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The psychoanalysis of time.

The experience of time has been studied psychoanalytically largely through the conceptual frameworks of ego psychology and classical analysis. The implications of self psychology and Lacanian theory for understanding time experience have been relatively little explored. These implications would develop, on the one hand, from Kohut's investigations of fragmentation phenomena and, on the other, from Lacan's concept of the ego and his use of the short session. But time experience cannot be understood entirely in terms of individual histories and the psychoanalytic situation. A preoccupation with time is central to Western culture and is traceable to the social context--thirteenth-century monasticism--in which the clock was first invented. Time enters the analytic session especially in the handling of beginnings and ends, reflecting divergent notions of the purpose of treatment. The standing of time-frame rules in the different systems defined by ego psychology, self psychology, and Lacanian theory are examined together with their underlying assumptions about the nature of reality. These metaphysical issues--no longer academic but made concretely meaningful in each session--go beyond illuminating the concept of time. Our response to them will determine both the direction of each patient's treatment and the course of psychoanalysis itself.

Adult↗

Dream frequency in psychoanalysis and psychoanalytic psychotherapy.

The authors examine data on dream frequency from 50 patients, half of whom were seen in psychoanalysis and half in psychoanalytic psychotherapy. Frequency, defined as the proportion of sessions where at least one dream is related, is analyzed statistically as a function of sex, age, and type of treatment. Also, treatment outcome is examined as a function of sex, type of treatment, diagnosis, and dream frequency. Psychoanalytic patients are found to have higher dream frequency than the patients in the psychotherapy group. Higher average dream frequency is correlated with a better treatment outcome in both patient groups.

Adult↗

The patient-analyst match and the outcome of psychoanalysis: a pilot study.

This paper presents a pilot study in which we explore the possibility that the match between analyst and analysand is a factor of central importance in the analytic situation. It is an attempt to look at the issue of match across a large number of patients. The data we used were not collected for studying this topic; thus, the study has serious limitations. Nevertheless, certain patterns emerged which support our thesis that patient-analyst match plays a significant role in the outcome of psychoanalysis. We present this work as a first step in developing concepts and methods which will be pursued in a more systematic and rigorous fashion in a later study.

Adaptation, Psychological↗

Followup in psychoanalysis: clinical and research values.

Psychoanalysis has never developed a tradition of systematic followup study to evaluate outcome and to improve technique and theory for a variety of reasons, partly theoretical, stemming from the conception of the unfolding transference neurosis and its analytic resolution as the precondition for cure, and partly historical, having to do with the happenstance of its development as a private practice-based discipline and training outside of the academic setting. Freud, however, was never bound by such strictures and published whatever post-treatment data he acquired on all his best-known case histories. But following Freud most analysts, with some notable exceptions, eschewed followup activity as unanalytic. It is this tradition that more recent studies like those of Pfeffer in New York and the Psychotherapy Research Project of The Menninger Foundation in Topeka have squarely challenged. Data are presented from the Menninger project dealing specifically with the impact of routine planned followup on issues of treatment termination and resolution and on the nature of the post-treatment period. The degree and kind of patient cooperation with the followup inquiry, the impact of followup on treatment termination and resolution (both impeding and facilitating), and the role of followup intervention in relation to return to formal post-treatment therapy (or consolidating against it), are all discussed.

Adaptation, Psychological↗

The dread to repeat: comments on the working-through process in psychoanalysis.

This paper focuses on the process of working through in psychoanalysis. Reemphasis of the centrality of the empathic listening perspective and discovery of the selfobject transferences made it necessary to reconceptualize various aspects of the analytic process from the perspective of psychoanalytic self psychology. With the help of a clinical vignette, the paper illustrates the manner in which archaic defense organizations and newly developing psychic structures find a compromise solution in a transference symptom. Such symptoms can serve as nodal points in the process of working through; they represent a transitional phase between the old automatic responses to narcissistic injury and an increased capacity to use signal anxiety. The psychopathology that became illuminated in this process can be described phenomenologically as a self-defeating personality disorder.

Adult↗

Toward integrating psyche and soma: psychoanalysis and neurobiology.

The brain is the "key organ" for understanding mind/body/illness relationships. During the past two decades neurobiological research has generated a plethora of new data and concepts which have increased tremendously our knowledge of the functioning brain. As a result the psychoanalytic view of the relationship between mind and brain may seem at risk of becoming outmoded. Yet while psychoanalytic theory may no longer be wholly tenable, psychoanalysis continues to offer interesting and heuristically valuable isomorphic models of cortical function. On the other hand neurobiology provides a corrective influence on psychoanalytic concept-building, causing theory to be refined as it is tested against the results of research. One possible result of interdisciplinary cross-fertilization is that a revised theory of the function of dreams and fantasy may throw light on the vicissitudes of somatic experience, and the pathogenesis of psychophysiological disorder.

Brain↗

An African therapy in dialogue with Freudian psychoanalysis.

This article summarizes and compares selected characteristics of Freudian psychoanalysis and of African psychotherapy. The author concludes that the Freudian emphasis on the individual and the African therapy's emphasis on the community may both lead to the positive restoration of both therapies' clients.

Africa↗

Psychoanalysis and the moral high ground.

The author reflects on the power and ubiquity of moral issues in the human psyche and thus inevitably in psychoanalysis, and suggests that our moral sense may be an adaptive biological strategy. Goodness is sought in others and aspired to in the self, as part of an innate need to build the ego upon experiences of good objects. Kleinian theory suggests a 'natural morality' that can be discerned in the move towards the 'depressive position', involving increasing care and concern for others. The hunger for goodness within is experienced as a moral quest, with strivings both to approve of, and to be approved of by, one's objects. Goodness, felt as moral rightness, is highly prized, and may be claimed falsely for the self or for objects in the form of the 'moral high ground'. Derailments of the analytic standpoint easily occur, away from the search for objective truth towards assumption of the moral high ground, on the part of the patient, the analyst or both. The author shows this occurring clinically and reflects also on how psychoanalytic theory can be misused in the pursuit of moral superiority.

Adult↗

Psychoanalysis and cognitive behaviour therapy--rival paradigms or common ground?

The author suggests that contemporary enthusiasm for cognitive-behavioural therapy reflects our longing for swift, rational help for psychological suffering. Competition for funding threatens the psychoanalytic presence in the public sector. The psychoanalytic and cognitive-behavioural models are contrasted, and the relative richness of the psychoanalytic paradigm outlined. The author suggests that a cognitive model is commonsensical, but less complex, with less potential explanatory and therapeutic power. She discusses how the analytic stance is always under pressure to 'collapse' into simpler modes, one of which resembles a cognitive one. This also occurs inevitably, she argues, when attempts are made to 'integrate' the two models. Cognitive and 'integrated' treatments nevertheless have the advantage that they are less intrusive and hence more acceptable to some patients. Selected empirical process and outcome research on cognitive and psychoanalytic therapies is discussed. Brief psychotherapies of either variety have a similar, modestly good outcome, and there is some evidence that this may be based more on 'dynamic' than 'cognitive' elements of treatment. Formal outcome studies of more typical psychoanalytic psychotherapy and of psychoanalysis itself begin to suggest that these long and complex treatments are effective in the more comprehensive ways predicted by the model.

Cognitive Behavioral Therapy↗

The only clinical and quantitative study since Freud of the preconditions for recurrent symptoms during psychotherapy and psychoanalysis.

In this paper the author aims to evaluate theories of onset conditions both before psychological and before somatic symptoms by the first ever clinical-quantitative assessment of their preconditions, and then to compare these preconditions with Freud (1926) and with other theories of symptom formation. The seven cases in the sample were the only cases of recorded psychotherapy or psychoanalysis, each with recurrent symptoms in segments of sessions before symptoms versus segments of sessions before controls (with no symptoms) that were suitable for 'the symptom-context method'. The recurrent psychological symptom cases were: momentary forgettings, depressive shifts, and phobic feelings and behaviours; the recurrent somatic symptoms were stomach ulcer pains, migraine headaches, absence (petit mal) episodes and premature ventricular contractions (PVC) of the heart. Independent ratings of pre-symptom segments versus pre-control segments showed significant differences in all seven cases. Many emotional state qualities differentiating the pre-symptom from the pre-control segments were similar across cases. These were, in rank order, hopelessness, lack of control, anxiety, feeling blocked, helplessness, concern about 'supplies', depression, hostility to therapist, guilt, involvement with therapist, separation concern and hostility to others. For example, hopelessness significantly differentiated pre-symptom versus pre-control for all seven cases. For the first time, samples of segments of sessions before recurrent symptoms have been both clinically and quantitatively compared with segments without symptoms. Brief segments before recurrent symptoms showed significantly more of certain qualities than brief segments before controls where no symptoms appeared. These qualities led to the author's revised symptom-context theory of symptom formation and then to a comparison with five classical theories of symptom formation.

Adult↗

A 9-year-old with conversion disorder, successfully treated with psychoanalysis.

This paper outlines the successful psychoanalytic treatment of a latency-aged boy with severe conversion disorder. Details of clinical treatment are presented. As no tested treatment has yet been found that reliably treats chronic conversion in children, this case is of importance in demonstrating the usefulness of psychoanalysis as treatment for severe psychopathology. The patient's unconscious fantasy constellations that gave rise to this syndrome are highlighted.

Child↗

Transformations of early infantile experiences: a 6-month-old in psychoanalysis.

The aim of the paper is to study the theoretical and technical tools for psychoanalysis adapted to an infantile analysand's requirements. The author presents the case of a 6-month-old boy with his mother in psychoanalytical sessions four times a week; the analysis was terminated after six weeks. After the first two sessions the disturbances between the infant and the mother disappeared from everyday life but continued with increasing intensity as an emotional storm in the sessions during three weeks up to a 12-day break. During and after the break everyday life continued without disturbances. After the break the emotional storm continued in the sessions but abated and was replaced by playing. The infant's creation of a 'fort-da' game with his pacifier indicated a transformation of the mental functioning. The analysis could then be terminated. The study of the process indicates good reasons to adapt psychoanalytical concepts to the prerequisite of the infantile personality and to use the concepts of 'unconscious', 'infantile repression', 'substitute formation', 'return of the infantile repressed', 'infantile transference', 'splitting', 'xKy', 'reverie' and 'containment' as some of the theoretical tools for understanding the infantile personality in a clinical psychoanalytical setting.

Humans↗

Some functions of being fair and just--or not, in clinical psychoanalysis.

The author suggests that the concepts of fairness and justice might be psychoanalytically useful. They are social ideas but often arise clinically. Since psychoanalysis is about intimate and internal events, the wide social and legal settings associated with formal justice are not addressed. Fairness and informal justice arise more intimately and are central here. Fairness is concerned with thorough consideration of an issue. To be fair, the people involved must be considered with impartiality before a decision. Justice generally is more formal, aiming to ensure the integrity of a system, its parts and individual members. It is noted that psychopathogenic conditions can arise in conflicting situations involving fairness and justice. Clinical illustrations suggest that the psychoanalytic process can implicitly aim to resolve their after-effects. Technique is addressed in this light. A central suggestion emerges here. The philosopher Jürgen Habermas proposes that justice rests essentially upon opportunity for argumentation between all those affected. The author suggests that psychoanalytic therapy is likewise a constructive argumentation.

Female↗

False memories, negative affects, and psychic reality: the role of extra-clinical data in psychoanalysis.

Psychoanalysis as a treatment originated in the idea that neurosis is related to the ways in which individual psychic reality departs from actuality. Psychic reality includes memories, beliefs and their associated affects and fantasies connected with an individual's experience of the inner and outer world. The psychoanalytic determination of what meaningful memories or beliefs are inaccurate, distorted or false ordinarily relies upon principles of intra-clinical validation. By itself, however, intra-clinical validation is subject to limitations and pitfalls that conviction alone about what is actual cannot circumvent. Despite this fact, there are remarkably few analytic case reports demonstrating false or significantly distorted memories through the use of data obtained from outside the consulting room. This paucity of reports may be related, at least in part, to the belief that the use of extra-clinical data is essentially unanalytic or supports resistance. Based on the views that (a) psychic reality cannot be regarded as exclusively subjective or objective but is inherently both; and that (b) a goal of analysis is to achieve a different, acceptable and more accurate view of reality, the authors report a clinical case involving a confirmably false pivotal memory and its associated negative affects. They discuss theoretical and technical considerations in utilizing extra-clinical data during the treatment process.

Adult↗

Affect and the therapeutic action of psychoanalysis.

In connection with controversial IJP articles by Stern et al. and Fonagy on the interpretation of the repressed and the recovery of past memories, the author maintains that the affect that is inherent in positive transference is at the heart of therapeutic action. Points of view put forward in the controversy (based on neurobiological knowledge) are related to Freudian metapsychology, as well as to their precursors whose scope was necessarily limited by a lack of access to more recent scientific discoveries. The author demonstrates metapsychological elements of therapeutic action inherent in the intersubjective relationship, especially identification, manifested in introjection and empathy. He describes cognitive development as spontaneously blossoming from the affective nucleus, and he explains the neuroscientific bases of this step forward. The classic (interpretative) psychoanalytic method makes up the cognitive superstructure necessary for the organisation of the mind that has sprung from the affective substructure. As a primary factor in psychic change, interpretation is limited in effectiveness to pathologies arising from the verbal phase, related to explicit memories, with no effect in the pre-verbal phase where implicit memories are to be found. Interpretation--the method used to the exclusion of all others for a century--is only partial; when used in isolation it does not meet the demands of modern broad-spectrum psychoanalysis, as the clinical material presented illustrates.

Adult↗

Psychoanalysis or psychoanalytic psychotherapy? Shifting the debate from theoretical to clinical with the concept of analytic contact.

There have been numerous books, papers, panels, and debates over the years regarding the differences and similarities between psychoanalysis and psychoanalytic psychotherapy. This article shifts the often circular and political argument from a theoretical tug-of-war to a clinical focus. The author provides clinical material to show that frequency, diagnosis, or use of couch are at best external enhancements to a process of analytic exploration. The case material illustrates the concept of analytic contact, in which the aim of treatment, regardless of setting, is to establish an ongoing investigation into the patient's defenses, phantasies, and internal conflicts that come out of the patient's object relational experiences. Analytic contact is evoked, established, maintained, and protected by the consistent interpretation of transference and extra-transference experiences that occur in the treatment relationship. External issues and life circumstances cannot be avoided and must be given equal focus, but always in the pursuit of understanding their associated underlying object relational phantasies. Clinical matters must take precedence over theoretical ideals in the struggle to establish analytic contact. The analyst consistently seeks, sometimes failing and sometimes succeeding, to understand how the patient either builds on genuine analytic contact or seeks to dismantle it.

Adult↗

Beyond dualism: psychoanalysis and medication in the 21st century.

Dualistic thinking continues to pervade psychoanalytic views of psychopathology. The author points out the shortcomings of this perspective as represented in Mark Swoiskin's article, "Psychoanalysis and Medication: Is Real Integration Possible?" She contends instead that the latest scientific evidence does not support a dichotomy between organic (biological) and psychodynamic (nonbiological) factors in psychopathology. She presents two cases to illustrate both the challenge and the importance of reformulating psychoanalytic views in an integrated, holistic way.

Adult↗