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PubMed1999

The logic of play in psychoanalysis.

The paper puts forward the idea that play is at work all the time in psychoanalysis. The play element functions continuously to sustain a paradoxical reality where things may be real and not real at the same time. This paradox is what allows the work of psychoanalysis to take place. The concept of play covers different activities with complex interrelations, and general definitions may be misleading. The essential element is the framework that makes the paradoxical reality possible. The logical structure of the play framework is investigated, and the paper clarifies the relations between the play frame, transference and enactment. Play and humour are compared. Spontaneity is the essence of both, and the criterion for analytic validity in both cases is whether they deepen the analytic process. The tragic and ironic aspects of psychoanalysis are related to the intrinsic connection between play and loss. The relation between play and games is discussed. The rule-bound quality of games can block more exploratory kinds of play, but it may be necessary to accept this, in order for analysis to feel safe enough. Clinical material illustrates the importance of the play framework, both in a case marked by prolonged hostile and negative states of mind, and in others where more straightforward playfulness was possible.

Hostility↗
PubMed2006

The stranger.

This work concerns a nine-year analytical experience with a patient who presented as a main feature an apparent inability to experience and express feelings. Right from the beginning the author was confronted with the question of the viability of analytical work, considering transference or emotional involvement in the absence of perceptible establishment of an affective link on the part of the patient. The patient never missed a session, was usually very punctual and presented very rich material, but the accounts of his life, everything he was saying, hearing and observing was manifestly deprived of any emotional meaning for the patient and consequently deprived of sense for the analyst. If, at the beginning, the question was how to communicate with the patient, after some time it became a problem of how to enable the patient to communicate with himself. Confirming an observation by Bion that the patient is the best colleague the analyst can have, the way forward was indicated by the patient himself. This article is a theoretical exercise based on this clinical experience, using concepts developed by Bion, Ferro and Winnicott.

Adult↗
PubMed2006

The emotional experience of K.

The author raises the question of the emotional experience of K in Bion's schema of affective links, L, H, and K, suggesting that it is the emotional experience of feeling curious. He explores the central role curiosity has in 'On arrogance' and 'Attacks on linking' and hypothesizes that in Learning from experience the more complex notion of K is introduced in its place. Thus, Bion's affective schema is taken to be a version of Freud's account of experience in terms of instinctual impulses recast in terms of emotional experience. Freud's primary developmental dichotomy, the tensions between the pleasure principle and the reality principle, can be seen as the dichotomy of tensions between the emotional experience of L/H and the emotional experience of K. This suggests that the potential tension between K and L/H is critical to what happens in the consulting room. Finally the author argues that containing as a developmental dynamic is an expression of a K-state-of-mind and thus the container is thus a container-in-K. It concludes that one important aspect of what Bion called -K is an attack on a K-state-of-mind by an intrusion of L/H which has the effect of contaminating and dominating the urge to know.

Drive↗
PubMed2006

Psychotic withdrawal and the overthrow of psychic reality.

The author attempts to distinguish between the world of fantasy and the imagination (which fuels our capacity to 'dream') from a withdrawal into fantasy. In this withdrawal, the foundations of which are laid in childhood, a dissociation from psychic reality starts and from it the delusional world arises and constitutes the adult illness. During therapies of adult patients who have experienced a psychotic state, it is often possible to reconstruct the state of infantile withdrawal and understand how their dissociation from reality was ignored or unknowingly encouraged by their parents. Children destined to develop psychosis enter into the dissociated world not just as a defence against anguish or loneliness, but also for the pleasure of experiencing a delusional self-sufficiency and a gratifying omnipotence in which anything is possible. Mental workings that take place in the withdrawal do not follow the rules governing normal psychic functioning. Those fantasies cannot be either repressed or 'dreamed' in order to be transformed into thoughts. These psychopathological structures, which develop early and autonomously, have to be understood during analytical therapy in their origins and 'deconstructed' in order to help the patient to escape from their dominion. By means of clinical examples, the author tries to shed light on the possible ways of reaching patients in their psychotic shelters, thereby helping them to re-emerge into a psychic reality.

Adolescent↗
PubMed2006

Dreams that mirror the session.

Dreams in which the analyst appears undisguised almost always depict violations of the setting. Often experienced as special, epiphanic moments, they give a glimpse of an intense, emotional reaction to traumatogenic or otherwise significant events that have occurred during the session or in the most recent previous ones. Probably, the essential aspect of these dreams can be found in the 'form of their content'. This may be paralleled by the narrative technique of mise en abyme or mirror-text. The dream appears as a story within the main story and the scene of the analysis is reflected anti-illusionistically. The fictional structure of the setting is emphasized. Its theatrical self-consciousness quality is revealed at its best. The author postulates that the transformative therapeutic value of these dreams derives from denouncing the referential illusion of 'concrete reality' and of 'what really happened'. For the analysand, they are an effective (i.e. emotionally intense) opportunity to discover the spatial articulations and the staggering refractions of the inside/outside, the textual/extra-textual, the psychic reality/material reality. In the continual comings and goings from one term to another, the work of symbolization is reactivated and the subject is constructed. Dreams that mirror the session, from this point of view, provide a model for conceptualizing the analytic work, and their significance goes beyond the specific phenomena referred to. A clinical case is given, in which some of one patient's dreams are considered as they occurred over a short period. In one of them, the dream-within-a-dream phenomenon is present.

Adult↗
PubMed2005

Experiences in K and -K.

In this paper the author explores and expands Bion's concepts of K and -K and delineates the nature of the relationship between the two. While Bion views envy as a principal motivating force for -K, his conception of -K goes considerably beyond this. The author explores manifestations of -K not driven by envy and, consequently, not necessarily pathological or pathogenic. -K is viewed by the author as a psychological process, which may serve many functions, including the communication of the patient's fear that knowing will bring on psychological catastrophe. -K, under circumstances that he describes, may serve to protect the individual's sense of continuity of being. The need to know the truth (K) may be at odds with the need to survive psychically, for example, when a person fears that the truth will kill him, or those he loves and depends upon. This idea is explored in two ways: first, by means of a discussion of the Oedipus myth in which Oedipus attempts to evade knowing for fear of recognizing that a prophesied catastrophe has already occurred; and, second, by means of a clinical exploration of the conflict between the need to know and the need to survive. The author discusses his analytic work with a severely disturbed patient for whom not knowing was felt to be essential to her psychic survival. Her need not to know reached a point where she psychically obliterated the analyst through the use of negative hallucination.

Adult↗
PubMed2001

Minimum and comfortable driving headways: reality versus perception.

A field study was conducted to evaluate drivers' actual headways in car-following situations, their relationship to the drivers' brake reaction times, and their relationship to the drivers' ability to estimate those headways using different metrics. Drivers were asked to maintain "minimum safe distance" and "comfortable, normal distance with no intention to pass" behind the car ahead. The lead car speeds varied from 50 to 100 km/hr. The results showed that under both sets of instructions, drivers adjusted their distance headways in relation to speed, maintaining constant time headways. A significant portion of the drivers maintained time headways that are considered unsafe in relation to drivers' reaction times. There was no significant relationship between the minimal headways maintained by the drivers and their brake reaction times under conditions of maximum attention and preparedness to apply brakes. Accuracy of spoken estimates of headways varied widely among the three measures used to report perceived headway; meters and car lengths yielded much lower estimates (and ones closer to the actual headways) than did seconds. The results have implications for headway perception, driving safety, driver education, and smart cruise-control design.

Acceleration↗
PubMed1979

Change in psychoanalytic treatment.

Psychoanalytic treatment aims not simply at removal of symptoms but at basic characterologic improvement. Although change in psychoanalytic treatment is traditionally attributed primarily to insight, the author asserts that insight, although valuable, is not essential to the achievement of such change. Other elements basic to the therapeutic efficacy of all psychoanalytic techniques regardless of their theoretical orientation are discussed. Among additional factors, the implications of warmth and activity on the part of the analyst, and of setting a termination-date, are specifically elaborated on.

Awareness↗
PubMed1988

Time, reconstruction and psychic reality.

This paper illustrates certain relationships between the concepts of time, reconstruction and psychic reality as they appear in the clinical situation. A case example introduces the literature concerning the difficulty of knowing over time "what actually happened." Arlow's model of the two projectors, which has been used to describe psychic reality, is extended from a developmental point of view. Two further case examples then illustrate how attention to the patient's unique psychic reality can lead to different reconstructive problems and interventions. The two case examples raise certain questions about the nature of early experience and the role of external reality. The conclusion takes a broader view of the relationships between time, reconstruction and psychic reality utilizing two examples from contemporary Western literature.

Adult↗
PubMed1989

The "holding function" of the therapist in the treatment of borderline patients.

In this paper, I have attempted to show that during crises in the therapy of borderlines it is crucial not to respond, needless to say in reality, but neither by confrontation nor with interpretation to the apparently impulse-ridden transference. To interpret to the patient, during such periods, the vicissitudes of the object hunger in the transference often intensifies the turmoil, confuses the issue, and precipitates further regression. It is of primal importance to recognize that during these crises the patient needs a holding environment to restore and enhance the observing, anxiety-containing, and integrative capacity of the ego. This holding environment rests not only on the stability of the therapeutic setting, including the reliability and acceptance of the therapist, but on helping the patient acknowledge and process the precipitants of the emotional crises.

Borderline Personality Disorder↗