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PubMed1995

Hermeneutics and psychoanalytically oriented psychotherapy.

Psychic or psychosomatic disorders--symptoms as well as the structures on the basis of which symptoms usually develop--include substantial impairment of communication. Psychogenic symptoms often seem incomprehensible and strange. Psychotherapy then involves the figuring out of the meaning of a symptom and, at the same time, the effecting of change in the sense of an enhancement of communication. Here, philosophic hermeneutics can point the way for psychotherapeutic reflection. Hermeneutics, when applied to psychotherapy, is the art of understanding and of making understood when the means of understanding and agreement between persons is disturbed. The psychotherapeutic process itself is executed within a "hermeneutic circle." A short case presentation illustrates the hermeneutic technique.

Adult↗
PubMed1995

Unearthing shame in the supervisory experience.

A premise of this article is that the supervisee typically experiences shame in psychotherapy supervision. The purpose is to demonstrate that the discovery and exploration of shame by the supervisor and the supervisee enhance both the therapy and the supervision. The focus is on the supervisor's attitudes and behaviors toward the supervisee's shame. Using a case example, three important sources of that shame are discussed: (1) Shame that evolves from the relationship between therapist and patient. (2) Shame that arises from the therapist's fears of, or actual experience of, not being approved of or admired by an idealized supervisor. (3) Shame inherent in revealing personal material in a supervisory relationship. Six recommendations for exploring shame are offered to supervisors: (1) be alert to the therapist's disguised shame, (2) encourage the supervisee to explore how the therapy and supervision are experienced, (3) demonstrate the qualities of a psychotherapist by assisting the therapist in uncovering personal material that affects the psychotherapy, and (4) create an environment of safety where shame-related phenomena can be discussed with candor and curiosity. Supervisors should also (5) ease insecurities by modeling the activities they seek to encourage, and (6) avoid attempts to dissuade the supervisee of an idealizing transference toward them. Limitations of the recommendations are discussed.

Adult↗
PubMed1995

The phenomena of Pine's "four psychologies": their contrast and interplay as exhibited in the Beatles' "white album".

Psychoanalytically informed clinicians are frequently challenged with recognizing and integrating into their work the diverse phenomena central to differing psychoanalytic theoretical frameworks. In addressing this dilemma, Pine has formulated a "multiple model" that recognizes the qualitatively different psychological phenomena and the distinct motivational forces emphasized by what he calls "the four psychologies of psychoanalysis," the psychologies of drive, ego, object relations and self. This model makes it possible to describe individual personality organizations in terms of psychological hierarchies of the phenomena of the four psychologies. Use of this model promotes a particular kind of listening stance that facilitates recognition and use of a wide variety of clinical data. The usefulness of this model is demonstrated through its application to a creative work, the Beatles' "White Album." This application shows the utility of Pine's psychological hierarchies in describing differing personality organizations, the "multiple functions" mental events can represent through serving the motives of multiple psychologies, and the frequent interactions that occur between the differing psychological phenomena. Pine's model facilitates a recognition that an important quality found in works by the Beatles is their demonstration in strikingly clear form, of the qualitatively different aspects of human experience emphasized by the four psychologies. The accessibility of Beatles music makes it a potentially valuable teaching tool for demonstrating Pine's model.

Creativity↗
PubMed1995

The image of the psychotherapist in literature.

The current study explores the image of the psychotherapist as he/she is portrayed in literature in an attempt to broaden the perspective of existing research on this topic. In the past, studies and surveys on the image of psychotherapists have mainly been conducted among the general public and fellow colleagues rather than among the patients of psychotherapists. It is suggested that psychotherapists shy away from being the subjects of study. Moreover, it is proposed that research on the image of the psychotherapist suffers from a one-way gaze, whose bias stems from the asymmetrical nature of therapist-patient relationships. The present study explores the image of the psychotherapist through an analysis of nineteen literary works featuring twenty-six figures of psychotherapists. The literary image was examined by means of a questionnaire and content analysis. The profile that emerges suggests that psychotherapists and the psychotherapeutic process are well understood by authors representing both individual patients and the general public.

Humans↗
PubMed1995

The "erotic transference": some technical and countertransferential difficulties.

This paper highlights dynamics that may interfere with the therapist's identifying and addressing the erotic transference: (1) deficient training; (2) theoretical orientations that devalue the transference while espousing a "real" relationship including self-disclosure; (3) countertransference responses to the erotic transference; and (4) clinical errors of focusing on the manifest erotic transference while overlooking significant but latent pre-oedipal, oedipal, aggressive, or selfobject issues. Inattention to these dynamics may render the therapist vulnerable to sexual acting out with his patient.

Adult↗
PubMed1997

The narrative and rhetoric of dreams: six literary fragments by a novelist.

Four of a novelist's dreams and two contemporaneous pieces of her fiction are examined through the lens of poststructuralism; thus viewed they display narrative coherence in form and content, a reciprocal interaction between dream and written day residue, and a rhetorical function in trauma resolution. Lacan's theories about the linguistic nature of the unconscious are particularly powerful in understanding these six works especially their recourse to figurative language in deconstructing and reconstructing the traumatized self. Dream narratology suggests the close relation of unconscious processes to creativity and the unity of storymaking and personal meaning. Narrative conventions in these dreams and related fiction illustrate the functions of metaphor and metonymy in traversing Lacan's "registers of experience" and his ideas about the "itinerary of the signifier," the way dreams and art capture the elusive object of desire. Creativity serves not only a wish-fulfillment function but also a self-fulfillment function. Dreams, then, as creative acts, claim a privilege unto themselves and support Lacan's argument for a therapeutic approach of "desirelessness."

Creativity↗
PubMed1997

Psychotherapy with HIV-positive gay men: a psychodynamic perspective.

This paper examines psychotherapy with HIV-positive gay men from a psychodynamic perspective. Adjustment to being HIV-positive is conceptualized as an ongoing process of confrontation with loss and uncertainty. Interventions offered to HIV-positive gay men range from counseling, indicated in response to an "uncomplicated" adjustment process; to dynamically oriented psychotherapy, indicated when the functioning of the self has been thrown off balance by HIV illness. The client's process of accepting his HIV illness is shaped and colored by the degree to, and manner in, which he has accepted being gay and integrated this into his identity. Sexuality is a core theme in psychotherapy with this population. It often plays a prominent role in the past unresolved conflicts (feelings about having become HIV-infected) as well as present concerns (feelings about living with HIV illness) which the client has come to therapy to address. The process of addressing the meanings being HIV-positive holds for the client in therapy can promote acceptance of the illness and cohesiveness of the self. Cultural and subcultural differences in how life stress is experienced must also be taken into account by the therapist in order to fully appreciate the client's concerns.

Adult↗
PubMed1997

Techniques to accelerate dynamic psychotherapy.

The techniques described above outline specific ways to deepen the patient's affective experience within an emotionally close therapeutic relationship. When effective, they all enhance the patient/therapist bond, raise self-esteem, reduce defensiveness and anxiety, and facilitate emotional healing. Psychodynamic treatment, long or short, is a complex process uniquely constructed by each therapist/patient pair. AEDP strategies are not intended as recipes for treatment. Good dynamic work depends on the therapist's ability to grasp the patient's capacities and limitations, understand relational dynamics, and interact with the patient in an empathically attuned, emotionally receptive, and flexible way. In that context, these strategies can be helpful tools to facilitate and accelerate the process. The choices made by AEDP--privileging adaptive strivings over defensive reactions, the stance of emotional engagement rather than neutrality and abstinence, the focus on health and change over pathology and stasis--are informed by traditional STDP aims to maximize depth, effectiveness, and efficiency. AEDP's contribution is a set of techniques relying on a response repertoire that is available to a wide range of therapists. Therapists can use these techniques to be more effective while simultaneously retaining the experience of speaking with patients in an authentic voice.

Affect↗
PubMed1997

The use of metaphor by an artless first-time psychotherapist.

The experience in a psychiatric residency of being a psychotherapist for the first time can be overwhelming and anxiety-provoking. This paper examines a first psychotherapy case which utilizes a theory-distant approach based on the use of metaphor. Metaphorical theory is reviewed, and potential benefits and pitfalls of using metaphor are examined. An in-depth case study is done, focusing on the following six metaphors: Art as Psychotherapy; Psychotherapy as Art; The World Is a Trap; Mothers Are Martyrs; StepMothers Are Evil; and Artists Are Crazy. Each metaphor was utilized in multiple layers through the course of the therapy. Some of the current research in the use of metaphor in psychotherapy is reviewed. Through this approach, I was able to develop necessary psychotherapeutic skills without being overwhelmed by traditional theories such as Freudian, Object Relations or Self Psychology. I conclude that the use of metaphor with my first psychotherapy patient strengthened the therapeutic alliance, allowed an idiosyncratic language to develop in the therapy, structured recurrent themes, and permitted me to respect the patient's defenses.

Adolescent↗
PubMed1997

Protein extract as a surrogate mother.

Brief dynamic psychotherapy, carried out by an resident in training, can bring significant improvement to a patient who does not necessarily meet ideal selection criteria. S. had experienced early childhood deprivation resulting in adult psychosomatic manifestations of feeling hypoglycemic under pressure of responsibility or during fear of abandonment. He soothed himself with the aid of a bottle of "protein extract," which he carried at all times on his belt. The 21-week therapy resulted in his increased ability to differentiate the sources of his anxiety and allowed him to find new and more mature ways of coping with stress. Although still confronting internal conflicts and anxiety, he relinquished the protein-extract bottle and began to take a more active role in work and relationships. With the help of brief dynamic psychotherapy, this patient was able to start moving forward in his personal growth. Finally, although requiring ongoing supervision and training, resident therapists should be encouraged to treat difficult patients with brief dynamic psychotherapy despite their limited experience with such a promising therapeutic technique.

Adaptation, Psychological↗
PubMed1998

Self-mutilation, substance abuse, and the psychoanalytic approach: four cases.

While self-injury and substance abuse are difficult symptoms for both analyst and patient to cope with, and relapses are frequent, the emphasis does not have to be on managing crisis. The initial ego support and therapeutic boundary setting in these difficult cases must be matched by psychoanalytic exploration. In working with these patients, I find that, through mutual projective identification processes, the analyst and the patient are frequently resurrecting certain aspects of the patient's archaic phantasy life as defined by various self and object representations. Therefore, the continuous analysis of the transference and the countertransference is certainly essential. However, the additional willingness on the part of the analyst and the patient to explore the frequent and mutual interpersonal/intrapsychic acting out is paramount.

Adult↗
PubMed1998

Reconsidering the transference paradigm in treatment with the bereaved.

What is to be expected of bereaved people years after a loss? How will life be lived following the conclusion of the mourning process? Answers to questions such as these are inherent in the use of terms such as recovery following loss or the resolution of bereavement. From the perspective of the Two-track Model of Bereavement, it should be clear that the outcome of loss needs to be examined along the dimension of functioning, where the term recovery might well be adequate, and along the dimension of the continuing relationship to the deceased, where resolution would be the more precise term. When one considers the impact of bereavement upon the individual years following the loss, it is well to keep in mind that both recovery and resolution range across the continuum, with varying degrees of adjustment, coping, and continued relationship to the representations of the deceased neither fixed nor static. In many ways, the continuing relationship to the deceased is similar to the relationships we have with living individuals. The more comfort and openness characterize the connection to memories and thoughts of a particular relationship, the greater the likelihood that the relationship is not a focus of conflict or difficulty requiring intervention. Changes in the relationship to the deceased will continue across the life-cycle. The presence of flexibility and resilience in the internal object world are important features of the individual's ability to deal with the ebb and flow of a life course.

Adult↗
PubMed1999

The evolution of the internal dialogue during the psychoanalytic psychotherapy process.

This article illustrates curative changes occurring in psychoanalytic psychotherapy by developing the internal dialogue in the mind. By the internal dialogue, I mean the internalization of the therapy process during the recurrent therapy sessions so that the external dialogue between therapist and patient becomes the corresponding internal structure of the patient. In this way, there is a development of the patient's capacity to identify himself and the therapist as separate, sentient, thinking, and reflecting individuals, who have a free internal world of their own. The evolution of the internal dialogue takes place by gradually progressing symbolization achieved through a four-step symbolization-reflectiveness approach. This process is one of the specific curative factors in the psychotherapeutic treatment of borderline patients. The psychodynamics are illustrated by material from one session each of the early and the final stages of therapy, showing a shift from monologue to internal dialogue. The evolved internal dialogue is a central part of the patient's budding thinking capacity, which creates a ground for her subjectivity and autonomy. This study underlines and specifies three factors as cornerstones of the evolution of identity in psychotherapy: symbolization, reflectiveness, and the internal dialogue.

Adult↗
PubMed2000

Finding the neutral position: patient and analyst perspectives.

In light of current debates between classical and intersubjective schools of psychoanalysis, the challenge posed by the latter to such basic concepts as the analyst's neutrality, anonymity, and abstinence is taken up. It is maintained that the term neutral position is today more germane and meaningful than the term neutrality, which frequently has been taken to prescribe the analyst's posture. It is proposed that for each patient the neutral position is uniquely sited and that it is incumbent on the analyst to find its location. The neutral position is defined within the context of the interaction between analyst and patient. The concept is therefore compatible with--indeed it is essential to--an intersubjective or relational orientation. The manifold reasons, conscious and unconscious, why the analyst is vulnerable to leaving the neutral position are considered. The patient's reaction to the analyst who has left the neutral position and the analyst's clinical use of this reaction are discussed.

Countertransference↗
PubMed2001

Psychoanalysis and homosexuality: do we need a new theory?

No need exists, it is argued, for a new psychoanalytic theory of homosexuality. Certainly psychoanalysis should not be expected to generate such a theory using its own methodology alone. The preoccupation with producing such a theory avoids more important questions about psychoanalytic theory building raised by an examination of the long relationship between psychoanalysis and homosexuality. These questions concern the problems related to using psychoanalytic methodology (1) to construct categories (including the categories normal and abnormal), (2) to construct causal theory (the problems include the limitations of psychoanalytic developmental theory and a long-standing confusion between psychoanalytic developmental theory, psychoanalytic genetic reconstruction, and psychodynamics), and (3) to identify "bedrock." Finally, the question is addressed of what might be needed that is new in the psychoanalytic approach to homosexuality.

Female↗
PubMed2001

Freud's struggle with misogyny: homosexuality and guilt in the dream of Irma's injection.

The highly condensed dream element trimethylamin is central to the dream of Irma's injection. After a brief review of the medical literature on timethylamine (TMA), it is suggested that two important meanings of this chemical and its properties lie in its disguised reference to disparaging views of women, as well as to Freud's homosexual connection to Wilhelm Fliess. Freud's misogynistic and homosexual impulses were stimulated by Fliess's recent surgical error committed while operating on Freud's patient Emma Eckstein. Evidence is presented that the collaboration between Freud and Fliess in performing an aggressive act toward a woman was for Freud an enactment of a childhood situation in which he and his nephew John had ganged up on John's sister Pauline. The later relationship between Freud, Jung, and Sabina Spielrein is seen as an additional reenactment of this childhood triangle. An examination of Freud's associations to and analysis of the Irma dream, as well as some of his later relationships with women, indicates that guilt and the wish to make reparation were also prominent themes in Freud's inner life.

Austria↗