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The female psychoanalyst in the movies.

The last five decades of the American cinema have produced a remarkably consistent stereotype of the female analyst. In films such as Spellbound (1945), Knock on Wood (1954), Sex and the Single Girl (1964), They Might be Giants (1971), and The Man Who Loved Women (1983), women analysts are swept away by countertransference love that leads them to become sexually or romantically involved with their male patients. In stark contrast to the data from studies of patient-therapist sexual involvement, there are more than twice as many films portraying unethical sexual behavior on the part of a female analyst as there are films depicting similar countertransference acting out by a male analyst. Moreover, a stable relationship with a man and a successful analytic practice never coexist for any woman analyst in the cinema. Neither does a female analyst ever successfully treat a male patient in the American cinema unless she falls in love with him. On the contrary, the male patient is more likely to cure his female analyst. Clinical reports from cross-gender analyses are useful in understanding these cinematic myths.

Countertransference↗

Where the action is: the enacted dimension of analytic process.

Enacted processes--variously addressed in the current literature by such terms as enactment, actualization, and interaction--represent the conceptual reuniting of Freud's concepts of transference and acting out. These various concepts include a recognition that transference may be represented not only on the verbally symbolized level but also on the enacted level, through psychic organizations and processes that use behavior, silence, and even speech as symbolic vehicles. Countertransference too finds representation within the enacted realm, in response to and in concert with the patient's enacted processes, though in more attenuated fashion. Enacted transference-countertransference processes are conceptualized as a continuously evolving second dimension of analytic treatment. This enacted dimension of analytic process exists alongside, and inextricably interwoven with, the treatment's verbal content, with characteristics unique to each analytic dyad. It occurs naturally and inevitably, without conscious awareness or intent, and is outside the domain of explicit technical interventions. The observable outcroppings or end points of processes within the enacted dimension are what are currently referred to as enactments. Attention to these unintended but meaningful and often elaborately developed characteristics of the treatment process furthers our understanding of the therapeutic action of psychoanalysis. The process of integrating the enacted with the verbal dimension of treatment enables the analysand to achieve higher levels of psychic organization.

Communication↗

Is stuttering a contraindication to psychotherapy?

This is a case report of a patient who stutters and was treated for problems of self-esteem with focused brief psychotherapy. The literature by and large is against the use of individual psychotherapy for neurotic problems in patients who stutter. The countertransference may account for the unwarranted pessimism in the literature about such patients. In this case the successful resolution of countertransference feelings facilitated the achievement of the goals of therapy. Further reports on such treatment attempts are warranted. Speech therapy may be facilitated by brief focused psychotherapy for the stutterer.

Adult↗

Psychoanalytic supervision: the intersubjective development.

The author argues that an intersubjective perspective on the analytic process makes the notion of purely didactic supervision, avoiding countertransference issues, untenable and that countertransference is both a clue to the analysand's psychic reality and a factor in its evolution. Supervision is seen as a highly personal learning process for both supervisor and supervisee and its emotional climate as a crucial factor in its evolution into a transitional space, generating new meanings. Supervision is portrayed as the crossroads of a matrix of object relations of three persons, of a complex network of transference/countertransference patterns. The avoidance or denial of the supervisor's subjective role in it, maintaining 'a myth of the supervisory situation', may make supervision stilted or even oppressive and stand in the way of resolving supervisory crises and stalemates. It is argued that several factors contribute to the conflictuality of supervision for all partners (often including the analysand): the continuous process of mutual evaluation, the reciprocal fears of exposing one's weaknesses, the impact of the institute as a setting and the transferences it arouses and the inherent conflicts of loyalty for each participant in the analytic/supervisory triad. The resulting dynamics and relational patterns could become a legitimate and freeing topic in supervisory discourse.

Countertransference↗

Full and empty spaces in the analytic process.

In this paper the author discusses two categories of patients which differ in terms of the impact they have in the countertransference. On the one hand, there are patients who create an empty space in the analyst's mind. The response they provoke is a kind of depressive feeling that remains after they leave. The patient may bring dreams and associations, but they do not reverberate in the analyst's mind. The experience is of dryness, a dearth of memory, which may--at times--leave the analyst with a sense of exclusion from the patient's internal world. At the other extreme, there are patients who fill the consulting room. They do that with their words, dreams and associations but also with their emotions and their actions. The experience is that the analyst is over-included in the patient's world. They have dreams that directly refer to the analyst and the analyst feels consistently involved in the patient's analysis. The pathway through which the analyst can understand both these types of patients is via the countertransference or, to put it another way, the analyst's passion. In 'Analysis terminable and interminable' Freud suggested that the bedrock of any analysis is the repudiation of femininity. The author believes this statement may be viewed as lying at the crossroads of the discussion about the limits of the theoretical and clinical psychoanalytic formulations which she refers to. In the examples presented the author relates the repudiation of femininity in its connections to the gaps implicit in psychoanalytic understanding.

Adult↗

Some psychoanalytic viewpoints on neuropsychiatric disorders in children.

The author addresses issues interfacing neuropsychiatry and psychoanalysis. He recommends psychoanalysis for children with Attention Deficit, Hyperactivity Disorder (ADHD) and Dysfunction in Attention and activity control, Motility control and Perception (DAMP). He attributes its low status in neuropsychiatric treatment recommendations partly to the fact that psychoanalysts do not always declare their specific field of investigation. The scientific community then assumes that psychoanalysis aims to comment on issues outside its field of investigation, e.g. on neurobiological aetiology. The community therefore fails to discern the psychoanalyst's specific task, to help the child express and work through his conscious and unconscious experiences. Clarity on the analyst's part will improve relations with the scientific community and facilitate a relevant comparison of treatment methods. Another reason for neuropsychiatry's negative attitude towards analysis is its unwillingness to accept that unconscious conflict influences behaviour. With theoretical and clinical arguments, the author argues that unconscious factors must be taken in to understand and to treat the child. Countertransference, often cumbersome with neuropsychiatric children, becomes easier to handle if the analyst is clear about his field of investigation. If he sees through simplistic formulations on aetiology, countertransference gets even more manageable. Psychoanalysis can result in considerable intellectual and emotional development, as illustrated by work with a latency boy with DAMP, autism and slight mental retardation. In his psychoanalytic theoretical framework of the case, the author unites ego-psychological formulations with a Bionian conceptualisation of the thought disturbance.

Attention Deficit Disorder with Hyperactivity↗

A severe sexual inhibition in the course of the psychoanalytic treatment of a patient with a narcissistic personality disorder.

This case report illustrates how an analysis of oedipal conflicts gradually resolved a severe and extended inhibition of sexual desire that developed as a new symptom in the termination phase of psychoanalytic treatment. The enactment in the countertransference of castration anxiety, against which the patient was successfully defending himself by projective identification, produced an extended stalemate, which was resolved once the countertransference was transformed into transference interpretations. This treatment also illustrates the intimate connection between pre-oedipal and oedipal conflicts in the advanced stages of the treatment of narcissistic personalities, and the need for very careful assessment of the patient's sexual functioning before deciding on terminating the psychoanalysis of a patient with a successfully resolved narcissistic personality structure.

Anxiety, Castration↗

20 Years is not long enough.

The author presents some Latin American sociopolitical vicissitudes exemplified by Argentina, where she lives and where she trained and practices as a psychoanalyst. The exposition is based on the impact that her experience with two patients, Ana and Juana, had on her, and is presented in the form of clinical vignettes. The author reflects clinically and technically on the transference and countertransference and on the ways in which self-analysis enabled her to distinguish between the countertransference related to the patient and that related to the psychoanalyst. Finally, the author discusses the traumatic effects of 'the human condition', 'social violence' and 'Evil', referring specifically to the 'repetitive trauma' individuals experience under the globalization of terror and to the use of mechanisms of disavowal that result in serious splitting. The author confronts the reader with totalitarian terror as something that attacks and destroys the main constitutive characteristic of human beings, namely, their ability to think, remarking that H. Arendt is the one who speaks about 'radical evil' as 'the banality of Evil'. The author addresses the question of whether by tempering aggression and organizing levels of symbolization 'words' might prevent the emergence of 'pure jouissance' and be more powerful and significant than violence, overriding it.

Argentina↗

Short-term hospitalization: an aspect of the psychoanalytic treatment of character disturbance.

Brief psychiatric hospitalization of borderline patients is often necessary to avert the disintegration of therapy and the likelihood of suicide. Such hospitalization almost inevitably arouses intense countertransference reactions in therapists and other hospital staff members. If properly used, these reactions provide a significant opportunity to achieve change in a patient's underlying character disturbance. The author presents a detailed case report of a patient's 3 1/2-week hospitalization to illustrate how efforts to work through a transference-countertransference impasse prevented the premature dissolution of the patient's outpatient psychotherapy.

Adult↗

Talking about medication.

With the increasing use of psychotropic medication concomitant with psychoanalysis, attention must be given to the challenges created by complaints of medication side effects. When confronted with these side effects, analysts may experience specific, uniquely actualized countertransference anxieties that can prompt the abandonment of transference analysis. Particular countertransference fantasies that arise in combined treatments are examined, as are the reasons for the analyst's suspension of curiosity and openness and its clinical consequences. In these situations, effective analysis requires the analyst to be "bilingual," to hold in mind both the analytic and the pharmacological model.

Anxiety Disorders↗

Catastrophic illness in the analyst and the analyst's emotional reactions to it.

The author reviews the fact that there is very little literature available on catastrophic illness in the analyst and the analyst's emotional reactions to it, compared with other topics of interest. Some of the factors suggested to account for this are exhibitionistic concerns, concerns about one's privacy (including psychic privacy), embarrassment related to countertransference, and concerns about losses of referrals if colleagues perceive the analyst to be impaired. The author then draws a distinction between the emotional life of analysts and countertransference, and discusses how and why he defines them differently. The major part of the paper then goes on to discuss two major technical questions in considerable detail: (a) whether or not to give factual information to patients about one's condition, and (b) the manner in which the material is introduced into the analysis. A number of case examples are cited. The author closes with a discussion of the question of the pros and cons of reporting on the experience immediately versus waiting for the passage of time.

Adaptation, Psychological↗

Some experience in psychotherapy with suicidal patients.

Changes in actual relationships and self-esteem are of particular importance. The therapist must be more direct, personal and interrogating than is the case with other types of patients, especially with regard to the suicidal fantasies and acts, i.e., plans and methods. The author emphasizes the importance of identifying hateful countertransference reactions in the therapist, and points out just how these can be controlled, and used constructively as means of understanding the more subconscious aggressive feelings of the patient, which are projected on to the therapist. There is often a fragile balance between trust, realistic agreement and the availability of the therapist with regard to out-patients, and limit-setting of admission to emergency wards. An important aspect with regard to consultations with hospitalized patients is always to ask questions and employ direct communication about suicidal intentions and risks; further, no secrecy or vagueness about these matters should be permitted at ward meetings or in group work. The therapist must be open and direct, informing the patient as to just how he looks upon suicide as a mindless act, which once and for all destroys totally the interests and goals of the patient. It is also essential to work all the time on countertransference reaction in the staff, both the anxiety and the hate. The post mortem work after a successful suicide must include fellow patients, staff members and the family.

Aggression↗

An analyst's regressive reverie: a response to the analysand's illness.

A psychoanalytic session is described where both the analyst and analysand experienced a dream-like state associated with the theme of childhood illness. The analyst's countertransference took the form of a hypnogogic reverie concerning a dying boy's plea for his help, while the analysand's transference reaction was to re-experience the analyst as the negligent anaclitic father and himself the neglected child. The analyst's frustrated reverie and the patient's frightened angry response was a regressive expression of what previously had been unconsciously shared, but not totally congruent, fantasies. Although this was initially disillusioning experience in the analysis, with attempts at working through, the analysand was subsequently freer with his associations and positive feelings. There was also recovery of associated childhood illness experiences. It is suggested that these transient periods of altered consciousness provided a shared experience that was eventually analysable and therefore therapeutic. This paper considers the interaction between latent transference and countertransference fantasies during analyses. A clinical vignette illustrating the vicissitudes of empathy is explored primarily from an intersubjective point of view.

Anxiety Disorders↗

A topographical model of clinical decision making and interviewing.

A model linking clinical decision making, interviewing skills, and countertransference is presented. It derives from the psychoanalytical topographic model which is hierarchically organized into unconscious, preconscious, and conscious aspects of thought, feeling, and action. This model provides a format for understanding and teaching about physicians' unconscious, unrecognized responses to patients (countertransference), an important determinant of physician learning about clinical decision making and the clinical interview.

Countertransference↗

[Empirical research and the psychoanalytic situation].

The possibilities of applying empirical research methods to the psychoanalytical treatment situation are discussed. Until now, the application of such methods has been too closely bound to the fixing of aims in standard quantitative scientific terms. Frequently "reasons" in psychological areas have been compared to "causes" in scientific terms. As a result, a displacement has occured in the understanding of the reciprocality and circular nature of communication processes. In order to achieve a differentiation between scientific approaches it has proved useful to contrast concepts of linear-causal determination with those of interaction. The consequences of placing varying emphasis on such concepts within the therapeutic situation are described. The important differentiation between a level of working alliance and one of transference and countertransference processes in psychoanalytical treatment technique may perhaps be pursued according to basic logical concepts. On the level of the working alliance, the therapeutic relationship is understood to be mainly linear-causal: working alliance does, of course, mean working together, however, the analyst is seen to evoke a specific effect in the patient, a specific way in which attitudes and fantasies are questioned. When processes of transference and countertransference have reached a specific intensity, the constellations of the relationship can be more precisely comprehended in terms of parameters based on interactional concepts: specific unconscious processes in a given therapeutic situation can most be easily be discerned in the reciprocality of feelings, associations and reactions, and not in terms of a theory which persits in conceptions of linear-causal determination. Hitherto, it has hardly been possible to comprehend those processes where interactional determination predominates, in quantative terms.

Communication↗

Studies on hysteria: Dora.

This paper reviews the fascinating case material of Freud's "Fragments of an Analysis of a Case of Hysteria" and the subsequent material that has come to light about Dora. The analytic material is reinterpreted in the light of more contemporary analytic perspectives. The difficulties can be considered in terms of the problem of diagnosis, in terms of the dynamics inherent in Dora's personality structure, and finally in terms of the difficulties in the transference-countertransference interaction that played such a significant role in the premature termination of the case. Dora is far from simply a case of hysterical neurosis, but her pathology not only reflects the dynamics of the paranoid process, but also falls within the range of the borderline spectrum of personality disorders that have been described previously (Meissner 1982b.). Moreover, the borderline quality of her psychopathology gave rise to certain transference-countertransference interactions that lend themselves to more adequate formulation in terms of the paranoid process (Meissner 1978b). This gives rise to a variety of theoretical and therapeutic considerations that bear on our understanding of the nature of hysteria and of the psychoanalytic process itself.

Adolescent↗

[The prospective image the psychotherapist holds of his patient and its effect on the therapeutic process].

Psychonalytic theory of the therapeutic process is predominantly determined by the concepts of transference, resistance and countertransference. Decisive through the insight into the relationship between analyst and patient thus derived may be, the range of, potential meanings of these concepts does not in the first place encompass a complete theory of the therapist-patient-relationship. It mainly indicates how to use the therapeutical techniques which in turn define the theoretical scope of these terms. What is called the real aspects in the therapeutic relation, ie, those relatively free from transference, and their influence on the therapeutical process are so far unterrepresented in the theory of psychoanalysis. Yet the prospective view the therapist holds of his patient most probably has a decisive impact on the course of a treatment. Although the notion of countertransference offers some technical possibilities for correcting this image and for adjusting it to reality it is not sufficient to account for the complexity of the process in the psychoanalytic theory. The real features of the therapeutical relationship are the secret condition, the very background which alone allows the phenomena of transference and counter-transference to be detected as such.

Countertransference↗

[Sigmund Freud in supervision].

Hilda Doolittle's memories of her analysis with Sigmund Freud in the years 1933/34 motivated the author to act playfully as a posthumous supervisor of Freud. It becomes obvious that a transference/countertransference configuration which manifested itself in the very first hour could not be analyzed. The reason was found in an unsolvable contradiction between Freud's countertransference feelings of disappointment and rage and his wishes as an old man threatened by death to be loved by a young woman and to assure posthumous fame. Both the countertransference feelings and the wishes of Freud were not analyzed but acted out. In this process the favorite dog of Freud, Jofi, had an important part as a mediator and transitional object. It was Jofi which protected the working alliance against the conflicting non-analyzed feelings of Freud.

Countertransference↗