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PubMed1983

A note on consummation and termination.

The sensation sometimes expressed by analytic patients, most notably during termination of having left some "unfinished business" (to which they hope to return) is not necessarily simply a judgment about the analysis; frequently it is an affective component of the wish for consummation which has not been granted by the analysis. Simultaneously, it expresses the defense against that very consummation. The wish to give the analyst a gift is in some sense the direct opposite, or more correctly, expresses the defense more openly as a bribe and warning to the analyst that he should not expect or hope for consummation of the instinctual wishes which have been the center of analytic work; i.e., it is a defense against the fulfillment of those wishes almost as if the analyst, by attempting to analyze them, insists upon their enactment. Nevertheless, and despite the apparent contradiction, both affects, which serve similar functions, may appear simultaneously.

Coitus↗
PubMed1983

Psychoanalysis of a patient who received a kidney transplant.

A young man who had glomorulonephritis at age five was treated psychotherapeutically for an anxiety neurosis with phobic and obsessional features. He was referred for psychoanalysis at a time when he was approaching kidney failure, but was referred back for more psychotherapy with the possibility of future psychoanalysis. He underwent renal dialysis and then received a kidney transplant from a brother. The psychoneurosis became worse, and a psychoanalysis was begun about one year after the transplant operation. The clinical report illustrates the developmental effects of the childhood illness, as well as the patient's response to the adult treatment and the renal transplant. Nonanalytic observations by others on renal dialysis and transplant patients are reviewed and compared with the findings in this analysis. The psychoanalysis of a renal transplant patient is feasible if other indications for analysis are present. A previously unreported finding is the problem of changing a lifetime adaptation from illness to relative health. This involved the analysis of the narcissistic conflicts of the oedipal stage of development as well as the preoedipal maternal transference.

Adult↗
PubMed1984

Pathological narcissism in childhood.

Matt's analysis yields a number of theoretical and clinical implications. It demonstrates that narcissistic character pathology can exist in childhood and shows how family dynamics may contribute. The clearly defensive function of Matt's pathology and his later progress through normal infantile narcissism toward further development suggest that the pathogenesis of narcissistic pathology resides neither in regression to an infantile position nor in untamed infantile narcissism. Rather, as the case demonstrates, narcissistic pathology actually reflects a pathological formation of the self used for defensive purposes. Matt's analysis also shows how such pathology in children may be effectively resolved through interpretation. Finally, the analysis demonstrates the peculiarities of the countertransference in such cases and how they may be pivotal in the course of treatment.

Child↗
PubMed1984

Fear of humiliation.

This paper explores the ontogeny of fear of humiliation, conceived of as an important organizing affect-laden fantasy in certain narcissistic personality disorders. The influence of the pleasure of the parental object in sadistically humiliating is emphasized in the overdetermined genesis of this fear. While, in elaboration of Loewenstein's (1957) and Eidelberg's (1959) contributions, "seduction of the humiliator" is a fundamental defensive process observed in masochistic characters, identification with the humiliator is a sadonarcissistic defense observed in work with certain narcissistic personality disorders. The countertransference potential to enjoy humiliating such analysands, as well as the defensive functions of fear to humiliation, are noted.

Fear↗
PubMed1984

The multiple meanings of masochism in psychoanalytic discourse.

The term masochism was originally used in a narrow, specifically sexual sense (referring to perversions ), but has come to encompass for many analysts an exceedingly broad and variably determined range of clinical phenomena that bear no consistent relation to sexual excitement. In addition, these expanding clinical perspectives have long been entangled with Freud's shifting metapsychological constructions designed to ground masochism in instinctual theory. As a result, the term is used with little consistency and at varied levels of abstraction: loosely descriptive, dynamic, theoretical. It is not always explicit which meaning is intended or what inferences, if any, are meant to be drawn from the term. When used in its broadest sense, masochism may falsely suggest dynamic similarity between diverse phenomena, and is often ambiguous with respect to the presence or absence of underlying erotic or perverse excitement. In the clinical situation, the categorization of material as masochistic may evoke an associated set of genetic, dynamic, or theoretical ideas which may alter the perception, ordering, and interpretation of clinical data. Particularly conducive to this subtle steering process are the enduring influence of the early concept of feminine masochism and the related concept of sadistic and masochistic paired opposite component sexual instincts--a theoretical, physicalistic , linear concept incompatible with the clinical model of overdetermination and multiple function. This paper includes a review of the terminological and conceptual history of masochism, briefly touches on the parallel history of sadism , and offers some provisional definitional solutions.

Anxiety, Castration↗
PubMed1984

Psychic trauma and masochism.

Three analyses are presented in which acute trauma (overwhelming internal or external stimulation so great as to preclude the patient's utilizing his usual defenses adequately) in childhood contributed to the development of masochism. The patients later attempted mastery through repetition, reversal, and erotization , and employed regression as a defense against feared oedipal wishes.

Child↗
PubMed1984

Denial in fantasy and hypomania: an exploration.

There is a spectrum of normality and psychopathology in which we see the presence of denial in fantasy, action, and word. The underlying ego distortions, such as the overuse of a denying fantasy in reality testing, will determine the clinical appearance of this mechanism. Traumatic experiences in the first 18 months are a determining factor in the development of these ego distortions. Clinical material is presented that supports a theory of elation put forward by Lewin (1950) who suggests that denying elations are repetitions of childhood dreams with their adult elaborations. In Mrs. A., the denying elations occurred particularly when experiences of castration anxiety or object loss became intolerable.

Adult↗
PubMed1985

A case of phallic-narcissistic personality.

A case of phallic-narcissistic personality is presented to demonstrate the intermingling of oedipal and narcissistic transferences and to suggest a therapeutic rationale for the analytic treatment of similar cases. The therapeutic approach to dealing with the narcissistic configurations involves: Empathic and receptive listening to the patient's material relating to and reflecting narcissistic motifs. This early objective extends only to gaining access to the detailed scope of the narcissistic material in its multiple aspects. Clarifying and identifying the relevant narcissistic configurations, both superior and inferior aspects, so that the patient becomes increasingly aware of their pervasive influence, and increasingly able to identify the respective motifs. Interpretively linking the narcissistically inferior and superior configurations into a common gestalt, so that the patient comes to understand that these opposing aspects are mutually linked, defensively interconnected, and reciprocally reinforcing. Identification and interpretation of interlocking patterns of projection and introjection, particularly as they reflect and express narcissistic configurations. Modification of patterns of projection and introjection through the medium of the ongoing interaction (partly interpretive, partly extra-interpretive) that characterizes the relationship between analyst and patient. Patient projections are thus modified and replaced by more autonomous and adaptive introjections derived from the analytic relation that facilitate the alteration of pathogenic narcissistic formations.

Adult↗
PubMed1985

Determinants of object choice in adulthood: a test case of object-relations theory.

A clinical example of the effects of the absence of the father during the early childhood of a male analysand and its consequences for his later object choice is presented. This patient's biological father left the household when the patient was only a few months old, and his mother did not remarry until he was five years of age. Unconscious fantasies of the lost father, with whom the patient had no contact in reality, and longing for him organized the patient's drives and determined his self-identity as well as his later object choice. The patient developed both a positive and negative identification with the lost father. The identification was with a fantasy object not a real one. The case highlights the need to use a precise term in talking of the object, namely the mental representation of the object which may or may not be built up out of experiences with the real object.

Adult↗
PubMed1987

Falling off the couch.

The patient's therapeutic regression intensifies certain unconscious meanings of the analytic couch. In addition to representing the analysis or the analyst in general, the couch can represent the unconscious, or it may take on the symbolic significance of the analyst's or mother's arms, lap, breasts, or womb. When the genetic roots of the patient's transference include substantial experiences of disappointment, narcissistic injury, and mistrust, the theme of falling from the couch may emerge as a dream, an association, or even an enactment. This theme usually implies the presence of a deepening but mistrustful transference, based on earlier disappointments by the patient's primary objects. Falling off the couch may be associated with being dropped as an infant, rolling out of bed as a child, birth, miscarriage, castration, death, termination, defending against passive wishes, punishment for sexual or aggressive transgressions, escaping an attack, descending into the unconscious, or wanting to be picked up and comforted.

Accidental Falls↗
PubMed1989

Negative oedipal transference of a male patient to his female analyst during the termination phase.

There has been some debate in the literature concerning the ability of the male patient to experience his paternal, and particularly negative oedipal, transference feelings directly toward his female analyst. In this context, the author describes paternal transference manifestations evident throughout her male patient's analysis, and presents detailed process material from the termination phase. At this time the patient's obsessional neurosis was revived in the context of setting a termination date, and transference to the negative oedipal father could be clearly demonstrated. The paper illustrates that even the negative oedipal component of the paternal transference can be experienced directly in the male patient/female analyst, dyad, and interpretation of this material can bring it into clearer focus. The author discusses some possible influences of her sex on the timing and intensity of the material.

Alcoholism↗
PubMed1989

Infantile sexuality, gender identity, and obstacles to oedipal progression.

Contrary to when it was first proposed, infantile sexuality nowadays is accepted as an important part of child development. However, Freud's views on masculine primacy and feminine inferiority are seen to be incomplete and inaccurate not only because they over-emphasize sexuality and sexual anatomy, but also because they neglect aggression, object relations, ego and superego functioning, and the sense of self. Infantile sexuality is therefore reconsidered within the broader perspective of gender identity. Within this broader perspective, normal and aberrant sexual development is discussed, and new ideas are offered about familiar concepts such as castration anxiety and penis envy.

Child↗
PubMed1990

Unconscious fantasy: developmental and self-psychological considerations.

The authors view unconscious fantasy from the perspective of self psychology as a significant addition and emendation of the classical framework. A selective review of the pertinent literature is presented, followed by clinical material illustrating the contribution of self-psychological concepts to the understanding of unconscious fantasy formation.

Child, Preschool↗