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PubMed1981

Freud's "analytic pact": the standard therapeutic alliance.

Freud's "analytic pact," as the final therapeutic model he evolved (1937, 1940), places the fundamental rule in a two-person structural framework that operates in a continuum between the inner reality and outer reality of both patient and analyst as these come to center in the analytic situation. To Freund's basic definition of psychoanalysis as related to resistance and transference, a third component is added, the collaboration that has been a feature of the treatment since the beginning. The alliance postulated by the pact relates a helpful physician to a sufferer in a carefully regulated operational field and atmosphere suitable for a particular technique and therapeutic goal. Actually the alliance may be described from the aspect of component combinations as described in different frameworks--structural, topographic, developmental, realistic, adaptive, etc. In diverse forms of analytic or analytically oriented forms of therapy, selected aspects of the alliances receive greater prominence--but a fully informed analytic therapy retains contact with all the elements involved. Organizational aspects of the fundamental rule with respect to the flow of associations and the transient and structured interactions of patient and physician are examined with regard to their dynamic and linguistic features.

Child↗
PubMed1982

The resolution of a transsexual wish in a five-year-old boy.

The brief truncated psychoanalytic treatment of a transsexual boy described in this paper demonstrates the development of transference reactions and their subsequent resolution. The analytic situation allowed this young patient to live out again his relationship with his parents in his relationship with the analyst, to recover from wishing to be a member of the female sex, and to work through his conflicted symbiosis with his mother. Carlos became able to individuate and disidentify from her into a separate male child, in order to be able to identify with, and accept, his own biological and psychological maleness. It is to be hoped that our success with this patient will encourage others to treat and study children suffering from gender identity problems via the psychoanalytic approach.

Anxiety, Castration↗
PubMed1982

The patient's own pillow on the couch.

Material is presented from two hypochondriacal patients who insisted on using their own pillows on top of the bolster-pillow on the analyst's couch. A number of important transference fantasies are seen as underlying this unusual resistance to the progress of the analysis. In addition, the analyst's countertransference feelings are described.

Adult↗
PubMed1982

Twin transference as a compromise formation.

This paper explores the meanings and functions of a transference paradigm of a fantasied twin relationship with the analyst. Twin transference in the analysis of nontwins has been reported infrequently in the psychoanalytic literature, except recently by Kohut and his co-workers, who refer to twinship transference as a variant of narcissistic mirror transference. We suggest that such narrow definition tends to reduce the complexity of the wish for a twinlike relationship with the analyst. Analytic data are used to show the advantages of examining twin transference within structural theory, in terms of the multiple functions served by this rather primitive transference paradigm, rather than reducing it only to one variant of the need for certain mirroring functions. We suggest that twin transference, together with all twin fantasies, subserves multiple functions, of which we highlight gratification and defense against the dangers of intense object need. In this formulation, the twinlike representation of the object provides the illusion of influence or control over the object by the pretense of being able to impersonate or transform oneself into the object and the object into the self. Intense object need persists together with a partial narcissistic defense against full acknowledgment of the object by representing the sought-after object as combining aspects of self and other. Further analytic attention needs to be directed to the specific representation of the needed object in certain primitive transference paradigms instead of exclusive emphasis on the functions required of the object. Our analytic data are used to argue that intense early needs of an object are best understood analytically within a conflict model in which they are modified by multiple wishes, drives, fears, dangers, and needs for defense.

Dreams↗
PubMed1982

The current psychoanalytic dialogue: its counterpart in Renaissance philosophy.

It is my premise that psychoanalysis is involved in a phase of metapsychological and technical debate typical during the course of intellectual history. In general, the more traditional school textually conceptualizes psychoanalysis as a natural, observational science involving subject-object duality, determinism, and causality, and tends to separate theory and practice, interspersing a force-energy metapsychology. The recent critics of traditional theory view psychoanalysis as closer to cultural science and art. They do not subscribe to a strict determinism and conceptualize that they work more within a field of free will. Their tendency to keep theory close to practice leads to more experience-colored, closer to the clinical, theoretical models. I have tried to provide some early evidence that, through mutual influence, a dialectic is rising above the heat of this debate, with each group incorporating some of the ideas of the other. At the same time, since all differences are not true polarities, and not all polarities can be reconciled, the possibility that psychoanalytic theory will necessarily reach a new level of synthesis must be looked upon with caution. It is hoped that a broad view of this theoretical struggle in psychoanalysis can be enriched by an awareness among its participants of the related counterparts in Western intellectual history.

Communication↗
PubMed1984

An example of self-analysis.

The literature on self-analysis indicates that it is a desirable process to cultivate postanalytically for continued self-growth, analyzing countertransference problems, and dealing with symptoms or problems of living that might arise after formal analysis is completed. A number of techniques are described, the choice of which is probably dependent on the personality of the individual who wishes to pursue self-analysis. I describe an episode of self-analysis occurring near the end of the analysis of a woman who aroused in me an unusual degree of positive feeling, at least part of which can be considered countertransference. After she had aroused negative feelings in me, she was able to deal in an affectful way with strongly repressed impulses, actually acted out in early childhood, to steal from her mother. This stimulated dreams in me that allowed me to work out guilt for hostility to my mother. A dream representing stealing her purse altered long-standing compulsive thoughts I had known meant guilt to my mother. The self-analysis was not undertaken to deal with a countertransference problem, but arose out of it to deal with a symptom, or old conflict, 25 years after the completion of formal analysis.

Adult↗
PubMed1984

Psychoanalytic perspectives on emptiness.

A clinical example illustrates the thesis that the experience of feeling empty, like any other mental event, can be understood in terms of the conflicting wishes, prohibitions , compromises, and gratifications that color any experience in ways that clarify its meaning. Theoretical hypotheses which explain mental events and experiences as the result of deficiencies of structures are difficult to translate into therapeutic practices. This is especially true in the case of the experience of emptiness which, in and of itself and often vigorously, asserts an absence of content. The equating of deficiencies of structures, however formulated, with deficiencies in mental content or activity can result in unconsciously joining the empty patient in repudiating important aspects of internal life, maintaining ultimately pathological gratifications , and often contributing to treatment stalemates in which the "absence of content" is often preferred to the presence of frightening wishes, fantasies, and memories.

Adult↗
PubMed1984

Further reflections on Freud and his writing.

As we broaden our frames of reference, Freud's genius looms larger. An adequate appreciation of Freud accordingly necessitates an examination of how he read and wrote and how Strachey translated him. Despite the enormous amount of psychoanalytic commentary, the subject of his writing qua writing still remains untapped to a considerable extent. By deepening our awareness of the nuances and implications of the manner in which Freud wrote, we correspondingly increase our knowledge of his original mind and the way he understood psychoanalysis.

Dreams↗
PubMed1985

Psychoanalysis as science: the inductivist's resistance revisited.

The scientific status of psychoanalysis has been the focus of heated debates among philosophers of science and among psychoanalysts. The most recent challenge to psychoanalysis as a science comes from the quarters of the inductivist philosophy of science. Since inductivism is a self-defeating philosophy, it is not surprising that inductivists demand that psychoanalysts pay an unlimited price for their claim of scientific status for psychoanalysis. Most psychoanalysts, in their response to this impossible challenge, unwittingly claim to have paid the price. What is worse, the claim is made in a confused and emotionally charged manner. Hence, psychoanalysts are usually defensive and, thus, in error when repelling (in this way) the attack of the inductivist philosopher. It is not psychoanalysis inductivists attack, but their own commitment to their own logic which leads inexorably to the dissolution of their argument, of all science, and, indeed, of psychoanalysis as well. It seems much more reasonable to postpone any response to the challenges that confront psychoanalysis today and to invest effort in a reformulation of the problem of the scientific status of psychoanalysis. Different rational solutions to the problem may evolve if we take care to become well informed first about the limits of our theoretical frameworks and show readiness to change them, if and when needed. That is to say, we can start with a somewhat tentative, not to say skeptical, frame of mind concerning the very concept of scientific status. We may try to keep and to contain our skepticism to the degree required by the discourse at hand, carry on exploring in our practice, report our results, and discuss them respectfully. We should start by admitting that, quite possibly, our discourse will end inconclusively.

Generalization, Psychological↗
PubMed1985

The common mirror dream, dreamer, and the dream mirror.

From the widely diverse category of so-called mirror dreams, we have differentiated the most frequent, which we have designated the common mirror dream (CMD). It is one in which the dreamer at some point looks into a mirror and reports seeing himself, a part of himself or a distorted though recognizable version of himself. Mirror dreams, including CMDs, are distinctly uncommon. Every dreamer of CMDs in our series had felt enjoined by the mother (in most cases with the father's collusion) not to see and regard her clearly and not to be an accurately reflecting mirror for her. The intensity with which the maternal injunction against accurate visual perception and evaluation was feared was an important distinguishing feature in our patients with CMDs. The essence of the CMD has been hypothesized to be a reciprocal, reverberating, visual-exhibitionistic dyad representative of the mother-child relationship. The dream mirror may represent the wish that the analyst-mother counter a feared parental injunction against accurate visual perception and evaluation so as to correct the distorted perceptions of self and objects and provide visual affirmation of the value and integrity of the self-representation. For some patients, defense against the dangers of castration and loss of maternal love was accomplished by the mirror mechanisms of magically transforming images in the mirror, the ease of creating illusion in the mirror, and a fetishistic mechanism of visually reintrojecting a phallic symbol from the mirror. Our data failed to confirm many of the hypotheses of previous contributors as to specific symbolic meanings of the dream mirror. More relevant than the symbolism of the dream mirror are the many functions of the dream mirror for the dreamer. These are analyzed and discussed.

Adult↗
PubMed1985

Insurance.

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Confidentiality↗
PubMed1986

The microstructure of free association.

The author's purpose is threefold: first, to demonstrate the redundancy in the events of the complex life of a patient as told to a psychoanalyst; second, to show two novel ways to represent those events simply; and third, to suggest that the field of psychoanalysis, under assault from philosophers of science and hermeneuticists alike for either not being or for trying to be a science, can in principle be reclaimed for science. It can be done by abandoning a widely held belief that human behavior is simply too complex, too malleable, too rooted in ineffable experience to permit of systematic scientific capture.

Free Association↗
PubMed1986

The place and value of bestophilia in perversions.

An attempt is made to place bestophilia in cultural, clinical, and theoretical perspective. Archeological and anthropological documentation and records of the widespread appearance in mythology of this practice are cited. This archaic form of perversion is still practiced in rural environments and isolated communities. The treatment of a man who grew up in such an environment gave the author the opportunity to study this form of perversion. The correlation of clinical findings with culturally sanctioned bestophilia provides a bridge between the understanding of psychopathology and anthropological variation.

Adult↗