When "something more" is less: commentary on the Boston Change Process Study Group.
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Certain ambivalent reactions to undergoing analysis add content and intensity to the analysand's transference and to some extent to the analyst's countertransference. A significant share of these reactions may be attributed to the structure of the psychoanalytic situation. Among other things, analysands' reactions feature fantasized and sometimes realistic experiences of being coerced by their analyst's counter-transferences. However, to achieve a clear view of these coercive experiences, they must be considered in relation to another, equally weighty structural feature: ambivalent reactions to the analyst's concerned care. Observation suggests that an intervention can be experienced, simultaneously or sequentially, as both coercive and caring, and that, when analyzed, each of these experiences is usually found to be saturated with mixed feelings.
This paper offers a further expansion of the author's continuing endeavor to highlight and explore subtle distinctions and lingering paradoxes in how we listen, and to reconsider their profound implications for clinical work and discovery. Several perhaps commonplace clinical moments are used to sharpen illumination on psychic experience that might otherwise remain outside conscious awareness, whether in the domain of the repressed or in other mnemonic realms, such as "implicit" or "procedural" memory. It is suggested that added dimensions of these different levels of memory may, through our struggle to listen, be ultimately knowable.
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A clinical term is introduced to capture a defense that develops with the patient's deepening but fleeting awareness of painful transference feelings. The analyst's attention to countertransference in such situations is central to the analysis of these defenses. An attempt is made to distinguish defense enactments from other types of defenses, and to differentiate the analyst's countertransference reaction to this type of defense from countertransference reactions that might appear similar. The reasons for this dynamic in the interpersonal space are explored, and a clinical example that describes this phenomenon in the analytic moment is given.
Although the training analysis is considered by many to be the most important element of a candidate's analytic training, its aim remains unclear. Some think of the training analysis as being a strictly therapeutic tool, while others assign it a more frankly educational role. This paper reviews the literature on this topic from Freud to the present, discusses the problems that lack of clarity about the aim of the training analysis generates for psychoanalytic education, and proposes future research in this area.
The function of autistic defenses in the generation of agoraphobic symptoms is explored in the case of a patient treated in psychoanalytic psychotherapy. The therapist's growing awareness of autistic modes of relating in the case facilitated various changes in the transference relationship. Although oedipal concerns are seen as important, a formulation is presented whereby autistic modes of generating experience are viewed as fundamental to an understanding of agoraphobic experience. Clinical findings in the transference-countertransference relationship led to the additional observation that the retardation of defensive forms of projective identification further contributed to the patient's agoraphobic difficulties. This formulation is tied theoretically to the idea that agoraphobic experience occurs when the dialectic between paranoid-schizoid and autistic-contiguous modes of generating experience collapses. The treatment implications of these observations are briefly explored.
In recent attempts to bring psychoanalysis into greater contact with other sciences, a number of works have explicated neural science concepts and phenomena--affect, memory, consciousness--for the psychoanalyst. These efforts have helped analysts build a more scientific foundation for their theory and practice. A related task remains--namely, to take psychoanalytic concepts and see how they relate to other sciences. The concept of identification has a long history in psychoanalytic theory. It is seen in parent-child interactions, in teaching and mentoring relationships, and in psychoanalysis and psychotherapy. Neuropsychology and evolutionary biology have explored the phylogenetic precursors of identification, while genetics and infant observation provide insights into individual processes of identification. Finally, neuroscience, particularly recent studies of mirror neurons, offers information about the biological mechanisms of imitation and the relationship of imitation to identification. Findings from these sciences are presented in an effort to further the psychoanalytic understanding of identification, especially its biological underpinnings.
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