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PubMed1991

Observation and theory in psychoanalysis: the self psychology of Heinz Kohut.

The development of self psychology by Heinz Kohut illustrates the influence of observational method on theory formation in psychoanalysis. In 1959 Kohut began to emphasize empathy and introspection over the traditional combination of free association and evenly suspended attention. This became an important part of a process of revision in psychoanalytic theory which culminated in self psychology. This paper demonstrates how and why that particular change in observational method influenced that particular revision of theory.

Attention↗
PubMed1990

The concept of truth in psychoanalysis.

A philosophical controversy concerning the nature of truth has begun to play an important part in psychoanalytic theorizing. The two major philosophical notions, the coherence and the correspondence theories and their use in psychoanalytic theory making, are examined. It is argued that although coherence is part of the criteria of truth, correspondence is the more essential and fundamental criterion. It was in this way that Freud used these concepts in creating psychoanalysis. Psychoanalytic discoveries concerning the psychogenesis of objectivity in perception and thought support the correspondence theory of truth and provide, in addition, an answer to the third party critique of correspondence. The correspondence theory as a basic attitude of mind is a necessary element in the respect for the patient upon which psychoanalytic therapy depends.

Attitude↗
PubMed1990

[Anorexia nervosa from the aspect of psychoanalysis].

The author demonstrates the possibilities of therapeutic collaboration as regards treatment of anorexia nervosa by combined psychoanalytic and somatic treatment. He demonstrates this collaboration on a particularly severe course of the disease which was successfully reverted. The author indicates briefly the approach of modern psychoanalysis to this remarkable psychosomatic disease. The disease is conceived as the consequence of complete failure of feeding in the widest sense of the word during the period of preverbal childhood, caused by emotionally equivocal behaviour of the mother. This prevents satisfactory definition of the ego and non-ego of the child and interferes with the process of separation. This has then an impact on all further stages of development and the disorder leads to failure during adolescence. The mental anorectic symptomatology is then a persisting unconscious attempt to re-establish the lost unity with the mother which releases fear of the loss of self-limitation.

Adult↗
PubMed1990

A severe form of breakdown in communication in the psychoanalysis of an ill adolescent.

The paper focuses on a particularly severe kind of breakdown in communication that can arise in the psychoanalysis of ill adolescents who have experienced a real breakdown in functioning, such as a severe suicide attempt or one or more psychotic breakdowns. Clinical material is presented from the analysis of a suicidal and self-mutilating adolescent as an illustration of the theme. Included is a discussion of different types of breakdown in communication.

Adolescent↗
PubMed1987

[Narcissistic disorders in the light of modern psychoanalysis].

Whereas psychoanalysis in its beginnings was based preponderantly on drive-theory, later on attention was paid essentially on ego-psychology and in the last years on self-psychology. This development is seen in the context of developments in society, especially of the fact of an increasing outer direction of man in the modern world with the danger linked with it of loss of ego and of self. The designed development may be understood as a reactive one. After an overview on the different concepts of the self it is defined as the narcissism which gives to the instances ego, id and super-ego as well as to the body the feeling and the impression, to be an individual capable for feeling and cognitive processes, forming an entity which is experienced continuously and in its continuity. Two different narcissistic disturbances are described: Narcissistic neuroses (= narcissistic personality disorders in the sense of Kohut) with a consistent ego, but a lack in self-representation because of deficiency experiences in early childhood, Borderline-conditions with a severe ego-pathology and, as a consequence of it, rigid defense-mechanisms, extreme fusion tendencies and projective identification, splitting etc. The development of normal narcissism is discussed. At the end the slightly modified psychoanalytic technique in the treatment of patients with narcissistic neuroses and the analytically oriented expressive psychotherapy of borderline-patients which is directed on reality testing is described.

Borderline Personality Disorder↗
PubMed1989

Trauma as a shibboleth in psychoanalysis?

The authors consider that the subject of trauma is a good example of how metapsychological constructs (in this case, in particular, the economic or quantitative point of view) originated as essential working hypotheses necessitated by clinical observation. These conceptualizations may help us to understand what finds expression in processes that are sensed as affects (als Affekte der Empfindung bemerkbar werden) either by the patient or by the analyst. In the case of trauma (in analysis), an object-relations approach is not only compatible (Balint) with metapsychology but seems to be positively implicit in a correct interpretation of the latter. Two clinical vignettes are given as evidence for this assumption. They illustrate an irruption of stimuli through the protective shield (Reizschutz) of the analytic field, initiated by the patient and the analyst respectively. For the purpose of grasping and working through such situations--thus helping the patient to fill the gap (Ablösung) between the quota of affect (Affektbetrag) and the idea (Vorstellung)--it is very useful for the analyst to refer to the concept of trauma, either in the narrow or in the broad sense proposed by Freud. For this reason, the authors believe that the concept of trauma is a shibboleth of psychoanalysis.

Adult↗
PubMed1988

Our changing views of the therapeutic action of psychoanalysis: comparing Strachey and Loewald.

A comparison of Strachey and Loewald on the nature of therapeutic action reveals a deep shift in analytic interest away from the structural point of view and toward object relational and interpersonal frames of reference. Loewald's theoretical and technical revisions are far more sweeping than is usually acknowledged, and we can better benefit from his contribution by recognizing the full extent of his originality. Loewald's work also illuminates a major challenge for contemporary psychoanalysis: the need for an integration of the now disparate languages of metapsychology and clinical process.

Freudian Theory↗
PubMed1987

[Changes in emotional insight in the course of psychoanalysis. A single case study].

The initial phase and the termination phase (8 sessions each) of a psychoanalysis are compared according to changes of emotional insight. Aspects of emotional insight are investigated using contentanalytic rating scales which allow to determine the integration of emotional and cognitive aspects of experiencing. There are significant differences of insight between initial phase and termination phase. Regarding the mean scores of single sessions, we observed in the course of the initial phase a decrease of insight and of the emotional access to experiencing, that is in contrast to the changes described before. A systematic clinical description can explain the contentanalytic results. Obviously the psychoanalytic process is influenced by a complex interaction of different factors.

Adaptation, Psychological↗
PubMed1987

Unsuspected multiple personality disorder: an uncommon source of protracted resistance, interruption, and failure in psychoanalysis.

Multiple personality disorder (MPD) is being recognized with increasing frequency. A great imitator, it may be encountered among patients who appear to have a wide range of other diagnoses, and have been in treatment for years without the presence of MPD being discovered. Nine of 241 MPD patients interviewed by the author, 3.7%, had been accepted for psychoanalysis. In only one case had the diagnosis been appreciated by the analyst prior to his accepting the patient for analytic treatment. Four patients were profoundly resistant and or inaccessible to analysis for protracted periods. In one of these cases the diagnosis became clear and successful analysis was concluded, but three analyses ended unsuccessfully with the diagnosis still unknown. Two patients' analyses were interrupted due to abrupt regressive events initially perceived to indicate severe ego weakness incompatible with sustaining an analytic process, but later appreciated as signs of MPD. In three cases it appeared that the patients' being accepted for analysis triggered the emergence of the dissociative process, and either the patient or the analyst decided to pursue a different form of therapy. Unsuspected MPD appears to account for a small percentage of stalemates, failures, interruptions, and early flights from analysis.

Adult↗
PubMed1979

[Ideology and education (influence): notices on the pseudo-question on medical and non-medical psychoanalysis].

Argumentations pro or contra "medical" or "non-medical" psychoanalysis are rarely free from ideologies. Only in the stage of psychoanalytical self-cognition the question becomes another one. It must be differentiated between the educational background and training of the psychoanalyst. It is just the educational background (academica finally examination in medicine, psychologie, theologie etc.) which produces attitudes, which can form (influence) the training in a wrong way. Such discussions become easily a pseudo-question because of a narrow class-arrogance. The urgency of using psychoanalytical concepts and methods in the social field should help to reconcile contrasts.

Education, Medical↗
PubMed1983

[Psychoanalytic data collection and the problem of dates--a contribution to the basic problem in psychoanalysis].

My thesis is that the specifically psychoanalytic form of data collection is unsuitable for checking at least two groups of hypotheses in psychoanalysis, namely neurosis aetiology and developmental psychology. The reason lies in the problem of reconstructing dates. In the psychoanalytic literature there are a number of arguments for the reconstruction of dates ( retrodating ). These arguments are critically examined and rejected. In the final part, I discuss an alternative approach, psychoanalytic child observation, and its advantages and problems.

Adult↗
PubMed1984

[Value testing in psychoanalysis--reflections on an ego psychologic concept coined by Heinz Hartmann].

We have attempted to demonstrate the importance of the concept of value testing set forth by Hartmann in 1960 in terms of both clinical practice and the theory of psychoanalysis. We use a case study to illustrate the way in which this subfunction of the inner reality testing ties in with the subfunction of signal guilt (the function of affect differentiation as one of the subfunctions of the perception of internal reality) and with the anticipation of the interpersonal effect of one's own behavior and the appropriateness of this behavior as subfunctions of judgment. In conclusion we discuss the suitability of the concept of value testing as a way of relating the psychoanalytic idea of the moral organization of action to the ethics of utilitarianism.

Ego↗
PubMed1982

Toward a methodology for applying psychoanalysis to literature.

This paper proposes a methodology which seeks to use psychoanalysis to fathom the unique quality of the literary text without turning the text into a symptom or its author into a patient. Its hypothesis: the literary text evokes an unconscious fantasy in its readers; critics who respond to the text empathically but without conscious understanding re-enact aspects of its organizing fantasy in the way they write their criticism. To test this hypothesis, the criticism of Jacques le Fataliste et son Matître by Diderot is examined. The phenomenon of parallelism is suggested as a clinical analogy for the re-enactment which takes place.

Fantasy↗
PubMedDate not supplied

Psychoanalysis of the impulsive character: a linguistic-communicative study.

The importance of the mode of communication, the dreams, and the linguistic study of impulsive patients is examined. The significance of the use of the imperative mood, with a rapid evacuation rhythm and good synchronization between the verbal and paraverbal levels is explicated. The obvious linguistic differences between sessions show, together with thematic clues, that it would be possible to predict impulsive discharges, that is, to formulate a predictive theory. The concept is defined, and clinical material is provided to illustrate the concept. A linguistic analysis of the patient's dreams is presented, as well as a thematic approach to the dreams. The ultilization of linguistics in psychoanalysis is systematized, and the verbs used by the patient are listed.

Adult↗
PubMed1982

Psychoanalysis and psychoanalytic psychotherapy of the older patient. A developmental crisis in an aging patient: comments on development and adaptation.

The psychoanalysis of a depressed 69-year-old woman is described briefly. She was seen four times weekly for two years and treated on the couch. The goal of analysis was modified in keeping with the concept of her problem as a developmental disturbance of aging. Here the aim of analysis was not extensive character change, as is usual in treatment of a person with neurotic disturbance, but help in making the necessary adaptive changes in the phase of aging. There was relatively less emphasis on the "archaeological" treatment model of uncovering the predisposing childhood neurosis, and more emphasis on analysis of the patient's current character structure and its underlying dynamics. The patient coped with threats of object loss and narcissistic injury by living through others, both helping and controlling them. The case exemplifies the way in which the analyst dealt with the patient's narcissistic injury of having to come for therapeutic help, the analyst's use of empathy and effort to understand transference and countertransference, and the course and results of the analysis.

Aged↗
PubMedDate not supplied

[Dyad as illusion? Reflections on some structural conditions in a 2 person relationship with the example of partnership and psychoanalysis].

The psychoanalytic situation is based on a dyadic concept where the relatives of the patient easily may be regarded as a disturbing element which should be eliminated as far as possible. In reality, however, there exist manifold interrelationships and feedback mechanisms among the psychoanalytic dyad and other significant relationships of a patient in psychoanalysis. The relational triangle of patient, partner and psychoanalyst is taken as an example to demonstrate within a sociological framework the process of competition of two primary one-to-one relationships mutually demanding exclusivity. Because of the inhibited communication between the analyst and the partner of the patient, this competition, however, cannot be settled obviously. It is rather shifted into the partner-relationship where it appears as a (originally iatrogenic) conflict of the couple which, then, easily may be misinterpreted by the psychoanalyst from a psychopathological point of view and not in terms of structural interrelations. In this process, a scapegoat function often is ascribed to the partner of the patient who is not able to disprove this interpretation and may react in a paranoid manner. The patient, on his part, in this situation often suffers from a loyalty conflict between his partner and his analyst which can be resolved in several modes. One pattern of solution is the splitting of the transference into a totally "good" and a totally "bad" relationship, the negative side generally ascribed to the partner-relationship. The different viewpoints of Kohut and Kernberg regarding these splitting phenomenons in the transference are discussed, and also the problem, whether a protracted narcissistic transference as required by Kohut for the treatment of narcissistic personalities must not lead to undue impairment of a concurrent real relationship of the patient. There is the question whether the present state of psychoanalytic technique can do justice to relational triangle as presented here from a sociological point of view, or whether they rather are denied (out of structural reasons, too) by a dyadic conception which does not correspond to the post-symbiotic reality of adult patients, even when a disturbance on the so-called prae-oedipal level is attested to them.

Communication↗