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Speaking in the claustrum: the psychodynamics of stuttering.

The author outlines the psychoanalytic theory of stuttering and, discussing material from the analysis of a stutterer and its transference and countertransference processes, puts forward a new hypothesis of the psychodynamics of stuttering in conjunction with Meltzer's theory of the claustrum. He argues that the stutterer is working out intolerable experiences of separation from the primary object and a resulting catastrophic experience of the oedipal situation through an unconscious fantasy in which anal qualities are conferred on the internal maternal object by a predominating hatred. The intrusive identification of parts of the self in the maternal rectum gives rise to a claustrophobic experiential world in which all obstacles that are encountered between self and object must be eliminated. The anal-sadistic object space of the claustrum is projected on to the external object space and thus also on to the mouth as the origin of the sound envelope, where it produces both a lifeless sound envelope and a torn content, i.e. stuttered sounds, words and sentences. Correspondingly, a dead speech melody and broken words have their parallels in object relations that are characterised by an attack on linking and by psychic withdrawal.

Adult↗

The impulse to infidelity and oedipal splitting.

Freud suggested that the child perceives parental intercourse as an act of infidelity by the desired but unfaithful parent. Parental sexual infidelity is felt to be a major narcissistic injury that gives rise to fantasies of revenge. A defensive organization arises to manage this trauma and its attendant revenge fantasies. That organization involves splitting of the desired parent into faithful and unfaithful parts, displacement of hostility on to the rival parent, and identification with the desired but unfaithful parent resulting in the impulse to infidelity. Romantic fantasies of escape and rescue from evil rivals provide guilt free ways of satisfying fantasies of oedipal revenge. In those fantasies the evil rival is turned into an injured third party who gets his or her just deserts as the romantic couple gets to live happily ever after. This defensive organization may embroil patients in complicated love triangles as adults for which they may seek treatment. Analyzing the repudiated narcissistic wound of parental infidelity and the disguised revenge fantasies that defend against that wound may provoke narcissistic rage towards the analyst as a moralistic, possessive, controlling, envious, and spoiling oedipal parent.

Conflict, Psychological↗

The profession of ferryman: considerations on the analyst's internal attitude in consultation and in referral.

Psychoanalytic consultation is an interview with a patient who will not be taken in treatment by the consultant analyst, but who will be sent to another, perhaps specifically chosen, colleague after one or more assessment sessions. This practice is becoming increasingly important since, besides traditional private relationships between consultant and patient, it is now common in many specialized centres affiliated to official psychoanalytical institutions. The author explores some fundamental aspects of the analyst's internal attitude in consultation: motivation to know; a 'concave' attitude to listening; responsibility in proposing suitable technical choices and referral to a further specialist; empathy and partial identification; the balance between authentic experience in the consultation and risks of seduction; internal links within the community of colleagues; the technique for sending patients on. He presents a clinical example, specifically aimed at reproducing the internal attitude of the analyst, together with the necessary work that allows a difficult patient to initiate psychoanalytic treatment.

Adult↗

Pentheus rather than Oedipus: on perversion, survival and analytic 'presencing'.

Following an introductory review of the main developments in the psychoanalytic thinking on perversion, the author focuses on her own understanding of perversion and its treatment, based on the psychoanalytic treatment of patients with severe sexual perversions. This paper uses the term 'autotomy' (borrowed from the field of biology) to describe perversion formation as an 'autotomous' defence solution involving massive dissociative splitting in the service of psychic survival within a violent, traumatic early childhood situation; thus, a compulsively enacted 'desire for ritualised trauma' ensues. The specific nature of the perverse scenario embodies the specific experiential core quality of the traumatic situation. It is an actual repetition in the present of the imprint of a past destructive experience which is pre-arranged and stage-managed; it thus encounters haunting scenes of dread or psychic annihilation while, at the same time, controlling, sanitising and disavowing them. Hence, the world of severe perversion is no longer oedipal, but rather the world of Pentheus, Euripides's most tragic hero--a world dominated by a mixture of a mother's madness, devourment, destruction and rituals of desire. According to this view, the (difficult) psychoanalytic treatment of perversion focuses on patient-analyst interconnectedness--brought about by the analyst's 'givenness to being present' or 'presencing'--at a deep, primary level of contact and impact (the emphasis being on the ontological dimension of experience). This evolving therapeutic entity creates and actualises a new, alternative experiential-emotional reality within the pervert's alienated world, eventually generating a change in the perverse essence. The author illustrate this approach with three clinical vignettes.

Adult↗

The controversial discussions and après-coup.

The author suggests a distinction between what is descriptively named après-coup, and what is dynamically identified as après-coup. This parallels Freud's distinction between the descriptive unconscious and the dynamic unconscious in the topographical model of the mind. The descriptive après-coup refers to the way in which the concept has found a use, especially but not only in the French literature, to refer to retrospective signification in the moment-to-moment progress of a session. The author outlines dynamic après-coup and she suggests it is at the core of Freudian metapsychology. Dynamic après-coup establishes a link between trauma, castration, repetition compulsion, sexuality and temporality in the context of the transference.

Adult↗

Experiences in K and -K.

In this paper the author explores and expands Bion's concepts of K and -K and delineates the nature of the relationship between the two. While Bion views envy as a principal motivating force for -K, his conception of -K goes considerably beyond this. The author explores manifestations of -K not driven by envy and, consequently, not necessarily pathological or pathogenic. -K is viewed by the author as a psychological process, which may serve many functions, including the communication of the patient's fear that knowing will bring on psychological catastrophe. -K, under circumstances that he describes, may serve to protect the individual's sense of continuity of being. The need to know the truth (K) may be at odds with the need to survive psychically, for example, when a person fears that the truth will kill him, or those he loves and depends upon. This idea is explored in two ways: first, by means of a discussion of the Oedipus myth in which Oedipus attempts to evade knowing for fear of recognizing that a prophesied catastrophe has already occurred; and, second, by means of a clinical exploration of the conflict between the need to know and the need to survive. The author discusses his analytic work with a severely disturbed patient for whom not knowing was felt to be essential to her psychic survival. Her need not to know reached a point where she psychically obliterated the analyst through the use of negative hallucination.

Adult↗

The erotic transference in women and in men: differences and consequences.

Although the erotic transference is believed to be universal, it is variable in its expression. Drawing on the distinction between transference resistance and resistance to the awareness of the transference, I have proposed that, in general, the erotic transference utilized as resistance is more common among women, while resistance to the awareness of the erotic transference is more common among male patients. Erotic transference as resistance poses different analytic problems from those posed by resistance to its awareness. With women in treatment with men, the erotic transference is more often overt, consciously experienced, intense, long-lived and directed toward the analyst, and focused more on love than sex; with men in treatment with women, the erotic transference is muted, relatively short-lived, appears indirectly in dreams and triangular preoccupations, is seldom consciously experienced as a dominant affective motif, is frequently transposed to a woman outside the analytic situation, and most often appears as sexual rather than as a longing for love. In women, the strength of the erotic transference may obscure other important dynamics and conflicts. In short, the strength of the erotic transference, while it has significant therapeutic potential, often acts as a strong transference resistance to working out underlying conflicts. In contrast, in male patients in treatment with women, there is a resistance to the experience of the transference and, frequently, one witnesses defenses against the erotic transference rather than the transference itself. Yet, the dangers are substantial when the erotic transference fails to develop or is suppressed. This difference in the manifestation of the erotic transference parallels an extratherapeutic difference. In general, women achieve their self-identity as women by virtue of certain defining relationships, whereas men achieve their self-identity as men through achievement and autonomy. The reasons for these differences have been explored in terms of cultural dictates, but more particularly in terms of an asymmetry in psychological development.

Adult↗

Apples falling far from the tree.

This paper describes a common life-constricting dynamic among therapy patients. The affected person cannot accept certain traits held in common with an ambivalently loved parent. The patient is damaged by being unable to tap potentially valuable segments of himself--thoughts, feelings and behaviors which could enrich his life. Ultimately, his relationships may suffer, as well as his potential for creativity and achievement.

Adult↗