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PubMed1987

Changes in the level and quality of object relations in psychoanalysis: followup of a longitudinal, prospective study.

As part of a prospective, longitudinal study of suitability for and outcome of psychoanalysis, 22 patients were evaluated for changes in the level and quality of their object relations. These patients had been accepted for supervised analysis with candidates in training by senior analysts who had diagnosed them as neurotic. The majority of these patients reported difficulties in relationships as at least one of their reasons for originally seeking psychoanalytic treatment. Prior to beginning analysis, each patient was given a battery of psychological tests. One year after the termination of analysis, the test battery was readministered and a followup interview was conducted separately with each patient and analyst. Ratings of change based on patient and analyst interviews and comparisons of psychological tests before and after treatment all showed statistically significant improvement in the level and quality of object relations for this patient group. The results of this study support what is often observed in clinical practice, that psychoanalysis has a positive effect on the level and quality of a patient's object relations.

Adult↗
PubMed1987

Reconstruction of an early seduction and its aftereffects.

This clinical presentation deals with the aftereffects, in a male patient, of a severely disturbed rapprochement phase, marked by many separations and a molestation before the age of three. The patient dreamed repeatedly of violence, often directed against himself, but the actual molestation was sealed off by formidable repression. A first analysis, with a male analyst, produced no relief from the patient's depression, crippling insomnia, and inability to form an intimate relationship. The second analysis progressed only when the repetitive dreams were understood to be repressed experiences of seduction and molestation.

Child Abuse, Sexual↗
PubMed1987

Falling off the couch.

The patient's therapeutic regression intensifies certain unconscious meanings of the analytic couch. In addition to representing the analysis or the analyst in general, the couch can represent the unconscious, or it may take on the symbolic significance of the analyst's or mother's arms, lap, breasts, or womb. When the genetic roots of the patient's transference include substantial experiences of disappointment, narcissistic injury, and mistrust, the theme of falling from the couch may emerge as a dream, an association, or even an enactment. This theme usually implies the presence of a deepening but mistrustful transference, based on earlier disappointments by the patient's primary objects. Falling off the couch may be associated with being dropped as an infant, rolling out of bed as a child, birth, miscarriage, castration, death, termination, defending against passive wishes, punishment for sexual or aggressive transgressions, escaping an attack, descending into the unconscious, or wanting to be picked up and comforted.

Accidental Falls↗
PubMed1988

Use of audiotape recording in impasses with severely disturbed patients.

The psychoanalytically oriented treatment of patients with severe personality disorders is characterized by impasses and by efforts to resolve them. Patient audiotape recording and review of sessions can be a particularly useful technical parameter in such situations. When judiciously employed, it is unusual, if not unique, in that it selectively amplifies the power of traditional elements of technique as well as some of the constructive elements of the analytic process itself, while reducing the power of some of the destructive elements of the transference. Indications for using this parameter are discussed, case illustrations presented, and hypotheses advanced about its mode of action. No single element of technique is responsible for the success or failure of analysis. The most that can be expected of tape recording is that it help break up the treatment log jam and facilitate further work.

Adult↗
PubMed1988

Transference across gender lines.

Four clinical examples of oedipal-based transference across gender lines are presented with the aim of illustrating (1) its existence, (2) the defenses against its emergence, and (3) the use of the analyst's gender as both an organizer of and resistance to certain transference manifestations. Factors that contribute to the availability for analysis of cross-gender transference are discussed, as are the resistances and other obstacles to its actualization.

Adult↗
PubMed1988

The psychoanalysis of art: some ends, some means.

The psychoanalysis of art has been a lively activity for virtually a century, ever since Freud first likened certain findings of his self-analysis to certain turns of plot in Oedipus Rex and Hamlet. Yet over this time a lack of clarity has persisted with respect to the kind of knowledge applied psychoanalysis achieves and its means of justification. Starting with the observation that clinical and applied psychoanalysis are, in every respect, radically different endeavors, this paper goes on to identify some ends and means of the psychoanalytic study of art and to suggest a few criteria of adequacy for the outcomes of such study.

Art↗
PubMed1988

Concurrent individual and individual-in-a-group psychoanalytic psychotherapy.

This paper's thesis is that concurrent individual-in-a-group and individual psychoanalytic psychotherapy can be conducted in conformance with psychoanalytic principles of treatment as well as can individual psychoanalytic psychotherapy alone. American psychoanalysts have shown little interest in group psychotherapy, probably because of earlier criticism that transference is diluted by the greater reality of the therapist in group psychotherapy. This is a misconception extrapolated from the mirror model of dyadic analytic technique. The criticism was formulated during a period when that model was prominent and there was little awareness that the actual personal relationship between patient and analyst played an important facilitating role in the dyadic analytic process, including providing a basis for investiture of transference. Also, the criticism was based on one-session-per-week group psychotherapy, whereas concurrent individual-in-a-group and individual psychoanalytic psychotherapy utilizes two group sessions plus one or two individual sessions per week, enabling a more intensive patient-therapist relationship. Concurrent group and individual psychoanalytic psychotherapy constitutes a contribution to the widening scope of application of psychoanalytic treatment.

Combined Modality Therapy↗
PubMed1988

Patient's sleep on the analytic couch.

Published reports about sleep on the couch have primarily emphasized its preoedipal (especially oral) determinants and defensive purposes. A detailed case is presented in which sleep became the central symptom of the transference neurosis. The primary determinants of the symptom were from the phallic-oedipal stage of development. Like other symptoms, the sleep symptom was a reliving of earlier experiences and was analyzed primarily through the transference. The analytic data from the case are used to illustrate resistance as an ally in the psychoanalytic process.

Acting Out↗
PubMed1988

Day residue and screen memory in Freud's dream of the botanical monograph.

Freud's theory of dream construction allowed the censorship to intervene only when a repressed infantile wish emerged from the unconscious. In his (1899) paper on screen memories, however, he proposed a mechanism for the defensive displacement of current events as they are sorted for introduction into permanent memory. I suggest that Freud was actually describing the conflictual process through which the day residue of the dream is formed. Day residue and screen memory are closely related as elements of the dreamer's present and past experience displaced from his more central instinctual concerns. Freud's dream of the botanical monograph clearly illustrates this relation. Substituted day residues were matched in the dream with relatively innocuous memories of past events of similar cognitive and affective significance. By retracing the substitutions, one can see how a current conflict over Fliess's role in the writing of the dream book recapitulated a series of Freud's earlier conflicts concerning his father and the power of books.

Conflict, Psychological↗
PubMed1988

The psychoanalysis of time.

The experience of time has been studied psychoanalytically largely through the conceptual frameworks of ego psychology and classical analysis. The implications of self psychology and Lacanian theory for understanding time experience have been relatively little explored. These implications would develop, on the one hand, from Kohut's investigations of fragmentation phenomena and, on the other, from Lacan's concept of the ego and his use of the short session. But time experience cannot be understood entirely in terms of individual histories and the psychoanalytic situation. A preoccupation with time is central to Western culture and is traceable to the social context--thirteenth-century monasticism--in which the clock was first invented. Time enters the analytic session especially in the handling of beginnings and ends, reflecting divergent notions of the purpose of treatment. The standing of time-frame rules in the different systems defined by ego psychology, self psychology, and Lacanian theory are examined together with their underlying assumptions about the nature of reality. These metaphysical issues--no longer academic but made concretely meaningful in each session--go beyond illuminating the concept of time. Our response to them will determine both the direction of each patient's treatment and the course of psychoanalysis itself.

Adult↗
PubMed1989

How dreams are told: secondary revision--the critic, the editor, and the plagiarist.

Secondary revision is a highly provocative concept arising out of Freud's attempts to explain the construction of dreams, but it remains relatively ill-defined. It includes three related, yet by no means identical aspects of the process by which the dream acquires its more or less final form during the experiencing, the remembering, and the telling. It represents one of the most interesting hypotheses dealing with the fluid world between sleeping and waking, a field which still presents us with a host of unanswered questions. Secondary revision not only reflects the higher levels of the dreamer's mental functioning superimposed on his biological substructure, but it also operates as a sensitive indicator of the cultural factors which have helped mold his personality. These factors include both the subculture of the analytic situation and the impact of society in the larger sense. I make reference to individual dreamers in analysis and to the world of dreams recorded in the past from our own and other cultures.

Dreams↗
PubMed1989

The traumatic element in the typical dream of feeling embarrassed at being naked.

Material is presented from three cases, where analysis of repetitive dreams of feeling embarrassment at being partially or totally naked was an important feature of the treatment. The indifference by the other people in the dream to the dreamer's nakedness was initially linked to perceived transference slights at the hands of the analyst, and later to repeated episodes of actually being treated indifferently at the hands of the parents. This indifference was related to latency or adolescent attempts by the patients to gain love or attention from the parents by exhibitionistic means. The stereotypical presentation of the manifest content of these dreams is seen as evidence for their underlying traumatic roots. Such dreams are likened to the typical examination dreams described by Freud, which have also been noted by others to have traumatic roots. This finding is consistent with my own work with certain repetitive manifest dream configurations and with Freud's (1920) reevaluation of his theory of dreams in Beyond the Pleasure Principle, wherein he noted that dreams of patients suffering from traumatic neurosis often manifestly repeated the traumatic situation in an attempt to master it retrospectively.

Adult↗
PubMed1989

Panic attacks facilitating recall and mastery: implications for psychoanalytic technique.

A patient, during the course of a lengthy analysis, experienced several panic attacks. These regressive episodes, occurring only in the analytic setting, provided her with her special means for recalling and eventually mastering repressed elements of her life. This facilitating aspect of her disorganization, when identified and analyzed as such, helped deepen the patient's analytic experience. It was necessary for the analyst to define verbally and clarify her reconstructed past as it emerged as part of her panic state, transferentially, so that the patient could finally recognize, acknowledge, and understand hitherto hidden aspects of her life. The psychiatric literature in regard to panic states is briefly noted, as is the relevance of comparing the present almost exclusively organic, pharmacological orientation, with Freud's discussion of the "actual" or current neuroses of his day, almost a century ago. On the basis of this case report, the importance of understanding the content and meaning of the panic attack, by analytic means, is once again emphasized.

Adaptation, Psychological↗
PubMed1989

Aspects of nonperverse scopophilia within an analysis.

This essay is intended to contribute to the increasing importance ascribed to scopophilia in modern psychoanalytic literature. The exceptional position of scopophilia is twofold: by virtue of its subdivisions, voyeurism and exhibitionism, it constitutes one of the two pairs of component drives recognized by Freund; and it informs one of the two major perceptual avenues that comprise communication in the analytic setting. A case is presented which shows how the psychic life of a female patient was dominated by a nonperverse scopophilia in a remarkable variety of ways, ranging from hyper-investment to inhibition and phobic curtailment. The case is equally noteworthy for the way in which these various phenomena were reenacted in the transference and in the particular visual character of the analytic scene; thus the patient's optical focal symbiosis and ophidiophobia are related to what I call the analyst's "retro presence."

Adult↗
PubMed1989

Understanding negative hallucination: toward a developmental classification of disturbances in reality awareness.

Negative hallucinations are explored from a psychodynamic viewpoint in four cases of neurosis. Next, shifting to the level of clinical theory, negative hallucinations are contrasted with five better-studied disturbances in reality awareness. It is noted that all six function as screen phenomena, and all occur in everyday contexts. These and other phenomenological issues lead to an assertion that negative hallucinations are regressive perceptual phenomena, similar in form to both preconscious perceptions and infantile amnesia. Finally, developmental considerations are used to derive a coherent hierarchy of disturbances in reality awareness.

Adult↗
PubMed1989

Fetishism in a woman.

Fetishism is generally considered to be a perversion occurring only in males. In this paper a clinical illustration of an adult woman with a fetishistic perversion is offered and considered within the context of the classic concept of fetishism originally described by Freud. Similarities and differences between male and female fetishism are discussed, with attention given to the greater complexity of the perversion as it occurs in a woman. The clinical example confirms the existence of fetishism in women and suggests that subtle forms of the perversion may go unnoticed and be more prevalent than previously realized.

Adult↗