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PubMed1999

On subjectivity and objectivity in psychoanalysis.

Epistemological subjectivism has found its way into psychoanalysis along several theoretical and clinical paths. It has developed out of the clinical interest in transference and countertransference and, in particular, from the broadly generalized definition of countertransference now popular. The clinically necessary attention to analyst-analysand interaction has been turned into interactionism or intersubjectivism and a denial of epistemological subject-object differentiation. These perspectives transform a clinical focus on the here and now of the analytic relation into the determination of the past by the present and a teleological reversal of causality. Once this reversal is made, narrative in the analytic situation becomes the co-creation of the analysand's past by the present analyst-analysand relation. Psychoanalysis, on this view, can at best substitute a coherent, novelistic account for the life history of a person. Some of the problems of subjectivism are examined here with a view to restoring to psychoanalysis the epistemology of science and common sense.

Humans↗

PubMed1999

Erotic complications.

The author argues that erotic transference-countertransference dynamics present particular complexities when they develop between gender constellations other than male analyst and female patient. She addresses the dynamics of a complicated erotic transference in concert with an aversive countertransference response as it evolved between a female analyst and female patient. The intense erotic transference that developed defied classification as either maternallerotic or oedipallerotic, and instead included both features in a rapidly shifting process that was difficult to address analytically. The analyst's confused, often aversive, response to her patient's erotic wishes ultimately revealed a subtle re-enactment involving split-off and erotised experiences of emotional penetration and scrutiny. When these issues were addressed, the erotic transference dissolved, and the analyst's experience of her patient shifted rather dramatically. It is suggested that complex erotic transference sometimes contains within it evidence of previously repressed object experiences that were not primarily sexual in nature.

Adult↗

PubMed2005

Introduction.

In this introduction to the special issue on "Group Therapist Countertransference to Trauma and Traumatogenic Situations," the author notes that for many therapists it is not only group member disclosures and re-enactments, but also the co-occurring, sociopolitical contexts in which they live that may involve traumatic challenges. He considers three historically evolving views of countertransference: (1) the "classical" position, (2) the "totalistic" view, and (3) the "intersubjective/relational" view. He views the therapist's intense emotionality (as opposed to clinical detachment) in response to trauma as inevitable, and considers the particular roles of "bystander," "perpetrator," and "victim" induced in the therapist by traumatic re-enactments in the group. He concludes with a synopsis of some of the key points made in each of the contributions to the special issue.

Journal Article↗

PubMed1991

Analytic interruptions.

The author examines the phenomenon of analysand-initiated interruptions of psychoanalysis by briefly reviewing Freud's treatment of Dora and then describing his own similar experience. The deterioration in Freud's relationship with Wilhelm Fliess may have influenced Freud's handling of Dora's treatment, thereby contributing to the outcome. The author contends that, with his own patient, his plan to end a training analysis influenced his management of transference-countertransference dynamics, thus contributing to the patient's premature departure. The author suggests that there is a special period of countertransference vulnerability for psychoanalysts and psychotherapists.

Adult↗

PubMed1990

Self-analysis: a fool for a patient?

In this paper I first reviewed the scanty publications on the subject of self-analysis. Although it was recommended by Freud as early as 1910 for every analyst, self-analysis turns out to have many pitfalls and to be quite a complicated and controversial procedure. There is no agreement on the proper technique of self-analysis in the literature, nor is there any discussion of the determinants of the particular choice of technique of self-analysis that is employed, nor even of the reasons why some analysts do not engage in it at all. Using clinical data gathered from written material of many years of self-analysis following the termination of a successful training psychoanalysis, I have attempted to elucidate some of the problems posed by this procedure. These problems are in some ways similar to formal psychoanalysis, but are in some ways contingent on the fact that it is basically a different technique. It is a solitary occupation and therefore suffers from the dangers of disintegration into autism, narcissism, and obsessional rumination. There is no living presence of an analyst to serve either as a transference figure or to make interpretations and stimulate the production of material. The identification with the analyst's analyzing function is far from simple in self-analysis because of the complex nature of the various internalizations of the analyst that take place over years of a formal training analysis. Thus, Ticho (1967) is correct when she claimed that self-analysis is a skill that the analysand has to acquire by himself or herself. An important phase of the beginning of self-analysis involves the working through of the separation from the psychoanalyst and the re-evaluation of the analyst and the analytic process. This results in a heightened sense of independence and autonomy, increased cohesion of the self, and maturation--which is manifested by greater autonomous ego functioning, a more mature sense of identity, and continued transformations of narcissism which highly valuable goals, on the basis of the data I have presented, can be approached through the process of self-analysis. Above all this stands the most important goal of self-analysis, the understanding of one's countertransference reactions. This is especially important in the treatment of seriously disturbed patients who become disruptive, and thus get labeled borderline, often as a response to unconscious countertransference manifestations from the analyst which are then experienced in the self-object transference as failures in empathy.(ABSTRACT TRUNCATED AT 400 WORDS)

Conflict, Psychological↗

PubMedDate not supplied

Dreams: royal road but challenging journey.

A discussion of "Dream Analysis in the Treatment of an Eleven-Year-Old Boy" by Harold M. Voth, M.D. This discussion endeavors to make three points: (1) Advances in ego psychology have led to a shift in technique from the content interpretation of dreams to the ego-defense analysis of intrapsychic conflict, using dreams and associations to them as raw data in that process. Questions are raised as to how thoroughly Dr. Voth completed this process with his patient. (2) Transference and countertransference elements seem to have been overlooked; there is evidence of the mutual expression of transference-countertransference issues within the relationship. (3) Perhaps it is better to describe what Dr. Voth offered the young patient as a corrective emotional experience, rather than as a truly psychoanalytic one.

Association↗

PubMed1994

The confusion of tongues and psychic trauma.

'The confusion of tongues' characterised the polarised dimensions of the closing Ferenczi/Freud communication, and extended to problems of psychoanalytic formulation and publication. There were manifest and latent issues which remain of historic importance. Ferenczi was dying and assumed Freud was dying when he wrote this classic essay, so relevant to contemporary psychoanalytic thought and controversy. Denying and sometimes acknowledging his progressive, fatal illness, Ferenczi made enduring contributions to the understanding of child abuse and trauma while severely traumatised. Concepts of trauma and countertransference were amplified and expanded. Freud remained remarkably creative while physically declining with oral cancer; Ferenczi manifested progressive and regressive trends, fostering both sublimated innovation and wild analysis. Psychoanalysts tended to avoid, for half a century, confronting the problems of the ill, impaired, and dying analyst. The clarification of 'The confusion of tongues' continues in contemporary psychoanalytic discussion and debate. The paper presaged a widened interest in the analyst's analysing functions, unconscious communication, countertransference, and the interplay of reality and fantasy inside and outside the psychoanalytic situation.

Adult↗

PubMed1994

Freud's analysis of Ferenczi as revealed by their correspondence.

The relationship between Freud and Ferenczi was a very intimate one. Nevertheless--or consequently--when Ferenczi decided to undergo his own analysis, he couldn't imagine anyone other then Freud as his analyst. This remained true in spite of Freud's clearly expressed reluctance to analyse Ferenczi. The analysis stimulated very intense and passionate transference feelings in Ferenczi. In response, Freud desperately tried to cool down the situation, apparently by trying to keep things on an intellectual level. This analysis, carried out in three brief sections, was interrupted the first time by the beginning of World War I, the second time because the time planned for the analysis was over, and the final time because Freud obviously felt that it could not go further and considered it 'finished', even if not 'terminated'. It left unresolved a great part of the father-son relationship in both the transference and in the countertransference (Nemes, 1988). According to Ferenczi, Freud failed to analyse his negative transference. I would add the supposition that Freud also ignored his negative countertransference. This analytic experience certainly added to the complexity of their subsequent relationship, in spite of the warm feelings between them and the permanence of their friendship. Indications of that complexity can be found in the writings of both men.

Correspondence as Topic↗

PubMed1997

Is the transference feared by the psychoanalyst?

The author considers whether the reason for the variety and multiplicity of theories about the transference might lie in analysts' fears of its dangers. He reviews Freud's development of the concept from its origins, when it was seen as resistance, to its use as a fundamental instrument of the treatment, and lays particular emphasis on its perception as a burden. Classical and later authors' conflicting views of the transference and its management are surveyed in the light of the common ground otherwise existing between schools. Views of the negative transference are also presented. Some clinical vignettes are given, showing the analyst responding to the patient's transference, grappling with his own countertransference feelings and using them to illuminate the clinical situation. The author emphasises the importance of the analyst's training and experience in enabling him to withstand the regressive onslaught of the patient's projections without resorting to theory-related or technical defensive measures. In his view, the transference is not in itself a resistance but may be used as such. The analyst must not interpret merely in order to get rid of the anxiety aroused in himself by the patient's regressive feelings. The paper ends with a consideration of the importance of intuition, the countertransference and sublimated projective counter-identification.

Depressive Disorder↗

PubMedDate not supplied

The physician-patient relationship: three psychodynamic concepts that can be applied to primary care.

Psychodynamic concepts can be used to help understand and manage certain difficulties that arise within the physician-patient relationship. The concepts of transference, countertransference, and action (in the form of acting out and enactment) are discussed. A case description is included to show how these concepts apply to the day-to-day practice of primary care medicine. Arch Fam Med. 2000;9:1164-1168

Acting Out↗

PubMed1975

Psychotherapy in hospitalized research patients.

Operations at the clinical-research interface exert a signal influence on the therapy of patients being treated on investigative units. The effect on the treatment milieu has been described but the impact of a research climate on individual psychotheraphy of hospitalized patients has not. We observed research-therapy interaction in 25 acutely schizophrenic patients. Analytically oriented psychotherapy was carried out on a National Institutes of Health clinical research unit where drugs are only occasionally used, and patients are subjects in psychobiological investigation. The subtle, and often neglected, interplay between therapy and research is examined, with emphasis on the shifting meanings of the patient's participation or refusal to participate in therapy, research, or both. A research transference and countertransference are defined, and some special behavioral patterns of research patients receiving dynamic therapy are considered in this framework.

Adolescent↗

PubMed1980

Success and failure in time-limited psychotherapy. Further evidence (comparison 4).

This is the fourth in a series of comparisons involving patients treated in time-limited psychotherapy. The two patients were young men suffering from anxiety, depression, and social withdrawal. Both were treated by a highly experienced psychotherapist. One of the patients achieved lasting therapeutic results from the sessions; the other was a therapeutic failure. The comparisons are based on a set of objective measures as well as intensive clinical study of all tape-recorded therapy sessions. Results showed that the therapeutic outcome was a function of the patient's ability to become involved in a therapeutic relationship and to work productively within the framework proffered by the therapist. Equally important were countertransference reactions that seriously interfered with successful confrontation and resolution of the patient's negative transference.

Adult↗

PubMed1999

Getting cold feet, defining "safe-enough" borders: dissociation, multiplicity, and integration in the analyst's experience.

This paper attempts to explore the fate of the analyst's multiple self/other organizations during times of heightened countertransferential enactment. It is suggested that such countertransference activity involves the "de-homogenization" of otherwise indecipherably integrated self/other constellations, evoked independently or in response to, but always in interaction with, the patient's own unique organization of multiple centers of psychic awareness and unconscious receptivity. An extended clinical example is used to illustrate the theoretical conceptualization.

Adult↗

PubMed1999

Some implications of the analyst feeling disturbed while working with disturbed patients.

The analyst's experience of patients' disturbances is explored as an aspect of analytic technique. A number of premises are examined. First, it is expected that the analyst is committed to tolerating and understanding disturbances evoked in him by his patients' personalities and their disturbances. Second, that he regards the disturbances evoked in him as a form of manifest content to be understood in the usual method of association. Third, countertransference attitudes may propel the analyst toward rapid formulaic conceptions of his patients' disturbances or to considerations of diagnostic designations carrying serious, if not pejorative implications, such as borderline, narcissistic, perverse, or sociopathic. Such attitudes may also underlie the urge to consider psychotropic medications in response to the patients' disturbances. A selected review of the literature as well as illustrative work with disturbing patients are presented in support of the paper's premises.

Adult↗

PubMed2002

Reflections on creative aspects of psychoanalytic diagnosing.

This paper explores the therapeutic value of considering psychoanalytic diagnoses as co-constructions, and emphasizes two interrelated points: First, there are distinctions between medical, psychiatric, and psychoanalytic diagnoses, and similarly, a distinction may be drawn between diagnoses as nouns and the activity of diagnosing. Second, the author stresses that psychoanalytic diagnoses are theory bound. Various competing theories facilitate or interfere with the maintenance of an optimal analytic attitude. Some theories facilitate an analyst's urge to engage in the activity of diagnosing, which may reflect a destructive countertransference enactment. Analytic data in support of these premises is presented and discussed.

Borderline Personality Disorder↗

PubMed2004

Solving the problems of duality: the third and self-consciousness.

Locating the concept of the third in the debate about countertransference that began in the 1950s, the authors maintain that it originated to solve problems stemming from the recognition that the analytic encounter takes place between two individual subjects. This recognition can lead to discomfort for the analyst, once objective criteria to interpret reality have been lost due to adhesion to a dialectical constructionist perspective; it also implies a deeper involvement arising from the abandonment of neutrality. The concept of the third is often invoked to help avoid these risks. However, the authors maintain that only the human subject itself can grasp the self reflexively; this view has a referent in the Hegelian concept of self-consciousness and is also supported by the findings of infant research.

Adult↗

PubMed2004

The imaginer and the imagined.

A transference of the imaginer and the imagined, arising from largely unconscious fantasies of the way parent and child interact to construct a view of reality, is present in all analyses. For narcissistic patients, primitive fantasies of the imaginer and imagined form an enduring organization, and the enactment of these fantasies in transference and countertransference distorts the way analyst and patient construct meaning. Clinical material demonstrates the deepening that occurs when these fantasies are interpreted.

Adult↗

PubMed2004

The analyst's fantasy of the ideal patient.

Using detailed clinical vignettes, the author illustrates how the analyst's fantasy of the ideal patient can be used to advance an analysis at the same time as it fuels mutual resistances. The author suggests that all analysts carry with them a fantasy of the ideal patient that varies from analyst to analyst and from school to school. Such fantasies are often related to images of an ideal free-associative process. They are for the most part descriptively unconscious, becoming conscious only when prompted by the clinical moment. As such, they are part of a countertransference, broadly defined, that is responsive to both the analyst's and the patient's conflictual life.

Adult↗