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PubMed2005

Clinician reports of personality pathology of patients beginning and patients ending psychoanalysis.

OBJECTIVES: The purpose of this work was to use a clinician Q-sort procedure to describe the personality pathology and adaptive functioning of patients beginning and ending psychoanalysis. DESIGN: With a cross-sectional design, we compared a group of patients beginning and a group of patients ending psychoanalysis. METHODS: Twenty-six psychoanalysts described a patient beginning psychoanalysis and 26 described a patient ending psychoanalysis using the Shedler-Westen Assessment Procedure 200 (SWAP-200). Each clinician also completed questions about themselves, the patient, and the treatment. The most characteristic SWAP-200 items describing patients beginning and patients ending psychoanalysis provide a meaningful picture of the two groups. RESULTS: Among patients at the end of psychoanalysis, scores were significantly lower on the SWAP-200 Paranoid, Schizotypal, Borderline, Histrionic, and Dependent scales and scores were significantly higher on the SWAP-200 High functioning scale and the DSM-IV GAF scale. Common characteristics of patients beginning psychoanalysis were anxiety, guilt, and shame. Common characteristics of patients ending psychoanalysis were conscientiousness and responsibility, striving to live up to moral and ethical standards, and enjoyment of challenges. CONCLUSIONS: The findings demonstrate the usefulness of a clinician report measure for the study of psychoanalytic psychotherapy and psychoanalysis.

Adult↗
PubMed2003

Psychoanalysis and the Catholic Church in Italy: the role of Father Agostino Gemelli, 1925-1953.

Agostino Gemelli, a Catholic priest, psychiatrist, administrator, and educator, was an important figure in the early history of psychoanalysis in Italy. He was one of the few establishment figures to grapple with Freud's ideas in Italy during the first half of the twentieth century, a period during which Italy, compared to the rest of Europe and to the United States, was relatively impermeable to psychoanalysis. One of the factors that contributed to this was the opposition of the powerful Catholic Church, which identified in psychoanalysis a challenge to its authority. The author argues that Father Gemelli's shifting positions about psychoanalysis between 1925 and 1953 reflected the exigencies of his historical circumstances. Gemelli was able to identify in psychoanalysis an integrated view of the human condition in stark opposition to the brutal reductionism of psychiatry in Italy at that time, but also encountered in it elements intolerable to the Church. Examining specifically what it is that Gemelli could accept of psychoanalysis, and what needed to be rejected, between 1925 and 1953, illustrates the particular challenge posed by psychoanalysis to Catholicism in Italy.

Catholicism↗
PubMed1985

Psychoanalysis as science: the inductivist's resistance revisited.

The scientific status of psychoanalysis has been the focus of heated debates among philosophers of science and among psychoanalysts. The most recent challenge to psychoanalysis as a science comes from the quarters of the inductivist philosophy of science. Since inductivism is a self-defeating philosophy, it is not surprising that inductivists demand that psychoanalysts pay an unlimited price for their claim of scientific status for psychoanalysis. Most psychoanalysts, in their response to this impossible challenge, unwittingly claim to have paid the price. What is worse, the claim is made in a confused and emotionally charged manner. Hence, psychoanalysts are usually defensive and, thus, in error when repelling (in this way) the attack of the inductivist philosopher. It is not psychoanalysis inductivists attack, but their own commitment to their own logic which leads inexorably to the dissolution of their argument, of all science, and, indeed, of psychoanalysis as well. It seems much more reasonable to postpone any response to the challenges that confront psychoanalysis today and to invest effort in a reformulation of the problem of the scientific status of psychoanalysis. Different rational solutions to the problem may evolve if we take care to become well informed first about the limits of our theoretical frameworks and show readiness to change them, if and when needed. That is to say, we can start with a somewhat tentative, not to say skeptical, frame of mind concerning the very concept of scientific status. We may try to keep and to contain our skepticism to the degree required by the discourse at hand, carry on exploring in our practice, report our results, and discuss them respectfully. We should start by admitting that, quite possibly, our discourse will end inconclusively.

Generalization, Psychological↗
PubMed2001

The contemporary failure of nerve and the crisis in psychoanalysis.

The American Academy of Psychoanalysis is undergoing an identity crisis at this time, which is at least to a large extent a function of the whole current identity crisis in the field of psychoanalysis itself. In order to better understand this crisis, in this article I have first reviewed a similar situation which occurred in the history of classical Greece. Plato's famous Academy underwent a progressive deterioration and disintegration and fragmentation, until it ended up merely the handmaiden of another discipline, Christian theology, for a thousand years. I then propose that the identity crisis in psychoanalysis today has to do with our failure of nerve in the teeth of the abusive behavior of insurance companies regarding the payment for psychoanalysis and the current cultural ambience demanding "fast-fast-fast" relief. I call in this article for a return to Freud's basic principles as a focus for our identity. Of course we cannot ignore new discoveries in neurobiology if they are well established, or what we learn from the study of enactments in the here-and-how of the analytic procedure. Certainly the findings of Freud that are contradicted by firmly accepted empirical findings in neurobiology and other disciplines call for revision of some of his ideas, as do his mistaken views on the psychology of women and on certain other topics such as art, religion, and evolutionary biology. But this should not be permitted to blur our continuing focus on the fundamental principles of the clinical practice of psychoanalysis as Freud developed them over his lifetime. In this article I briefly reviewed those basic principles and proposed that we employ them as the basis for our identity as psychoanalysts and psychoanalytic psychiatrists. It represents a failure of nerve to drift this way and that with current fads and with the continuously deteriorating ambiance of our culture as the world slides into rampant global capitalism. Franz Alexander said years ago that psychoanalytic psychotherapy is one of the last remnants of the humanistic ideal, focussing on the individual unique person and his or her transcendent possibilities as well as maladaptive pathology. This article represents a clarion call for a debate on the identity of the American Academy of Psychoanalysis and what it stands for, which can only be clarified if we have a sharp focus on what we basically mean by "psychoanalysis." As Saul Bellow puts it (Atlas, 2000) in discussing the disappointing current situation for the arts and the humanistic disciplines, the intelligent public is waiting to hear from these disciplines what it cannot hear from pure science: Out of the struggle at the center has come an immense, painful longing for a broader, more flexible, fuller, more coherent, more comprehensive account of what we human beings are, who we are, and what this life is for...the individual struggles with dehumanization for the possession of his soul, (p.462). Below points out, in talking about writers, and in a discussion equally applicable to psychoanalysts, that if we do not "come again into the center it will not be because the center is preempted. It is not. [We] are free to enter if [we] so wish" (p.462).

Adult↗
PubMed1992

Psychoanalysis, science and clinical practice.

The question of the relationship between psychoanalysis and science, and the place of psychoanalysis in clinical practice is reviewed. A commonly held view that the central question is whether or not psychoanalysis is scientific is challenged. It is argued instead that psychoanalysis, science and clinical practice are epistemologically independent fields and attempts to subsume one within the other are unproductive. Psychoanalysis may have as much to say concerning the epistemological basis of science as science has to say concerning the epistemological basis of psychoanalysis. Only a proper appreciation of this enables the question of the relationship between psychoanalysis and clinical practice to be adequately examined.

Australia↗
PubMed1990

Foundations of psychoanalysis reconsidered.

Grünbaum's approach to psychoanalysis suffers from several difficulties. It imposes a standard of logical reductionism and methodological purity that not only violates the nature of psychoanalytic knowledge, but imposes an invalid standard of verification and scientific confirmation. It utilizes a brand of dichotomous reasoning that forces psychoanalytic propositions into artificial positions that do not reflect the actuality of analytic practice. It imposes a standard of verification that is impossible for psychoanalysis, along with all forms of psychological knowledge, to reach. It visualizes psychoanalysis as encompassing only one form of knowledge of human psychic life, forcing it into a model that eliminates other aspects of the psychoanalytic process, so that psychoanalysis is subjected to criticism only on one dimension among several--a kind of psychoanalytic straw man. The psychoanalysis that is so impaled often is difficult for the psychoanalytic practitioner to recognize. To the extent that Grünbaum's skillful and highly informed criticism of the philosophical bases of psychoanalysis encounters these difficulties, the value of his argument falls short of providing a useful basis for advancing psychoanalytic knowledge and particularly for promoting the quest for pertinent standards of validation within psychoanalysis.

Follow-Up Studies↗
PubMed2001

Contemporary psychoanalysis and hypnosis.

The relationship between psychoanalysis and hypnosis is presented in three parts: past, present, and future. First, the parallel developments in psychoanalysis and hypnosis over the past 100 years are summarized. Four major theoretical evolutions in psychoanalysis (drive theory, ego psychology, object relations theory, and self psychology) are described, with their corresponding influences on the practice of psychoanalytically informed hypnosis. Second, four contemporary movements in psychoanalysis are enumerated (postmodernism, spontaneity, pluralism, and integrationism), with commentary on these movements' likely impact on the current and future practice of hypnosis. Finally, the impact of shrinking mental health dollars on the practice of psychoanalysis and psychoanalytically informed treatments is presented. Hypnosis is offered as uniquely positioned, with its history of multitheoretically informed brief interventions, grounded in research and clinical practice, to provide psychoanalysis with a life raft into the next 100 years of practice.

Humans↗
PubMed2003

Psychoanalysis and creative living.

Psychoanalysis is ambivalent about creativity and its own creative potential. On the one hand, psychoanalysis offers enormous resources for elucidating obstacles to creativity, that way of living, making and relating to self and others that is fresh, vital, unpredictable and open to feedback and evolution. On the other hand, when we analysts know too much beforehand about what a work of art really means or the fundamental and singular motives of creativity, then psychoanalysis unconsciously partakes of a perverse scenario in which the work of art serves as merely a means to the author's ends and is psychologically colonized. When psychoanalysis is The Discipline That Knows, then art has nothing new to teach psychoanalysts and our field is impoverished. "Psychoanalysis and Creative Living" attempts to elucidate how psychoanalysis could work through this tension between its creative and perverse possibilities and foster creative living.

Art↗
PubMed1993

[Psychoanalysis between archeology and history].

Using the Freudian metaphor of psychoanalysis as archeology, we can identify several "archeologies" in the past of psychoanalysis: in the activities of non-analysts who, as practitioners, dug into the past of Freud, and of analysts who, as laboratory scientists, limited themselves to assembling concepts. We then compared these heterogeneous archeologies, be they scholarly, commonplace, or even scandalous, to the practice of the history of psychoanalysis initiated by Freud and continued by his disciples. The hagiography and more generally, the secrecy that surrounded certain parts of Freud's life and certain of his theories were demolished by the arrival of non-analyst historians, little concerned with preserving the aims that psychoanalysis, for self-preserving reasons, kept alive despite its ideal of a lack of purpose. The analysts, mediocre archeologists in the field, were compensated by their science of assembling piecemeal ideas. On the other hand, in the role of historian, of those who recount, the analysts were not well served by their techniques, coming as they did from the field of psychoanalysis. Thanks to this four-way comparison, archaeologist analysts, non-analyst archaeologists, analyst historians, and non-analyst historians, we can attempt to sketch several conclusions for a methodology of the psychoanalytical history of psychoanalysis.

Archaeology↗
PubMed2005

Psychoanalysis, science and the seductive theory of Karl Popper.

OBJECTIVE: To present a critique of the ideas of Karl Popper, the philosopher of science, whose depiction of psychoanalysis as a pseudoscience is often used to justify attacks on psychoanalysis. METHOD: Published sources are used to provide a brief intellectual biography of Popper, a summary of his concept of science and a summary of criticisms of Popper's view of science. His depiction of psychoanalysis and Freud's reply are presented. Clinical, experimental and neurobiological research which refutes Popper's view is summarized. RESULTS: There is a vast scholarly published work critical of Popper's falsifiability criterion of science. Less recognized is Popper's misunderstanding and misrepresentation of psychoanalysis; his argument against it is logically flawed and empirically false. Even if Popper's theory of science is accepted, there is considerable clinical, experimental and neurobiological research in psychoanalysis which meets Popper's criterion of science. CONCLUSION: Attacks on psychoanalysis based on Popper's theory of science are ill-founded and reflect inadequate scholarship.

Austria↗
PubMed1992

Therapeutic technique in psychoanalysis and psychoanalytic psychotherapy.

As the distinctions between what we consider to be psychoanalysis and what we consider to be psychoanalytic psychotherapy have become more uncertain and more blurred, it follows that it is equally difficult to designate the techniques that would be appropriate and specific for each modality. The problem has been compounded by the fact that in recent years psychoanalysis in the United States has become considerably less homogeneous than in the past and the ego-psychological structural model is no longer the only point of view in the psychoanalytic marketplace. Further, with alterations in the criteria for analyzability, cases which, generally, had not been viewed as suitable for analysis, have been appearing with increasing frequency on psychoanalysts' couches. We have also recognized that the degree of congruence between our expectations from and the results of psychoanalytic treatment was often less than anticipated. It appears that analysts have become considerably less arbitrary about what psychoanalysis is and how a psychoanalysis can be carried out. The author is unable to delineate one technique that is intrinsic to and limited to psychoanalysis. There are, however, differences in degree and emphasis in the ways in which various techniques are applied in the therapy of psychoanalysis as compared to the therapy of psychoanalytic psychotherapy. Special attention is given to the role of a psychoanalytic process and the central place the analysis of resistance plays in psychoanalytic therapy.

Defense Mechanisms↗
PubMed1992

The role of support in psychoanalysis.

A two-factor theory of clinical psychoanalysis is proposed. In accordance with the predominant position of the structural-adaptational ("classical") approach in psychoanalytic theory, the power of interpretation and insight in clinical psychoanalysis has received ample attention in psychoanalytic literature. There seems, however, to be a growing awareness among analysts that not all the facts of an analytic treatment can be accounted for by this approach alone. A second factor is increasingly recognized: the power of adequate support provided by the analyst and resulting in a specific experience by the analysand. In the application of the developmental ("postclassical") approach of psychoanalytic theory, the importance of this support-experience factor in the treatment of ordinary neurosis by means of ordinary psychoanalysis is emphasized. The relative neglect of this aspect of clinical psychoanalysis may be indicative of the present-day dilemma of how to translate advances in theoretical knowledge of mental development into the therapeutic praxis of psychoanalysis. There may, however, be another important reason. Support and experience are phenomena often occurring on the nonverbal level. In contrast to interpretation and insight, they are usually not voiced, let alone distinctly and loudly expressed. They are the silent power of psychoanalysis.

Humans↗
PubMed1998

Sartre's Freud and the future of Sartrean psychoanalysis.

I describe Sartre's analysis of Freud as an exemplary case study in existential psychoanalysis, a kind of anti-psychiatric analysis; in addition Sartre's analysis of Freud is a practical critique of the latter's theory. Sartre's overall aim is revolutionary, not primarily concerned with healing people; his method transcends the traditional aims of psychoanalysis and psychotherapy. The paper is divided into four sections: 1) Sartrean Existential Psychoanalysis: An explanation of the basic understandings of Sartre's Existentialism and Psychoanalysis. 2) Sartre and Anti-psychiatry: An analysis of the relation and influence of Sartre's philosophy on R.D. Laing's anti-psychiatry, and a review of the contemporary anti-psychiatric practice of the Philadelphia Association. 3) Sartre's Case-study of Freud: An exemplary application of Sartrean psychoanalysis and a critique of traditional psychoanalysis. 4) Transcending the Boundaries of Therapy: A proposal for a radical application of Sartre's philosophy that extends beyond the aims of clinical approaches.

Existentialism↗
PubMed2005

Strategic self-marginalization: the case of psychoanalysis.

Marginality is an important concept in the history of science, though it is often used in a manner that presumes marginality to be a static designation. We contend that the dynamics of marginality are crucial to the history of psychoanalysis, a discipline that has moved between dominant and marginal positions. We address psychoanalytic marginality via three specific "cases": the marginalization among Freud and his followers when psychoanalysis was an emergent discipline; the marginality trope in Erich Fromm's popular psychoanalytic writing when psychoanalysis was orthodoxy in American academic psychiatry; and the rhetorical marginality of psychoanalysis in Sweden as psychoanalysis entered a decline within psychiatry. Our aim is to show that marginalization and self-marginalization serve interpersonal, social, and professional strategies.

Freudian Theory↗
PubMed2002

Between certainty and uncertainty--observations on psychoanalysis in Russia.

'Diversity', the theme of our conference, carries a subversive sub-text in totalitarian societies. This is one of the themes presented as the current revival of psychoanalysis in the more democratic post-Communist Russia is explored. The history of psychoanalysis in Russia is summarized with a focus on its politicization, which led to initial interest in its theory (by way of a misapprehension of its tenets), and then to ultimate suppression of psychoanalytic thinking as an ideology deemed antagonistic to the totalitarian regime. In contrast, features of psychoanalysis and democracy are explored for their mutual affinities. The background of the resourceful new generation of analytic therapists is discussed, especially in regard to their experience of the parallel meanings of the word 'repression' (political, psychological). There is a persistence of some traits in patients and practitioners alike that are referable to past repression, such as the newness of verbal treatments, the inhibition of psychological curiosity, the ambivalent lure of certainty, and the pressure of authoritarian introjects. It is noted that psychoanalysis has its own history of a posture opposed to pluralism and diversity, which deepens the dialogue on the mutual engagement between psychoanalysis and the vicissitudes of its history in Russian culture.

Freudian Theory↗
PubMed1993

Reflections on the history of psychoanalysis.

The proliferation of psychoanalytic schools demands the reexamination of the history of psychoanalysis. Psychoanalysis emerged at the intersection between the rational heritage of the enlightenment and the interest in the morbid that was the hallmark of romanticism. This paper focuses on moments when psychoanalysis was poised at a crossroads where various routes could have been taken. Differentiation is made among the heretics, modifiers, and extenders of psychoanalysis. Discussed within a historical frame of reference are the contributions of leading modifiers--Melanie Klein, Hartmann, Winnicott, Kohut, and others--as well as their extenders. The paper concludes with a discussion of some current urgent problems facing psychoanalysis.

Europe↗
PubMed2002

The trajectory of psychoanalysis: a prognostication.

I present an overview of the development to this point of psychoanalysis as a discipline--both as a theory of the mind and a treatment of the disorders of the mind--and offer a prediction concerning evolving development over its (near) future. My focus is on the coherence of psychoanalysis as a theoretical structure, starting with Freud's strenuous endeavours to maintain the psychoanalysis that he had single-handedly created as a unitary and unified theory, tracing then the breakdown of this effort, even in Freud's lifetime, into the burgeoning theoretical diversity or pluralism that characterises worldwide psychoanalysis today, and then going on to the beginning appearance of evidences--not yet widely remarked--of growing convergences from within very disparate and even seemingly very opposed theoretical perspectives, at least at the level of technical interventions and experience-near clinical theory, with implications, however, even for the level of experience-distant general (metapsychological) theory. Such a development, if sustained, as I anticipate, would strengthen the credibility of psychoanalysis as a science of the mind, amenable to growth through empirical research in accord with the canons of scientific method.

France↗
PubMed2005

Psychoanalysis and psychotherapy: a long and troubled relationship.

The extended, inconclusive debate over distinguishing psychoanalysis and psychotherapy has been muddied by two underlying issues. The scientific identity that psychoanalysis claimed, leading it to affirm that it was more than a treatment modality, was in conflict with the actual therapeutic mission it assumed. Psychoanalysis was further hampered in those discussion by its internal conflicts over doctrinal purity; deviations for psychotherapeutic ends were vulnerable to the charge of dissidence. More recently, the debate has been clouded by the fact that newer candidates, by and large, can anticipate careers primarily as psychotherapists, driving a wedge between generations within institutes. The course of the debate and the problems encountered in it are affected by the formal relations between the psychoanalytic establishment and the health-care industry, including government agencies. In the long run, it appears to make little difference whether psychoanalysis is officially recognized as a mental-health treatment, as in Germany, or attempts to maintain its independence, as in the UK. Finally, as the debate appears to be winding down, the fate of dynamic psychotherapy is also in the balance. If in the past psychoanalysis seemed at risk of losing its specific identity, today dynamic psychotherapy is in danger as well.

Germany↗