transformed through positive, new experiences that impact and become integrated within primary consciousness. The relevance of recognition, adaptive matching, mapping, and remapping of trajectories of experience, primary emotions, and brain asymmetry to developmental change is discussed.
TL;DR: Working through has been defined in a variety of ways as discussed by the authors, including as a gradual process of altering automatic reactions and the anxiety that attends them, and as a mourning process in which old object ties, long-held fantasies and accustomed ways of thinking and responding are gradually relinquished.
Abstract: Y AIM IN THIS CHAPTER IS TO DISCUSS WORKING THROUGH IN THE M analyst as an ongoing process, one that, inevitably, has a major impact on clinical work. By “ongoing,” I mean an open-ended, often lifelong, effort to revisit, relive, and revise those unsatisfactory compromise formations that have contributed so much to our neurotic difficulties. As traditionally defined, the term working through has been limited to the analytic process itself and has been conceptualized in a variety of ways. Some authors (Brodsky, 1967) view working through as the gradual process of altering automatic reactions and the anxiety that attends them. Others (Ornstein, 1991) link it to early traumatic experiences and understand it as involving the slow integration and mastery of such experiences. Still others (Parken, 1981) regard working through as analogous to a mourning process in which old object ties, long-held fantasies, and accustomed ways of thinking and responding are gradually relinquished. Emphasizing its complex nature, Brenner (1987) regards working through as equivalent to the analytic process itself. He sees no need for a separate term to designate what for him is the essential work of analysis. Although Brenner is correct in pointing out that the working through of conflict is an integral part of analytic treatment, there is value, I
TL;DR: In this paper, the authors describe a psychoanalyst's journey from ego psychology in the early 1970s to the year 2000, where the emphasis was on retaining early valuable tenets and adding new theoretical and technical concepts.
Abstract: Challenged by clinical findings and necessity, psychoanalysts proceed on a lifelong professional journey of exploring, deleting, adding, and integrating from various theoretical and technical paradigms. This article briefly depicts one analyst's journey from ego psychology in the early 1970s to the year 2000. The emphasis on retaining early valuable tenets and adding new theoretical and technical concepts. As an example, conflicts involving problems of the self and ego ideal, brought to the fore through work with patients having significant self-esteem, shame, and envy difficulties, are singled out. These conflicts are found in cases such as those with anorexia, body image disturbance, gender identity and negative gender message problems, and cases having early denigrating environments. Shame dynamics are addressed. The presenting pictures for problems involving shame are usually new compromise formations prompted by signal shame. A case is reported to depict the use of modern conflict theory in analyzing...
TL;DR: Two seminal thinkers, Edelman and Damasio, offer neurophysiological models of brain development and functioning that correspond with a contemporary psychoanalytic focus on dynamic experiential intersubjective systems.
Abstract: Two seminal thinkers, Edelman and Damasio, offer neurophysiological models of brain development and functioning that correspond with a contemporary psychoanalytic focus on dynamic experiential intersubjective systems. I describe their respective contributions under three headings derived from Edelman: values, consciousness, and language. I consider the scope of each of these topics as it abuts related psychoanalytic concepts.
TL;DR: In this paper, the authors identify the psychological developmental issues of this period, such as changes in self concept, identity, the awareness of time, and changes in expectations and goals such as the wish to create a family.
Abstract: Changes in sexual orientation or object choice in midlife can represent many different dynamics. Understanding these involves recognition of the psychological developmental issues of this period, such as changes in self concept, identity, the awareness of time, and changes in expectations and goals, such as the wish to create a family. Other needs, for intimacy and emotional richness, or the revival of wishes for closer ties to one's mother, can then become dominant and be expressed sexually. Earlier, more conventional choices can be abandoned, particularly after children are born. For some women an early homosexual relationship is replaced temporarily or permanently by a heterosexual one. This can represent permission to move outside the world of women, or a wish for a family and children. Fluidity of choice may be more characteristic for women than men and may be related to characteristics of the female body.
TL;DR: Using the bibliography of the Committee on Homosexuality of the American Psychoanalytic Association as a resource, this paper conducted a wide review of the psychoanalyst literature on lesbianism and bisexuality in women and found that an evolution in theory over time was observed in the writing by authors more familiar to most analysts.
Abstract: Using the bibliography of the Committee on Homosexuality of the American Psychoanalytic Association as a resource, a wide review of the psychoanalytic literature on lesbianism and bisexuality in women was undertaken. An evolution in theory, over time, was observed in the writing by authors more familiar to most analysts. A second group of less widely known writers has also written extensively on the subject. This chapter focuses on the predominant, recurring themes found in the second body of work. These themes include: separating the concepts of gender identity and object choice; reexamining assumptions about developmental pathways; fluidity in object choice in women; dilemmas in lesbian experience; and treatment issues. Dilemmas include feeling different, coming out, relationship patterns, and decisions about parenting. Similarities between the ideas found in the two bodies of work are noted.
TL;DR: In this paper, the authors describe how an experience of profound loss and the special circumstances that surrounded it necessitated changes in their work with patients as well as changes in my understanding of myself.
Abstract: THIS PAPER IS ABOUT HOW AN EXPERIENCE OF PROFOUND LOSS AND THE special circumstances that surrounded it necessitated changes in my work with patients as well as changes in my understanding of myself. I want to write this paper partly because I’ve always found it helpful professionally when colleagues tell clinical stories about unusual circumstances in their practices. In the same way, I hope that what I have discovered and reflected upon in my clinical work will prove useful to others in the field. Perhaps as important, in the past I have found writing about the pain and stress of a traumatic event to be a healing and restorative process for myself. Nevertheless, writing this paper is difficult. What I am about to describe is so intensely personal to me that I’m not sure I could have attempted it were it not for a quotation of John Bowlby’s (1990) that I came across which seems to have provided the encouragement, and the courage, that I needed. He wrote: “When people start writing they think they’ve got to write something definitive. . . . I think that is fatal. The mood to write in is: ‘This is quite an interesting story I’ve got to tell. I hope someone will be interested. Anyway, it’s the best I can do for the present.’ If one adopts that line one gets over it and
TL;DR: In this article, the role of aggression in female development is discussed and the importance of ambivalence is considered in its impact on maternal identification and sexual object choice, as well as gender identity, gender role and object choice.
Abstract: In order to further our understanding of lesbianism the newer ideas of female development and of sexual object choice must be integrated into psychoanalytic theory. This includes such concepts as primary femininity, the girl's primary wish for a baby, and female genital sensations leading to a gradual understanding of female anatomy. Ties to each parent develop in tandem, not sequentially. Boys and girls have different attachment and separation experiences. Genital release, a major organizer of male psychological development, may not be as important as intimacy in the girl's development. Multitudes of environmental influences play a role in establishing gender identity, gender role and sexual object choice. Nature and nurture interact. Homosexuality and psychopathology are not connected and psychodynamics is not the same as etiology. A case presentation focuses on the role of aggression in female development. The importance of ambivalence is considered in its impact on maternal identification and sexual o...