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PubMed2004

Epistemological premise, developmental idea, main motivation in Jung's and Kohut's psychoanalysis: looking for some analogies.

We are living the passage from the positivistic ideal to a new cultural climate which may be called post-modernism, subjectivism or perspectivism and in which we have lost the conviction that it is possible to reach an absolute knowledge. This climate can become a strong stimulus to a dialogue and a comparison among different psychoanalytical schools and between psychoanalysis and empirical research to find some of the reference points we need in our work. In my paper I will compare self psychology and analytic psychology in order to point out several strong analogies. Firstly, they are based on the same methodological option which gathers knowledge through an empathic understanding 'from within'. According to both Jung and Kohut the individual has within himself a psycho-biological potential, an individual pre-formed core that asks to evolve completely: the central motivation of human beings is the realization of their own individuality. This shared theoretical and epistemological ground conveys convergences in the clinical field between the two disciplines (interpretation of dreams, respect of resistance, diminishing attitude regarding sexual drives, etc.) and specifically determines an attitude of the analyst, which respects the individual process of development, which pays attention to the inner experience, and which gives importance to the analyst's and the patient's subjective experience.

Humans↗
PubMed1987

Theoretical and clinical shifts in psychoanalysis.

Shifts in psychoanalytic theory and in conceptions of psychoanalytic practice over the past 15 years are examined, with particular attention to the advent and expansion of Kohutian self-psychology within the psychoanalytic movement. It is concluded that the nature of psychoanalysis is sufficiently heterogeneous that any attempt to encompass or define the field as a whole--rather than to analyze particular formulations and developments within the field--is doomed to failure.

Ego↗
PubMed1983

Obesity and psychoanalysis: treatment and four-year follow-up.

Psychoanalysts provided information about 84 obese patients and 63 patients of normal weight at the beginning of this study, 18 months later, and 4 years later. Treatment lasted from 3 to more than 7 years. Although obesity was the chief complaint of only 6% of the obese patients, their weight loss and maintenance of it compared favorably with results reported for other psychological treatments for obesity. Severe body image disparagement was present in 39% of the obese patients at the beginning of treatment but in only 18% at the 4-year follow-up. Most patients improved in their chief complaint and presenting symptoms. The study indicates that large-scale collaborative research in psychoanalysis is feasible.

Adolescent↗
PubMed1989

A developmental perspective on psychotherapy and psychoanalysis.

Some of the most important issues in dynamic psychiatry involve the mechanisms of action of and the distinctions between psychotherapy and psychoanalysis. Recent advances in developmental psychology and in clinical practice and theory provide new insights into these long-standing controversies.

Humans↗
PubMed2003

Does psychoanalysis really mean oppression? Harnessing psychodynamic approaches to affirmative therapy with gay men.

Freud's attitude toward homosexuals was overwhelmingly progressive for his time. In contrast, during the early forties, psychoanalysis began to adopt a more pessimistic view about the mental health of homosexuals. This article describes a psychodynamic model of affirmative psychotherapy for gay men. Special note is made of the clinical issues, which arise from antihomosexual attitudes that influence the psychological development of the homosexual male. In particular, the way in which identity formation is affected by heterosexual socialization is discussed. The psychotherapeutic implications associated with these developmental complications are pointed out as well.

Adult↗
PubMed2002

Slow magic: psychoanalysis and "the disenchantment of the world".

Freud's work can be situated in terms of the debate between Enlightenment and anti-Enlightenment thought. The attempts of both sides to claim Freud for their position have merit, but they miss the crucial point: namely, that the tension between its Enlightenment and anti-Enlightenment tendencies is what gives Freud's thinking much of its vitality and depth. The task that faces the interpreter is therefore to elucidate that tension and assess the alignment of forces between the two strands in his thought. An examination of the concept of magic in Freud's theory provides an opportunity to pursue this interpretive task. Although the Enlightenment position he often seems to embrace advocates the complete elimination of magic, many "magical" elements remain in his theory and clinical practice. Nor should this situation be deplored, for the ambition to completely exorcise "enchantment" from human experience is one of the misguided excesses of the Enlightenment. The question of an appropriate fate for magic in psychoanalysis is discussed in relation to the vicissitudes of the transference. Finally, the science versus hermenueutics debate is examined in the light of these considerations in an attempt to specify the unique nature of the psychoanalytic experience.

Humans↗
PubMed2004

Psychoanalysis--with whom, for what, and how? Comparisons with psychotherapy.

If psychoanalytic treatment is to survive in the era of evidence-based medicine and managed care systems, empirical evidence is needed to demonstrate its unique nature and effectiveness. To address this need, comprehensive analyses were conducted of data from the Menninger Psychotherapy Research Project (Wallerstein 1986). These analyses addressed three questions: (1) What are the differences in outcome between psychoanalysis (PSA) and supportive-expressive psychotherapy (SEP)? (2) With what types of patient, and in what ways, are these two psychodynamic treatments differentially effective? (3) Are these differences in outcome the consequence of possibly different mechanisms of therapeutic action? PSA was found to contribute significantly to the development of adaptive interpersonal capacities and to the reduction of maladaptive interpersonal tendencies, especially with more ruminative, self-reflective, introjective patients, possibly by extending their associative capacities. SEP, by contrast, was effective only in reducing maladaptive interpersonal tendencies and only with dependent, unreflective, more affectively labile anaclitic patients, possibly by containing or limiting their associative capacities.

Adaptation, Psychological↗
PubMed2005

Child psychoanalysis and obsessive-compulsive symptoms: the treatment of a ten-year-old boy.

Obsessive-compulsive symptoms have long held interest for psychoanalysts. Currently, pharmacological and behavioral treatments are commonly viewed as the standard of care, and psychoanalytic clinicians are often uncertain of how best to approach these patients. The successful two-year psychoanalytic treatment of a ten-year-old boy with obsessivecompulsive disorder, who remained symptom-free eight years after termination, is reported. While this is but a single case, its outcome implies that for some patients psychoanalysis may be the treatment of choice.

Child↗
PubMed2006

Re-reading "Little Hans": Freud's case study and the question of competing paradigms in psychoanalysis.

Psychoanalysts have long recognized the complex interaction between clinical data and formal psychoanalytic theories. While clinical data are often used to provide "evidence" for psychoanalytic paradigms, the theoretical model used by the analyst also structures what can and cannot be seen in the data. This delicate interaction between theory and clinical data can be seen in the history of interpretations of Freud's "Analysis of a Phobia in a Five-Year-Old Boy" ("Little Hans"). Freud's himself revised his reading of the case in 1926, after which a number of psychoanalysts--including Melanie Klein, Jacques Lacan, and John Bowlby--reinterpreted the case in the light of their particular models of the mind. These analysts each found "evidence" for their theoretical model within this classic case study, and in doing so they illuminated aspects of the case that had previously been obscured, while also revealing a great deal about the shifting preoccupations of psychoanalysis as a field.

Anxiety↗
PubMed2006

Learning about psychoanalysis combined with medication: a nonphysician's perspective.

When medication is at play in an analysis, the nonphysician candidate or psychoanalyst faces conceptual and practical challenges, as well as countertransference risks and opportunities. A psychologist psychoanalytic candidate describes the treatment of an analysand who underwent a gradual uncovering and worsening of obsessive-compulsive and anxiety symptoms; at twenty-one months, the analysand introduced the topic of medication. These developments brought to light transference and countertransference themes connected to the analyst's status as a non-physician candidate; conceptual and practical uncertainties about medication in the context of psychoanalysis; the complex meanings of, and indications for, medication in this case; and the ramifications of a nonphysician candidate's referring a patient to a psychiatrist psychoanalyst for medication while being supervised by another psychiatrist psychoanalyst.

Adult↗
PubMed1980

Reflections on some current controversies in psychoanalysis.

Recently published reports about completed analyses conducted by competent students with expert supervision permit us to compare two contrasting clinical traditions within psychoanalysis, that proposed by Heinz Kohut over the past decade and a conservative point of view sharply focused on elucidation of derivatives of the infantile neurosis. Analytic treatment based on each set of these theoretical assumptions will achieve valuable results--very different in kind in each instance. On the other hand, elucidation of oedipal conflicts without working through their developmental antecedents leaves patients with a variety of adaptive deficits and severe subjective discomforts. Kohut's clinical system produces important improvements in tension regulation and in reorganizing behavior in a more coherent manner, but it neglects a variety of other issues stemming from the less archaic sectors of the personality. Theoretical inferences derived from observations made in the course of such incomplete analyses fail to carry scientific conviction.

Female↗
PubMed1982

A method for studying the analysis of aspects of the patient's experience of the relationship in psychoanalysis and psychotherapy.

We have described a coding scheme for obtaining an objective account of the analysis of resisted aspects of the patient's experience of the relationship with the therapist in single, audio-recorded sessions of psychoanalysis and psychotherapy. The focus is on what is often regarded as an important first step in the analysis of transference: the identification and exploration of the preconscious points of attachment of transference ideas in the here-and-now. Related to the scheme is the view that there is generally a plausible basis in the here-and-now for the patient's ideas about the therapist. The implications of that view for the concept of transference are discussed. Future directions for research are noted, including improving the reliability of the scheme and testing various hypotheses regarding how the particular step in technique assessed by the method affects other aspects of the process and outcome.

Communication↗
PubMed1982

"Developmental lag" in the evolution of technique for psychoanalysis of neurotic conflict.

The practice of psychoanalysis of neurotic conflict has not--to the extent that might be expected--evolved a consistent use in technique of available knowledge of the ego's mechanisms of defense. This is primarily related to a general resistance that can usefully be regarded as a "developmental lag." The evidence for this, particularly in Freud's writings, is reviewed as are the observations of others who have made note of this phenomenon. Some of the reasons that have contributed to this resistance among analysts are discussed.

Conflict, Psychological↗
PubMed1984

The two concepts of action and responsibility in psychoanalysis.

I have presented two major concepts of action and responsibility which have a role in psychoanalysis and have been confused in the recent literature. Intentional action is the general action concept concerning consciously, preconsciously, or unconsciously enacted goal-directed behavior. Deliberate action is a type of intentional action, performed consciously or perhaps preconsciously, that involves a choice among specific possible ways of achieving a goal. Persons are ethically responsible for their deliberations and also responsible as the agent, deliberate or not, of the manifestations of their personal characteristics. Responsibility for mere agency is not the same as ethical responsibility, but since it is easy to confuse these two concepts they may be hazardous as features of clinical dialogue. Finally, "free will" and "determinism" are discussed as issues that historically attend the above subject matter. "Free will versus determinism" is argued to be a false issue properly replaced by Freud's actual interest in the "overdetermined" multiple motivations of behavior.

Dreams↗
PubMed1985

Psychoanalysis of the older patient.

A small informal poll of local colleagues revealed that despite their interest in the subject, many had doubts about the possibility of analyzing persons aged sixty or over successfully. Their specific questions are collated and are offered as a sample of the questions in the minds of many analysts everywhere. Selected material from the ongoing analysis of a sixty-four-year-old patient is presented that bears on some of the questions raised. In addition, changes in the patient are noted. These are discussed in terms of changes in function, which are equated with structural change. The major thrust of the paper is that development continues throughout the life course, and that the criteria for analyzability remain constant. The chronological age of the adult by itself is not an indicator of eligibility or of suitability for psychoanalysis.

Age Factors↗
PubMed1986

Can psychoanalysis find its self?

There is a place for the theory of the self in psychoanalysis. To justify that claim, I return to an era in the development of psychoanalytic thinking about the self that preceded Kohut's formulations and that has set itself on a course of evolving a concept of the self more congruent with extant structural theory. I try to articulate the potential role of such a self-concept in connection with the issues of personal agency and subjectivity, complex personal qualities, areas of the complex interaction and integration of intrapsychic structures, object relations, narcissism, and internalization. The intent of this discussion is to facilitate the further development and articulation of the psychoanalytic theory of the self, particularly in terms of its integration with structural theory, to promote clearer thinking and more effective clinical efforts.

Aggression↗
PubMed1987

The manifest dream in psychoanalysis: a clarification.

Controversies about the value of the manifest dream in psychoanalysis are usually a matter of semantics. The author concludes that two clinically meaningful questions about the manifest dream can be asked: Is the patient's report of a dream useful in formulating an interpretation if no formal associations to the dream elements are given? Inasmuch as such reports always include some kind of associations, and the analyst always possesses considerable knowledge about the patient, the answer to this question would seem to be "Yes, at least at times." In what ways can the manifest dream contribute to our understanding of the dream and the dreamer? Both the literature and clinical experience indicate that there are many ways; these are summarized in an appendix. One approach, the direct decoding of manifest dream elements, is discussed in some detail. Several examples of the undisguised appearance of memories of childhood traumatic experiences in the manifest dream are presented.

Association↗
PubMed1988

Psychoanalysis, marital therapy, and object-relations theory.

This paper attempts to indicate why psychoanalysts should be interested in marital therapy. It discusses the clinical advantages and disadvantages of marital therapy as compared to psychoanalysis, describes the contributions of the classical psychoanalytic viewpoint to marital therapy, and finally, attempts to complement the classical psychoanalytic viewpoint with an object-relations viewpoint which can illuminate marital dynamics and provide interpretive content during the course of marital therapy.

Adult↗