Showing papers in "The International Journal of Psychoanalysis in 2008"

The analytic situation as a dynamic field

Abstract: This paper discusses the consequences of the importance that recent 3 papers assign to the countertransference. When the latter acquires a theoretical and technical value equal to that of the trans...

Transference focused psychotherapy: Overview and update.

Abstract: This paper describes a specific psychoanalytic psychotherapy for patients with severe personality disorders, its technical approach and specific research projects establishing empirical evidence supporting its efficacy. This treatment derives from the findings of the Menninger Foundation Psychotherapy Research project, and applies a model of contemporary psychoanalytic object relations theory as its theoretical foundation. The paper differentiates this treatment from alternative psychoanalytic approaches, including other types of psychoanalytic psychotherapy as well as standard psychoanalysis, and from three alternative non-analytical treatments prevalent in the treatment of borderline patients, namely, dialectic behavior therapy, supportive psychotherapy based on psychoanalytic theory, and schema focused therapy. It concludes with indications and contraindications to this particular therapeutic approach derived from the clinical experience that evolved in the course of the sequence of research projects leading to the empirical establishment of its efficacy.

Protecting the Self: Defense Mechanisms in Action

Abstract: by Phebe Cramer Guilford Press , New York , 2006 ; 384 pp; $45 Protecting the Self: Defense Mechanisms in Action summarizes a lifetime of research on defense mechanisms. This book will be one in a ...

Phantastic objects and the financial market's sense of reality: a psychoanalytic contribution to the understanding of stock market instability.

Abstract: This paper sets out to explore if standard psychoanalytic thinking based on clinical experience can illuminate instability in financial markets and its widespread human consequences. Buying, holding or selling financial assets in conditions of inherent uncertainty and ambiguity, it is argued, necessarily implies an ambivalent emotional and phantasy relationship to them. Based on the evidence of historical accounts, supplemented by some interviewing, the authors suggest a psychoanalytic approach focusing on unconscious phantasy relationships, states of mind, and unconscious group functioning can explain some outstanding questions about financial bubbles which cannot be explained with mainstream economic theories. The authors also suggest some institutional features of financial markets which may ordinarily increase or decrease the likelihood that financial decisions result from splitting off those thoughts which give rise to painful emotions. Splitting would increase the future risk of financial instability and in this respect the theory with which economic agents in such markets approach their work is important. An interdisciplinary theory recognizing and making possible the integration of emotional experience may be more useful to economic agents than the present mainstream theories which contrast rational and irrational decision-making and model them as making consistent decisions on the basis of reasoning alone.

The body in the analytic session: focusing on the body-mind link.

Abstract: The author focuses on the importance of the body in the analysis of patients with a defect of thinking. In many cases this defect is not fully evident until concrete and bodily aspects begin to emerge in sessions. In the absence of awareness of the body, the patient’s personality is deprived of the main source of emotional stimulus, and mental growth is consequently paralysed. Hence the body is considered the starting point of mental processes and a progressive source of experience requiring the exercise of responsibility and thought. To indicate the theoretical background to this essentially clinical paper, some hypotheses about the body–mind link are very briefly considered. Specific emphasis is given to the development of Freud–Klein–Bionian theories about this subject and to some of Ferrari ’s recent proposals. The author discusses four clinical cases, emphasizing the encounter with the body in analysis and its integration in emotional and thinking processes. The analyst’s function in such cases is conceived mainly as that of midwife for a dialogue between the analysand ’s body and mind.

Donald Woods Winnicott (1896-1971): a brief introduction.

Abstract: This essay offers a guide to the trajectory of Winnicott’s theories from 1919 to 1971. Part one surveys the archives, publications, and the collected works project. Part two is divided into four se...

The language of absence

Abstract: This paper will focus on the concept of ‘absence’, which describes a continuum of non-responsiveness and misattunement of the environment in the stage of absolute dependence; it refers to concepts like lack, failure, non-recognition, impingement, neglect, tantalizing, ranging to mental, physical and sexual abuse. An extreme external absence causes shock and fear. The automatic survival response is an inner absence, an intrapsychic absence, a dissociation of parts of the self. The external and the inner absence are the negative image of each other. The concept of absence points to the synchronicity of outer and inner reality and portrays the non-responded-to needs of the self. This point of view of the development of psychopathology of the self on the basis of massive dissociation is inherently an intersubjective-field-theory. As the inner absence is created as a reaction to an absence of the other, in analysis – the analyst has an active role in reviving it. This paper will explore the language of absence, that is, the derivatives and consequences of these situations in the inner realm, and in the relations with the analyst. It is the author’s contention that understanding and speaking this language has important clinical and technical implications. Understanding the language of absence enables the analyst to recognize its intersubjective and its intrapsychic presence, to provide an environment that allows for its revival, and to facilitate and regulate the annihilation anxiety that awakens when dissociated self-states are experienced. When the absence is present, i.e. when the traumatic experience and the dissociated reactions to it are experienced in an attuned relationship, it is rendered with meaning, symbolization, and validation, and enables the survival mode of dissociation to be relinquished.

Biographical Truths and Their Clinical Consequences: Understanding 'Embodied Memories' in a Third Psychoanalysis with a Traumatized Patient Recovered from Severe Poliomyelitis

Abstract: The relationship between 'narrative' and 'historical-biographical truth' in psychoanalytic treatment has become the subject of many controversial debates in recent years. Findings of contemporary memory research have lead to great scepticism as to whether therapists are able objectively and reliably to reconstruct biographical events on the basis of their observations in the therapeutic situation. Some authors even claim that psychoanalysts should concentrate exclusively on observing the here and now of the patient's behaviour within the transference relationship to the analyst. In this paper it will be discussed whether the baby has been thrown out with the bathwater in this debate. Centred around the insights from a third psychoanalysis with a patient who suffered from a severe case of childhood polio, the hypothesis will be discussed that working through the traumatic experience in the transference with the analyst, as well as the reconstruction of the biographical-historical reality of the trauma suffered, prove to be indispensable for a lasting structural change. Integration of the trauma into one's own personal history and identity is and remains one of the main aims of a psychoanalytic treatment with severely traumatized patients. The reconstruction of the original trauma is indispensable in helping the patient to understand the 'language of the body' and to connect it with visualizations, images and verbalizations. The irreversable wounds and vulnerability of his body as the 'signs of his specific traumatic history' have to be recognized, emotionally accepted and understood in order to live with them and not deny them any longer. Another important aspect in psychoanalysis is to develop the capability to mentalize, in other words, to understand the intentions of central (primary) objects related to the trauma. The concept of 'embodied memory' might be helpful in understanding precisely in what way 'early trauma is remembered by the body'. Observing in detail the sensory-motor coordinations in the analytic relationship enables one to decode the inappropriate intensity of affects and fantasies which match the original traumatic interaction and are revealed as inappropriate reactions in the present, new relationship to the analyst.

Playing with unreality : Transference and computer

Abstract: In this paper I describe the impact of cyberspace on the analytical relationship My reflections will move from two clinical histories In the first history, I describe the case of Melania, a patient who, at a certain moment of her analysis, started sending me e-mails, almost building a ‘parallel setting’ I describe the relational dynamics linked to the irruption of the electronic mail into the boundaries of our psychoanalytic relationship The second case is Louis, a 25 year-old young man with a schizoid personality who uses cyberspace as a psychic retreat Over the years Louis told me, initially from a sidereal distance, of his necessity to create dissociative moments The entrance to these retreats procures for Louis an immobile pacification, which may assume the characteristics of a trance: life comes to a halt in a state of ‘suspended animation’ We can see the use that Louis makes of the computer as an attempt to live into a non-human object and to protect himself from relational anguish, but also to warm up a mechanical mother Melania used technology to communicate with me, albeit in a roundabout way; for Louis, virtual space was a ‘dissociative retreat’ located on the border between sleeping and waking, which for years went untouched by our analytical discourse For both patients, the computer was a tool for emotional regulation, and the analytical relationship aimed to give this tool some relational meaning, facilitating the shift from compulsive usage to a transformative use of the object

‘Caesura’ as Bion’s discourse on method

Abstract: The author contends that Caesura, one of Bion’s last works, can be read as the equivalent of Descartes’s Discourse on Method. In this compact and complex text, the dictate of ‘methodical’ and ‘hyperbolic doubt’– so called because it is taken to the extreme form of application to the faculty of thought itself – which, for Descartes, represents the fundamental principle of philosophical and scientific research, is reflected in the formula of ‘transcending the caesura’. Bion directs his attention successively to the pairs of opposing concepts that structure psychoanalytic discourse and demonstrates their paradoxical and non‐separative logic. The binary system of producing meaning is deconstructed through the systematic use of non‐pathological – i.e. not static but dynamic – reversible perspective. A viewpoint that appears natural, self‐evident and primary is plunged into crisis and proves to be founded on what the punctuation mark of the slash excludes. Yet the new point of view does not supplant its predece...

History of the unconscious in Soviet Russia: from its origins to the fall of the Soviet Union.

Abstract: Russia accepted the notion of the unconscious and psychoanalysis before many Western countries. The first Russian Psychoanalytic Society was established in 1911. After World War I and the Russian Revolution, for a short happy period, the following psychoanalysts were active: Sabina Spielrein, Tatiana Rosenthal, Moshe Wulff, Nikolai Osipov and Ivan Ermakov. Scholars associated with Soviet ideas participated too, including Aleksandr Luria, Michail Rejsner and Pavel Blonskij. Lev Vygotskij himself dealt with the unconscious. A second psychoanalytical society was set up in Kazan. Unfortunately, at the end of the 1920s, repression dissolved the psychoanalytic movement. Even the word 'psychoanalysis' was banned for decades. Nonetheless, interest in the unconscious, as distinct from psychoanalytic theory, survived in the work of the Georgian leader D. Uznadze. His followers organized the 1979 International Symposium on the Unconscious, in Tbilisi, Georgia, which marked the breaking of an ideological barrier. Since then, many medical, psychological, philosophical and sociological scholars have taken an interest in the unconscious, a subject both feared, for its ideological implications, and desired. Since the 1980s, psychoanalytic ideas have been published in the scientific press and have spread in society. The fall of the USSR in 1991 liberalized the scientific and institutional development of psychoanalysis.

The destruction of time in pathological narcissism.

Abstract: This paper describes the characteristics of subjective time (in contrast to objective time), with particular reference to a specific form of pathological experience and relation to the passage of time in patients with narcissistic personality undergoing psychoanalytic treatment. The clinical manifestations and technical approach to this pathology of time experience are outlined in the context of illustrative clinical vignettes.

On: repression and splitting: towards a method of conceptual comparison.

Abstract: An attempt is made to compare two psychoanalytic concepts which by ‘belonging’ to different psychoanalytic groups have come to be defined and used differently. The paper is also an inquiry into the possibility of a comparative psychoanalytic method. The two concepts are ‘repression’ and ‘splitting of the ego’ and an examination is made of the semantic similarities and differences. Some clinical material is offered that adds indicative clinical evidence to test the semantic comparison. The aim is to answer the question: Are the terms simply alternative ones for similar clinical phenomena? The paper offers one method which could provide an answer. It represents a general method for clarifying and maybe reconciling the differing points of view of competing psychoanalytic schools.

Enactment controversies: a critical review of current debates.

Abstract: This critical review of the current disputes concerning countertransference enactment systematically outlines the various issues and the perspectives adopted by the relevant psychoanalytic authors. In the light of this the ‘common ground ’ hypothesis concerning the unifying influence of contemporary countertransference theory is challenged. While the existence of enactments, minimally defined as the analyst’s inadvertent actualization of the patient’s transference fantasies, is widely accepted, controversies regarding the specific scope, nature, prevalence, relationship to countertransference experience, impact on the analytic process, role played by the analyst’s subjectivity, and the correct handling of enactments abound. Rather than taking a stand based on ideological allegiance to any particular psychoanalytic school or philosophical position, the author argues that the relative merits of contending perspectives is best evaluated with reference to close process scrutiny of the context, manifestation and impact of specific enactments on patients’ intrapsychic functioning and the analytic relationship. A detailed account of an interpretative enactment provides a context for the author’s position on these debates.

Un singulier pluriel. La psychanalyse à l'épreuve du groupe

Abstract: by Rene Kaes Dunod , Paris , 2007 ; 239 pp; €26 Rene Kaes’s most recent book, which is addressed particularly to psychoanalysts, is important in several respects.2Firstly, it may be considered as o...

Sexual Boundary Violations: Therapeutic, Supervisory, and Academic Contexts

Abstract: dangerous only if habitual or chronic. As a temporary phenomenon it is virtually unavoidable, and not the expression of a mistake or failure. Whereas on the one hand the phobic position constitutes a kind of bulwark against vulnerable areas of the analyst’s personality, on the other it is essential – and, in the author’s view, this is indeed the analyst’s principal contribution – for it to be worked through over and over again with the aid of self-empathy and self-reflection. One is impressed by the author’s courage in focusing, as the main subject of his book, on his own negative feelings and on a substantially de-idealized appreciation of himself as an analyst. The reader is persuaded that anxiety, uncertainty of professional identity, not-knowing, and perplexity, even after decades of psychoanalytic practice, are absolutely intrinsic to psychoanalysis, for all that these negative experiences hardly ever feature in the psychoanalytic discourse. In addition, the author reassures us that even defending against these negative experiences is not to be regarded as pathological, but is unavoidable. Yet here too self-reflection is de rigueur. Two criticisms are perhaps warranted. Firstly, more than half the book is concerned not with the analyst’s anxiety, but with the conditions of the analytic situation, considered substantially in intersubjective terms. A more correct title for the book would be The Analytic Situation and the Analyst’s Anxiety. Secondly, it is unfortunate that Ralf Zwiebel very often mentions the concept of anxiety in a single breath with shame and the sense of guilt, but fails to dwell further on the two latter notions. Yet, as we all know, the analyst’s ‘anxiety’ is in many respects a diffuse malaise in which anxiety is mixed with a sense of guilt about having done something wrong and shame at being inadequate. I nevertheless regard this book as an important contribution to the debate on the further development of psychoanalysis into a relational science.

Forms of Intersubjectivity in Infant Research and Adult Treatment

Abstract: The traditional psychoanalytic image of infancy was transformed in the 1980s by the application of observational research about infant–caregiver interactions to psychoanalytic developmental and clinical theorizing, as is well known. Recently, an array of articles and books has taken these original efforts forward in a further consolidation of new research, taking note of the apparent consilience of these advances with current findings from several adjacent fields. These include neuroscience, especially developmental neuroscience; affect theory and research; attachment theory; and clinical psychotherapy research and theory, especially that derived from psychoanalysis. Increasingly, these apparently diverse disciplines are linked – all organized within the broad conceptual envelope of non-linear dynamic systems theory. Overall, these convergences have been brought together to construct more complex and extensive models of the mind and its development; in turn, these have been applied to analytic theories of psychic structure, therapeutic action, and clinical technique. From this developing model has emerged the core of ‘intersubjectivity theory’: that the fundamental processes motivating and organizing both early development and psychoanalytic process are rooted in two-person interactions that are cocreated by the two participants, whether infant and parent or analysand and analyst. Transference and countertransference are viewed as fundamentally and inextricably intertwined within the dyadic system of the evolving analytic relationship, in an application of core concepts such as mutual interactive regulation and the ‘self-with-other’ internal representations. A strong analogy is made between early development and adult psychoanalysis. Forms of Intersubjectivity in Infant Research and Adult Treatment is a valuable addition to this literature. It offers a clear and forthright statement of both the intersubjectivist position and other substantial implications of the infancy–analysis analogy, a useful overview of some of the most recent relevant research findings, a thoughtful analysis of some of the different applications of these conceptualizations in the work of various analytic clinician–theorists, and extensive and creative elaboration of a variety of clinical implications of the authors’ reading of the new approaches. The main section of the book also includes a compelling and impressively detailed case report by Beebe that illustrates the application of these innovations to the analysis of a woman with a history of severe trauma. In addition, there are two very useful discussions by experienced analysts: Jacobs has himself made substantial contributions to the intersubjectivist clinical approach, while Pally has been a leading synthesizer of neuroscience research with psychoanalysis. Int J Psychoanal (2008) 89:885–917 885

Between private and public: towards a conception of the transitional subject

Abstract: Elaborating upon Winnicott’s seminal contributions on the transitional object, the author proposes a conception of a transitional subject in which the patient comes into being simultaneously between private and public, subjective creation and material life, me and not‐me. By anchoring subjective creation in the real world (including the body), the patient creates a basis for authentic psychesoma as well as for both personal and symbolic contributions to the world beyond omnipotence, including the world of other subjects. In this sense, intersubjective life is seen as predicated upon transitionality, with the patient seen as simultaneously coming into being as a distinctly personal subject and, in part, as a symbol. Clinical phenomenology is described and is interpreted with respect to the need within psychoanalysis itself for a third, and for a realm of meaning‐creation that lies beyond privacy, omnipotence, and the dyad.

Off the beaten track: Freud, sound and music. Statement of a problem and some historico‐critical notes

Abstract: The authors note that the element of sound and music has no place in the model of mental functioning bequeathed to us by Freud, which is dominated by the visual and the representational. They consider the reasons for this exclusion and its consequences, and ask whether the simple biographical explanation offered by Freud himself is acceptable. This contribution reconstructs the historical and cultural background to that exclusion, cites some relevant emblematic passages, and discusses Freud's position on music and on the aesthetic experience in general. Particular attention is devoted to the relationship between Freud and Lipps, which is important both for the originality of Lipps's thinking in the turn-of-the-century debate and for his ideas on the musical aspects of the foundations of psychic life, at which Freud 'stopped', as he himself wrote. Moreover, the shade of Lipps accompanied Freud throughout his scientific career from 1898 to 1938. Like all foundations, that of psychoanalysis was shaped by a system of inclusions and exclusions. The exclusion of the element of sound and music is understandable in view of the cultural background to the development of the concepts of the representational unconscious and infantile sexuality. While the consequences have been far reaching, the knowledge accumulated since that exclusion enables us to resume, albeit on a different basis, the composition of the 'unfinished symphony' of the relationship between psychoanalysis and music.

Theoretical plurality and pluralism in psychoanalytic practice.

Abstract: The author begins by characterizing the present situation of psychoanalysis as one of increasing theoretical and practical diversity. The aim of this paper is to consider in depth the impact of theoretical plurality on clinical practice. After noting that the analyst has much more than evenly suspended attention in his(2)mind as he works with his patient in a session, the author reviews both older and more recent contributions on what the analyst has in his mind when working with a patient. He suggests that the subject has been addressed mainly from a single-person perspective. In this connection, and on the basis of clinical material, he attempts to show how, against the background of the 'implicit use of explicit theories', an ongoing process of decision-making that is co-determined by the patient's action and reaction takes place in the analyst's mind. In his analysis of a session, the author introduces the concepts of theoretical reason and practical reason, and contends that, whatever theories the analyst may have implicitly or explicitly in his mind, they ultimately yield to practical reasons. Pursuing the same line of thought, he describes validation in the clinical context as a single, wide-ranging, continuous process of social and linguistic co-construction of the intersubjective reality between patient and analyst. This process includes mutual aspects of observation and of communicative and pragmatic validation. In conclusion, he suggests that the figure of the craftsman is an appropriate description of the analyst in this conception of his work.

Immersion versus interactivity and analytic field.

Abstract: Losing oneself in a story, a film or a picture is nothing but another step in the suspension of disbelief that permits one to become immersed in the ‘novel’ of reality. It is not by chance that the text-world metaphor informs classical aesthetics that, more than anything else, emphasizes emotional involvement. On the contrary, as in much of modern art, self-reflexivity and metafictional attention to the rhetoric of the real, to the framework, to the conventions and to the processes of meaning production, all involve a disenchanted, detached and sceptic vision – in short, an aesthetics of the text as game. By analogy, any analytic style or model that aims to produce a transformative experience must satisfactorily resolve the conflict between immersion (the analyst’s emotional participation and sticking to the dreamlike or fictional climate of the session, dreaming knowing it’s a dream) and interactivity (for the most part, interpretation as an anti-immersive device that ‘wakes’ one from fiction and demystifies consciousness). In analytic field theory the setting can be defined – because of the weight given to performativity of language, to the sensory matrix of the transference and the transparency of the medium – the place where an ideal balance is sought between immersion and interaction.

Sensuality and Sexuality Across the Divide of Shame

Abstract: by Joseph D. Lichtenberg The Analytic Press , New York, London , 2008 ; 160 pp; $90 This slim volume, the twenty‐fifth in the Psychoanalytic Inquiry book series, is composed of a brief, crisp intro...

Trauma and traumatic neurosis: Freud's concepts revisited.

Abstract: The authors examine Freud 's concepts of 'trauma', 'protective shield against stimuli ' and 'traumatic neurosis' in the light of recent findings. 'Protective shield against stimuli' is regarded as a biological concept which appears in mental life as the striving to avoid unpleasant affects. 'Trauma' is a twofold concept in that it relates to mental experience and links an external event with the specific after-effects on an individual 's psychic reality. A distinction needs to be made between mentally destructive trauma and affective trauma. A destructive trauma does not break through the protective shield but does breach the pleasure-unpleasure principle, so that in the course of its subsequent mastery it leads to a traumatic neurosis. An affective trauma can be warded off under the rule of the pleasure-unpleasure principle and leads to a psychoneurosis.

Leaps of faith: is forgiveness a useful concept?

Abstract: Using detailed clinical vignettes, the author argues that, despite the current idealization of the concept of forgiveness, the term has no place in psychoanalytic work, and there are some hazards to giving it one. Clinically, the concept of forgiveness is seductive, implying that there should be a common outcome to a variety of injuries, stemming from different situations and calling for different solutions. Every instance of what we call forgiveness can be seen to serve a different defensive function. While the conscious experience of what is called forgiveness is sometimes confused with the unconscious process of reparation, the two can only be described at different levels of psychic life. Despite the fact that in ‘the unconscious’ there is no such thing as forgiveness, the term has an adhesive quality in our thinking that also blunts the analyst'’s appreciation of the aggressive components in the work. In a final vignette, the author illustrates an analytic outcome that has the appearance of forgiveness, but is best understood as the complex result of the everyday work of analysis.

The analyst's implicit alpha-function, trauma and enactment in the analysis of borderline patients.

Abstract: The present paper discusses situations in which patient and analyst are involved in obstructive collusions, non-dreams-for-two, shaping enactments. Specifically, it describes explosions in the analytical field, acute enactments, which the analyst assigns, at first sight, to his faulty conduct. The subsequent amplification of the analytical dyad's capacity of symbolization makes the analyst investigate his presumed fault. The present work shows how acute enactments revive traumatic situations that were concealed by previous obstructive collusions, or chronic enactments. During chronic enactments unconscious exchanges occur between the dyad, in which the analyst provides implicit alpha-function to the patient, little by little recovering the traumatized parts. When there is enough recovery, the protective collusion is undone and the trauma is revived as acute enactment. This revival will not be traumatic because there are mental resources ready at hand to symbolize it. These situations are articulated with borderline patients. The patient clings to the analyst, using him as a protective shield against reality traumas. The implicit and explicit alpha-function exerted by the analyst contributes to the processing and symbolization of this reality, recovering the injured mind and elaborating the trauma. So the patient creates a triangular space to dream and think.

Psychoanalysis or Mind and Meaning

Abstract: by Charles Brenner The Psychoanalytic Quarterly , New York , 2006 ; 140 pp; $25 Charles Brenner’s new book, Psychoanalysis or Mind and Meaning (Brenner, 2006), is the fifth in a series that include...

Transference to the analyst as an excluded observer

Abstract: In this paper I briefly review some significant points in the development of ideas on transference which owe so much to the discoveries of Freud I then discuss some of the subsequent developments