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PubMed2002

From monologue to dialogue: a transition in psychoanalytic practice.

During the latter part of the twentieth century, psychoanalysts of various stripes espoused the move from free association and neutrality to various forms of intersubjectivity and dialogue. This shift is studied from the vantage point of conversational rules in terms of the shift from monologue to dialogue, using the concepts of semantics, syntax, and pragmatics. Viewing the data of analysis in this manner offers a means of evaluating the contributions of both monologue and dialogue to our understanding of the conduct of an analysis and the kind of information that can be expected to emerge. Exclusive devotion to either stance, it is argued, renders less understanding than would emerge from a balanced use of both.

Adult↗
PubMed2002

Words and wordlessness in the psychoanalytic situation.

The difference between words and wordlessness in the psychoanalytic situation is examined in the context of a detailed clinical example. Various pairs of terms that have been used to account for this difference are mapped onto it: word and act, thought and feeling, public and private experience. Each of these sets of differences suggests certain relations between consciousness and the unconscious, and each implies a position about the nature of language. All three prove to be incomplete or inadequate ways of accounting for the difference between words and wordlessness in the clinical setting. The divergence, though, is well described by the difference between self-reflection and unformulated experience. Reflection is then presented as situated in the unformulated background meanings that contextualize it. It is because of this contextual embeddedness that self-reflection can have the kind of depth, resonance, power, and nuance more commonly associated with the nonverbal. In the creation of an explicit meaning, we simultaneously reconfigure the wordless background, thereby creating new possibilities for other meanings.

Adult↗
PubMed2002

A new language for psychoanalytic diagnosis.

Many psychoanalysts believe it is impossible to conduct empirical research without eviscerating or trivializing psychoanalytic constructs, and past research efforts have all too often reinforced this view. A new method for studying personality and personality pathology is presented that challenges such beliefs. This method, the Shedler-Westen Assessment Procedure (SWAP), captures the richness and complexity of psychoanalytic constructs and formulations while also providing reliable data for research. The method is being used to develop a new personality disorder taxonomy, as an alternative to the DSM, that is both empirically grounded and psychoanalytically relevant. Its role in psychoanalytic training and supervision is discussed, as is its value as a measure of structural change in psychoanalytic process and outcome research.

Humans↗
PubMed2002

Where's the text? The problem of validation in psychoanalysis.

Whatever their differences, the various schools of psychoanalysis all subscribe to the case study, based on clinical vignette and anecdote, as the "text" of psychoanalysis. Because the typical case study presents not the actual analytic dialogue but a reconstruction based on the analyst's selective memory, the use of such a text renders problematic the validation of an analyst's case formulation, and has traditionally diminished the epistemological status of psychoanalysis. Pristine clinical data, as would be provided by verbatim transcripts of audio-recorded analytic sessions, are rarely created and even more rarely made public. Study of the psychoanalytic process is thereby made impossible, whether by clinical exegesis, qualitative analysis, or quantitative statistical analysis. Yet the analytic community, highly resistant to this public documentation, continues to marshal five common arguments against it. These arguments are reviewed and responded to in the belief that such documentation would enhance the field's intellectual status by allowing the problem of clinical validation to be addressed in ways that move beyond appeals to the authority of private clinical experience.

Confidentiality↗
PubMed2002

The problem of self-disclosure in psychoanalysis.

The problem of self-disclosure is explored in relation to currently shifting paradigms of the nature of the analytic relation and analytic interaction. Relational and intersubjective perspectives emphasize the role of self-disclosure as not merely allowable, but as an essential facilitating aspect of the analytic dialogue, in keeping with the role of the analyst as a contributing partner in the process. At the opposite extreme, advocates of classical anonymity stress the importance of neutrality and abstinence. The paper seeks to chart a course between unconstrained self-disclosure and absolute anonymity, both of which foster misalliances. Self-disclosure is seen as at times contributory to the analytic process, and at times deleterious. The decision whether to self-disclose, what to disclose, and when and how, should be guided by the analyst's perspective on neutrality, conceived as a mental stance in which the analyst assesses and decides what, at any given point, seems to contribute to the analytic process and the patient's therapeutic benefit. The major risk in self-disclosure is the tendency to draw the analytic interaction into the real relation between analyst and patient, thus diminishing or distorting the therapeutic alliance, mitigating transference expression, and compromising therapeutic effectiveness.

Countertransference↗
PubMed2003

The analyst's desire and the problem of narcissistic resistances.

The ways in which the analyst's desire for particular experiences with patients is inevitable and often leads to narcissistically based resistances are considered. Five propositions are examined: (1) that the analyst cannot help but have desires and want them recognized by the analysand; (2) that these desires frequently underwrite the analyst's theoretical beliefs and technical interventions; (3) that narcissistic desires and their influence are ubiquitous among practicing analysts; (4) that the patient is often on the lookout for the analyst's various agendas; and (5) that the patient often hopes the analyst will put his or her desire aside and listen so the patient can further his or her own interests. Lacan's concept of the "dual relation" is central to this discussion. The neo-Kleinian position on narcissistic resistances is explored, as is the idea of the "analytic third" as a potential solution to the problem they pose. An extended case description illustrates the main points.

Adult↗
PubMed2003

"Too late": ambivalence about motherhood, choice, and time.

This paper explores a particular constellation of fantasies and defenses that in some women leads to the delay of childbearing. Destructive wishes towards the woman's own womb and her mother's lead to behaviors that sabotage fertility and pregnancy. These wishes and behaviors meet up with an unconscious belief in and commitment to time standing still, and with cultural tropes and trends that obscure intrapsychic conflicts and denials about motherhood, aging, and time. Analysis, like childbearing, is constrained by the reality of time, and the complex untangling and connecting of these three not obviously related threads may not occur until it is, for the woman who wants a child, too late.

Adult↗
PubMed2003

Mothers' ambivalence with their babies and toddlers: manifestations of conflicts with aggression.

In this paper the author continues his study of conflicts over aggression in women, discussing the implications for contemporary theories of feminine psychology of observations of mothers in parent/child groups with their infants and toddlers. Many mothers experience conflicts over aggression (both in themselves and in their children) and become intolerant of their ambivalence toward their children. The author suggests that this observation provides an avenue that allows an integration of psychoanalytic ideas about maternity and childrearing with psychoanalytic understandings of women's conflicts about achievement in the social realm outside the home. In both roles, difficulties mastering conflicts with aggression may cause women to struggle profoundly, and to experience problems, in successfully negotiating their important life goals, whether the goals refer to their roles as effective mothers or their roles as effective individuals in the social sphere outside the home. Some women may demonstrate these difficulties in one sphere or the other, some in both, and others in neither. The author suggests on the one hand that we need to eliminate the concept of normality when considering the activities of women, and on the other hand that we need to normalize the omnipresence of ambivalence in the psychology of women.

Adult↗
PubMed2003

The femininization of the female oedipal complex, Part II: Aggression reconsidered.

This paper examines and explores the manifestations of aggressive impulses in the so-called female oedipal complex. The authors describe how competitive aggression on the part of young girls, seemingly missing in children's stories and myths, is unconsciously inhibited, disguised, or externalized. They report similar phenomena in women patients involved in triangular conflicts, and present a selected review of the literature on the inhibition of aggression within the female triangular situation. Stressing dynamic patterns in the object relationships in the female triangular situation, the authors offer a psychological explanation for this inhibition. They present clinical material to demonstrate how overt murderous and competitive aggression toward the mother appears after considerable analytic work. They conclude that girls and women frequently relinquish a sense of agency over both aggression and sexuality in dealing with triangular conflicts, to preserve a safe relationship with their mothers.

Adult↗
PubMed2004

Healing after Columbine: reflections of psychoanalytic responders to community trauma.

Following the shootings at Columbine High School on April 20, 1999, the Denver Psychoanalytic Society provided both immediate and long-term interventions to those closely impacted by the tragedy. In this effort, analytically trained volunteers faced many personal challenges and role adjustments. To address these issues a reflective study group was formed twenty months after the traumatic event. Group discussions revealed a surprising number of residual symptoms from secondary trauma, as well as opportunities for shared coping among analysts. Little has been written about the very human and subjective responses of analysts in such circumstances. These experiences may be helpful to others in today's world of terrorism and unexpected violent events.

Adaptation, Psychological↗
PubMed2005

Psychoanalytic controversies contextualized.

Psychoanalytic disagreements are famously heated, polarized, and prolonged. These controversies are often the reflection of a shared agreement by the participants to engage in debate at an abstract level far removed from the clinical context in which the disagreement first arose. As a specimen example of such disputes, a case report by Patrick Casement is examined, together with a series of polemical discussions it inspired concerning physical contact suddenly demanded by an analysand in session. Over two dozen authors were almost evenly divided on whether to agree with Casement's technical conclusions, but showed a disquieting indifference to the detailed information available in his report regarding how this clinical crisis developed. The substantive merits of the contending arguments are not at issue; rather, the point is to demonstrate the crucial need to refine a methodology of contextualization to clarify inferential assumptions in clinical discussions. Premature truth claims might then give way to a more rational comparison of the clinical sources of divergent opinions. The term contextual horizon is introduced to facilitate an understanding of how the psychoanalyst makes inferences from the patient's associations.

Adult↗
PubMed2005

Hidden shame.

Shame dynamics, after decades of neglect, reappeared in psychoanalytic thinking with increasing prevalence in the last thirty years. Shame that is hidden is an aspect of complex clinical phenomenology that is particularly likely to be missed and hidden further by partial psychoanalytic explanations that drive shame more and more from view. Shame is often hidden theoretically by formulations limiting conflict to conflict between drives or impulses and something opposing them. By contrast, the incompatible idea model propounded by Freud in Studies on Hysteria emphasizes awareness incompatible with the dictates of conscience, and hence is broader in scope and closer to actual experience. Although shame and guilt arise developmentally earlier than does a true sense of morality, these emotions and their unconscious variants become entwined with the individual's sense of morality as development proceeds. The dynamics of shame and guilt are considerably more complex than their phenomenology as overt emotions. Shame emphasizes weakness, vulnerability, and the likelihood of rejection--so much so that its acknowledgment often generates more shame. Guilt, however, since it is action- and power-oriented, often obscures shame and so defends against it.

Awareness↗