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PubMed1980

The value of reconstruction in adult psychoanalysis.

Reconstruction is clinically valuable for the patient and fundamental for the analyst. The analyst will inevitably use reconstruction in order to comprehend the patient and to understand how that adult has remained a disturbed child with that particular psychopathology. Although not necessarily specified, reconstruction remains a very important dimension of psychoanalytic technique that is regaining analytic attention. After reviewing reasons for the shift of attention away from reconstruction, the signifcance of reconstruction is emphasized for restoring personality continuity and cohesion and for explaining neurotic repetition as it has developed in life and in the analytic transference. This utilization of reconstruction is illustrated in a case of anniversary depression, demonstrating the linkage between historical events and their intrapsychic interpretation and response, as well as the linkage between past and present, childhood and adult disorder. Reconstruction does not always automatically follow from the transference and analytic work. It is an inferential and integrative act which may overcome resistance and amnesia, which synthesizes memories and genetic interpretations in addition to substituting for missing memory and gaps in history. Without reconstruction, the personal and familial myths of the past may be joined by current analytic myth. The reconstructive integration identifies patterns and interrelationships rather than isolated conflicts and experiences, and the intrapsychic configurations, consequences, and developmental influences are far more important than actual historical facts. The past is transformed to new meanings and reorganized on new levels of development. Reconstruction leads to consideration and investigation of the mental processes of childhood and early infancy. It has had a significant role in the development of psychoanalysis, and reconstruction contributes to the formation, testing, and validation of psychoanalytic theory. For clinical research, it will be particularly rewarding to reconstruct the different phases of the psychoanalytic process.

Adjustment Disorders↗
PubMed1980

The handling of presistances in adult psychoanalysis.

This presentation has somewhat artificially separated tactical from strategic resistances, and has singled out the handling of resistance from other aspects of the theory and practice of psychoanalytic technique. In the actual clinical situation, the handling of resistance is an integral and major component in over-all technique and practice. It is intertwined continuously with all the other technical elements and processes of psychoanalytic intervention. But the understanding of resistance and the systematic, continuous, and ever deepening ways by which the analyst helps the patient to deal with them is one of the crucial differences that separate psychoanalysis from all the other forms of psychiatric treatment.

Adult↗
PubMed1980

The problem of confirmation in clinical psychoanalysis.

The fact that a statement has scientific credibility only to the extent that it is confirmed makes it desirable to examine clinical confirmation of clinical hypotheses of the type that, when presented to patients in psychoanalysis or psychotherapy, commonly are referred to as interpretations. An attempt is made to show that clinical confirmation in significant ways resembles confirmation in natural science. Certain peculiarities of psychoanalytic prediction and postdiction are discussed.

Humans↗
PubMedDate not supplied

Transferences as differential diagnostic tools in psychoanalysis.

A discussion of "Clinical Application of the Concept of a Cohesive Sense of Self," by Joseph Lichtenberg, M.D. Clinical phenomena, symptoms and specific "events" such as fragmentation are not reliable differential diagnostic tools in psychoanalysis and psychoanalytic psychotherapy. Rather it is suggested that this purpose can be better served by the proper diagnosis of the developing cohesive transferences in the course of the psychoanalytic treatment process. The discovery of the selfobject transferences (the various forms of mirror and the idealizing transference) has broadened the scope of analyzable conditions. The recognition of these transferences which arise in relation to the reactivation of infantile narcissistic structures (the grandiose-exhibitionistic self and the idealized parent imago), are helpful in delineating patients with primary self-pathology from the neuroses on the one end and the borderline and psychotic conditions on the other end of the broad spectrum of psychological disorders. It is important to recognize the presence of cohesive transference in order to make a clinically meaningful diagnosis. This is demonstrated with the help of the clinical vignette presented by Lichtenberg. Mr. T is described as suffering from a narcissistic personality disorder--or what we would prefer to call primary self-pathology.

Adult↗
PubMedDate not supplied

Crisis intervention and psychoanalysis: compatible or antagonistic?

A discussion of "The Use of Psychoanalytic concepts in Crisis Intervention," by Robert Glick, M.D., and Arthur T. Myerson, M.D. Crisis intervention and psychoanalysis are frequently considered antagonistic or antithetical. Reasons for this seeming incompatibility of the two therapeutic modes are discussed along with the ways in which psychoanalytic concepts and techniques are used in crisis intervention. It is concluded that, while different, the two modalities are not antagonistic but extremely compatible.

Adaptation, Psychological↗
PubMed1995

Stilted listening: psychoanalysis as discourse.

The search for repressed memories and a one-sided emphasis on the analysis of transference together may serve to overrride the essential task of psychoanalytic technique, which is to demonstrate to the patient how his or her mind works and how more adaptive compromise formations may be achieved. Psychoanalysis is, after all, a mode of therapy depending upon discourse, the exchange of information, and mutual influence through the process of conversation. By being sensitive to the manner in which meaning and affect in relationships are transmitted during conversation, the analyst may more easily apprehend the nature of the patient's conflicts, defenses, and transference.

Affect↗
PubMed1994

What is a clinical fact? Clinical psychoanalysis as inductive method.

This paper is an inquiry into the nature of clinical facts in psychoanalysis. The attainment of representability of psychic reality being requisite for insight, the author examines inductive processes on the part of both analyst and analysand, which are to be considered proper aspects of the study of clinical facts. It is argued that the analyst chooses his interpretations guided in good measure by nonverbal material, based on how he intuits that he is 'used' by the analysand and the ways the analysand feels 'used' by him; such nonverbal clues on the nature of the unconscious relational 'frames' operating in sessions guide him to select relevant associations from the universe of the analysand's verbal utterances. He thus comes to voice his interpretations, purveying a 'mapping' of psychic reality that typically makes use of a new viewpoint for description. Insight is achieved when the analysand attains ostensive refutation or redefinition of his unconscious 'theories' about the relationship, and this happens only in concrete individual situations, when the effects of his relational unconscious 'theories' come to be contrasted observationally in diverse 'screens', perceptual and mnemic, against the background of the analyst's neutrality: in such a way unconscious 'theories' attain the Pcs.-Cs. domain of the 'no'.

Adolescent↗
PubMed1994

Comments on the conceptualisation of clinical facts in psychoanalysis.

Perception is an active process involving a complex system of perceptual and cognitive structures. Facts reflect the ways in which we organise the data received by our senses, and this organisation is highly selective. The private theories of psychoanalysis play a major role in the organisation of facts and in their conceptualisation. It is important that there should be more attention to clinical theories and technical frames of reference, and as an illustration of this a clinico-technical conceptualisation which has been found useful is presented in some detail. This makes use of the concepts of the present and past unconsciouses, in this way emphasising the topographical dimension which had come to be under-stressed in Freud's structural theory and in subsequent ego psychology. The past unconscious can be regarded as a sort of 'template' (structures, rules, schemata, etc.) developed in the child in the first few years of life. This contributes to the form of fantasies and behaviour arising in the depths of the present unconscious, in which system such representational content is acted on by defences and other mechanisms to prevent 'child-like' content from disrupting the older individual's equilibrium. The censorship between the present unconscious and consciousness is considered, and the view taken that the primary focus of the analytic work is in relation to this censorship. The links between the analytical aim of making previously unacceptable mental content acceptable to the individual, on the one hand, and the roles of construction and reconstruction, on the other, are discussed in relation to psychoanalytic technique.

Adolescent↗
PubMed1995

New findings on the neurological organization of dreaming: implications for psychoanalysis.

A recent clinico-anatomical study of the dreams of 332 neurological and neurosurgical patients suggests that the essential psychological processes of dreaming are mediated by higher forebrain structures (inferior parietal and mediobasal frontal lobes in particular) rather than the primitive brainstem nuclei which regulate REM sleep. The fundamental neuropsychological mechanisms involved in dreaming appear to be (1) inhibitory mental control, (2) spatial thought, and (3) quasi-spatial (symbolic) operations. The essential factor in REM sleep, by contrast, is basic arousal. These neuropsychological findings call into question prevailing theories (based on physiological evidence) of the relationship between dreaming and REM sleep. Dreams and REM appear to unfold over different anatomical structures, and they involve different psychological mechanisms. The implications of these findings for psychoanalysis are discussed in this paper.

Arousal↗
PubMed1994

Psychoanalysis as a lifeline: a clinical study of a transference perversion.

Case material from the analysis of a fetishistic cross-dresser is reported. The evolution of a transference perversion and treatment impasse, in the form of the recalcitrant symptom of anal flatulence, is described. The patient's contrasting needs to cling perversely and addictively to the analyst, on the one hand, and to provoke an acting out of the countertransference, on the other, are placed in the context of his dread of rejection and potentially suicidal reaction. The author argues in favour of offering psychoanalysis as a lifeline, but with the condition that the psychoanalytic setting and boundaries are maintained and that gratifications are denied. Limited but precise interpretive psychoanalytic work in the transference was maintained. The relatively good outcome is explained in terms of the provision of safety, survival of the analyst and avoidance of countertransference acting out, which, in the author's view, represents an implicit and mutative transference interpretation, the specific factor in bringing about psychic change. This enabled the patient to recognise and accept the analyst as a 'new' object and, as a consequence, to question and reject his idealisation of the anal universe that he inhabited.

Acting Out↗
PubMed1994

The transition process in converting to psychoanalysis.

Numerous psychological factors are involved in converting from psychotherapy to psychoanalysis with the same analyst. The process of making the recommendation and working through reactions to it, both before and after the analysis begins, requires heightened attention to the ensuing transference and countertransference reactions. After reviewing the literature on this area, the author highlights the main factors in this process and presents an illustrative case example.

Adult↗
PubMed1993

[Results of infant research and its clinical relevance for psychoanalysis with reference to the concept of intentionality (Schultz-Hencke)].

The reception of results put forward by empirical infant research has been gaining increased significance for Psychoanalysis. This applies to analytic theory formation as well as to the clinical-therapeutic field. In this context convergencies between Schultz-Henckes concept of intentionality and new views in analytic developmental theory seem to emerge. The paper presented discusses before this background the significance of the visual domain, the affects and the explorative motivational system. The consequences of pathogenic impacts within these fields shall receive special consideration with regard to later neurotic developments.

Cognition Disorders↗
PubMed1993

[Psychoanalysis, adolescence and subsequent psychological effects].

Theories of the avant-garde in art aim at discovering new meanings in what appear to be securely established traditions. This approach also plays an important role in psychoanalysis, inquiring as it does into the human capacity for subsequently relating to the past in such a way as to create new traditions with a view to restructuring the present. Erdheim's contention is that this historical capacity is a product of the two-phase nature of human sexual development and comes to fruition in adolescence: "Adolescence is the avant-garde of the individual." With reference to three specific factors--male-female polarity, the meaning of aggression and omnipotence, antagonism between family and culture--the author traces the way in which this past-oriented and future-related structure takes shape in adolescence.

Adolescent↗
PubMed1993

[Psychoanalysis--a procedure or a process?].

The author discusses two schools of thought on psychoanalysis, one regarding it as a scientific procedure requiring correct application, the other as a process initiated by the patient in an unconscious quest for what he/she is in need of. With reference to a case history, Casement illustrates how the analyst can be drawn by the patient into the experience of not being able to understand what the latter is trying to tell him. In the case in point, this inability to understand corresponds to an experience undergone by the patient in infancy when due to undiagnosed severe myopia he was forced to live in a state of near-blindness. In analysis he attempted via projective identification to give expression to the traumatic experience of not being able to see and understand.

Adult↗
PubMed1993

What is psychoanalysis now?

Firstly, Freud's classical statement that every treatment that takes into account the phenomena of transference and resistance deserves the designation psychoanalysis is critically examined in a current, post-classical context. The confusion as a consequence of the fact that two different concepts of transference are often used indiscriminately is elucidated. Likewise, the dynamic conditions of two types of resistance--the classical type, as a result of internal conflict, and the interactional type, having to do with empathic failure and countertransference--are disentangled and related to current ideas on two types of conflict, convergent and divergent. This is technically reflected in the understanding of two types of therapeutic action: a nonverbal, object-relational factor as distinguishable from the effect of insight and interpretation. Finally, the dialectics of insight and relation are theoretically clarified through the clinical concepts of background and foreground, which are clinically bound to the concrete psychoanalytical situation and form a tool to distinguish the two types of transference, resistance and conflict.

Defense Mechanisms↗
PubMed1993

Disruptions of the therapeutic relationship in psychoanalysis: a view from self psychology.

The progression of the therapeutic process in clinical psychoanalysis is, characteristically, punctuated by a series of breaches in the otherwise collaborative analytic relationship of analyst and analysand. In this paper, these disruptions are conceptualised from the point of view of self psychology. A focus on the subjective aspects of the analytic relationship, i.e. the selfobject experiences in the transference, illuminates the vicissitudes of the emergence, maintenance and transformation of the self. The analytic process proceeds against an unconscious conflict between the fears of repeated injury and the longing for needed selfobject experiences. Disruptions occur when analysands perceive the analyst to be less attuned to their issues and more involved in the analyst's own agenda. Acknowledgement of the analysand's subjective view as a valid experience must precede the interpretation of the relational dynamics before it can effectively lead to a restoration of the process.

Adult↗
PubMed1993

Concepts of reality and psychic reality in psychoanalysis as illustrated by the disagreement between Freud and Ferenczi.

In this paper, the concepts of reality and psychic reality are discussed in relationship to a number of controversies about the therapeutic and scientific aims of psychoanalysis, as illustrated by the disagreement between Freud and Ferenczi. Because the nature of psychic reality is necessarily incomplete and indeterminate, there are inherent limitations and dangers to any psychoanalytic attempt to discover historical and experiential truth. Modell's interpretation of Nachträglichkeit ('deferred action') as 'retranscription' expresses the ambiguity of psychic reality in analysis, which is not fixed or foundational but part of an evolving inner and outer dialogue in relation to new experience. It is argued that Freud accepted this ambiguity, while Ferenczi sought to overcome it through modifications of technique.

Freudian Theory↗
PubMed1995

Intersubjectivity in psychoanalysis: a critical review.

The intersubjective critique of the classical model's positivistic tradition is examined. Classical analysis construes the core of mental life as a discrete entity that can be relatively interpretively captured as such. In contrast, the intersubjectivists construe core psychic processes as inseparable from a relational matrix. The intersubjective critique is traced to the theoretical tensions in Freud's concepts of transference/countertransference and ego development. Questions are raised whether the current intersubjective challenges actually constitute changes in clinical activity and process. Noted is the ubiquitous overlap between the intersubjective and classical models in all theories of psychoanalysis, as each seem to capture different aspects of mental functioning. Classical analysis maintains a difference between a stultifying 'idealisation' of a positivistically-based objective orientation and a holding such a possibility as only an 'ideal' to strive for: absolutist approaches to theory are unfounded, as the irreducibility of our subjectivity does not reduce us to total ignorance. Adopting an intersubjective orientation does not stop analysts from idealising 'that theory' and imposing it on the patient in an authoritarian manner. Nothing intrinsic to any theory forestalls self-aggradisement, and answers to such problems may lie in other kinds of theoretical debates than these.

Countertransference↗