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PubMed1989

The questions and curiosity of the psychoanalyst.

Questions the analyst asks of the patient are a powerful but neglected aspect of the theory of psychoanalytic technique. Their importance resides in their dynamic impact on the psychic equilibrium of the patient because of their ability to destabilize existing compromise formations. A clinical vignette illustrates the view that the linguistic shift from other modes of discourse to the spoken question heralds a less visible parallel shift in the psychic equilibrium of either the psychoanalyst or patient. There is no more and no less complexity to questions than to any other communication by either analyst or patient. For that reason there can be no systematic classification of questions in the clinical psychoanalytic situation, just as there can be no definitive taxonomy of psychoanalytic discourse. It makes no sense to reduce the enormous diversity and range of all the questions the analyst asks to the simple dichotomy of good or bad for the analysis. Questions are the emblem of the analyst's mode of inquiry; they can further the development of self-observation, which is such an important concomitant, cause, and consequence of structural change.

Depressive Disorder↗
PubMed1989

Changing psychic structure through treatment: criteria for change.

The author outlines his clinical observations during the "middle game" of psychoanalysis, leading to recognition that structural change is taking place. "Middle game," "structure," process, and content are defined and critically discussed. Illustrative clinical vignettes are offered. The presentation emphasizes the importance of an active and resolving transference "struggle"; in addition, more traditionally noted criteria are briefly touched on, e.g., development of observing ego and treatment alliance, changes in dream function and communication, and the reviewing of the neurosis and transference during the termination phase as instances of mourning and working through. The concept of optimal psychobiological function in the service of a homeostatic principle is discussed.

Humans↗
PubMed1989

Spelunking as a manifestation of a counterclaustrophobia.

Material is presented from the case history of a patient whose interest in spelunking (cave exploration) was found to be an unconscious expression of a type of counterclaustrophobia. Both oedipal and preoedipal determinants of the claustrophobic anxieties are delineated. Of particular note in this instance is the testicular element in the genesis of the patient's claustrophobia. His confusion of the movements of his testicles into his inguinal canals during childhood defecation with the movements of the feces themselves lent an special intensity to his fear of being flushed away from the mother by an expulsive anal birth from the claustrum. Childhood anxiety aroused when his testicles would become trapped in the inguinal canals was an important forerunner of the adult fear of being trapped in confined spaces. A counterphobic element of the spelunking per se was his enjoyment in hanging suspended by a rope in caves. In this manner, he was able to act out (by virtue of his body-testicle equation) his identification with, and control over, the disappearing testicles in the setting of a claustrophilic union with the mother.

Adult↗
PubMed1989

Intolerance of responsibility for internal conflict.

A type of patient is described, who has marked intolerance of taking responsibility for his internal conflicts so as to confront them, analyze them, and change. Defensive repetition in pathological object relations aims to avoid what is wrong within and to engage another so as to protect oneself. Genetic, dynamic, and technical aspects of such defensive, dependent relating are considered. Responsibility for oneself and for what is within oneself is held to be terrifying--more than anyone can bear on his own. How destructiveness has become, and remains, so terrifying is discussed.

Adaptation, Psychological↗
PubMed1989

Emptiness as defense in severe regressive states.

This paper examines the empty states experienced by severely ill borderline patients. At times of stressful regression, these patients use complaints of emptiness to describe profound disturbances of affect, cognition, object relations, and bodily experience. Empty states may be seen as complex defensive configurations which protect a borderline level of psychic structure from the impact of aggressively charged object relations, and ward off further regression to states of fragmentation or fusion. Severely ill borderline patients consolidate an empty screen by means of a characteristic repertoire of primitive defenses consisting of various forms of projective identification, including bitriangulation and projective identification of psychic agencies, somatization, acting out, and specific alterations in cognition. The author describes the highly deviant organizations of the object world seen in empty states, and the complex and disturbing countertransferences which these states evoke.

Adult↗
PubMed1989

On structures.

Some of the metapsychology involving the concept of structure is briefly reviewed, together with some difficulties presented by it. The concept of structure is defined, for purposes of the paper, and various kinds of structures are delineated. The author confines herself to the "microstructures," such as memories, cognitive structures, affect structures, defenses, identifications. Possible factors related to the development and maintenance of structures are discussed. In addition, the concept of structural change is taken up. It is suggested that an essential in such change is conscious review, however brief. The author proposes that structure formation and change is a fruitful area for mutual work by psychoanalysts and basic scientists.

Adaptation, Psychological↗
PubMed1990

Unconscious fantasy: introduction.

Freudian psychoanalysis has long been a depth psychology with devotion to the idea that unconscious fantasies dictate behavior. That concept is traced from its origins to the present to expose its various forms as ego psychology has emerged.

Defense Mechanisms↗
PubMed1990

Transformations of unconscious fantasy in art.

Unconscious fantasy is conceptualized as a representation for drive-related, conflict-laden, wish-fulfilling views of human experience. These are usually related to sexuality, and refer to birth, intrauterine existence, primal scene, castration, and seduction. Unconscious fantasy may be transformed into works of art through a variety of artistic means. The employment of formal means for the representation of fantasy may be the product of an endopsychic perception. Thus, structural attributes of the psyche may also find representation. An example is used from the creative process in the construction of a novel by Henry James, The Spoils of Poynton. In the process of fulfilling artistic purposes in the construction of his plot, the author made use of derivatives of unconscious fantasy which surface in the process of creation. The work of art is the integration of unconscious derivatives which become transformed into artistic structure.

Creativity↗
PubMed1990

Unconscious fantasy: developmental and self-psychological considerations.

The authors view unconscious fantasy from the perspective of self psychology as a significant addition and emendation of the classical framework. A selective review of the pertinent literature is presented, followed by clinical material illustrating the contribution of self-psychological concepts to the understanding of unconscious fantasy formation.

Child, Preschool↗
PubMed1990

On patients' disclosure of parents' and siblings' names during treatment.

The patient's spontaneous disclosure of a parent's name is frequently associated with appearance of core conflicts, especially genetic and transference themes of incest, other oedipal derivatives, and separation anxiety. Using a parent's first name has the unconscious implication of incest, since one is doing something which one's other parent but not oneself is allowed to do. In some primitive cultures, saying aloud the names of one's parents was strictly forbidden. Disclosing a parent's name to the analyst may parallel the developmental step during childhood when the patient learned the parent had a first name. The child's acquisition of language, including proper names, fosters object constancy and the internalization of the parents, from whom language is learned. For patients who do not usually refer to a sibling by name, disclosure of the sibling's name may also reflect the concurrent emergence of central conflicts. In particular, such disclosure may accompany associations about an earlier closeness with the sibling giving way to subsequent estrangement. Naming the sibling may also mark an intensification of a sibling transference to the analyst.

Adult↗
PubMed1990

The transference neurosis in Freud's writings.

This paper reviews the evolution of the concept of transference neurosis in Freud's writings. It suggests that the language in which the concept of the transference neurosis is originally expressed by Freud includes an idea of the analyst as aggressively pursuing the analytic cure by waging a solitary battle against the patient's disease. With the representation of the death drive and the larger role accorded to sadism as its external manifestation in Freud's revised drive theory of 1920, the patient becomes the ally; resistance, in the sense of the conservative forces, not disease, in the sense of libidinal conflict, becomes the enemy. It is thus difficult to speak of a transference neurosis in the circumscribed way Freud originally meant it, and he ceased to use the term after 1926 rather than redefine it to fit his broader perspective. In this broader perspective, relative resolution of conflict replaced radical liberation of the patient from disease. That Freud did not redefine the term does not imply that he discarded it, or that we necessarily should. This paper suggests that Freud implied a functional distinction between transference as transforming agent and transference neurosis as result of that transformation. That distinction defines psychoanalytic cure in terms of the understanding of a symbolic transformation which is, through the transference neurosis, reexperienced as part of the psychoanalytic process.

Countertransference↗
PubMed1990

"Meaning" connections and causal connections in the human sciences: the poverty of hermeneutic philosophy.

In much of psychoanalytic theory and therapy, Freud repeatedly inferred a causal connection between thematically kindred events by relying on the kinship between their thematic contents. This paper strongly endorses his search for causal explanations. But it argues in detail that (1) his causal inferences from thematic connections rest on an important fallacy, which undermines major etiologic conclusions in psychoanalysis; (2) a related, weighty inferential error is damaging to the Freudian theory of transference, when it infers the pathogenic role of an early childhood scenario from the thematic reenactment (recapitulation) of that scenario in the adult patient's interactions with the analyst, and with other people. Both arguments draw on subject matter in psychoanalysis, physics, evolutionary biology, common-sense psychology, history, and medicine to arrive at a fundamental caveat for all of the sciences: Even when the thematic kinship (or so-called "meaning connection") between events is indeed of very high degree, this fact itself does not license the inference of a causal linkage between these events. A corollary of this result is that we must reject the accusation of Karl Jaspers and the hermeneutic philosophers that Freud's own conception of the psychoanalytic enterprise suffered from a "scientistic self-misunderstanding."

Defense Mechanisms↗
PubMed1990

The rhetorical voice of psychoanalysis.

The rhetorical voice of psychoanalysis has a long history and has only recently come to be seen as a special feature of the theory. Its beginnings can be found in Freud's earliest pleadings for the usefulness of metaphor and analogy, although he felt that they were largely provisional and would eventually be replaced by more durable concepts. We have begun to see problems in replacing the central metaphors; the rhetorical base of psychoanalysis may be more enduring than we thought. While our metaphors may never provide epistemic access to the stuff of the mind, they can and do point to specific clinical encounters. Ways must be found to expand our rhetorical treasure chest and develop language even better suited to our concepts and observations.

Freudian Theory↗
PubMed1990

Helping patients by analyzing self-criticism.

This paper is addressed to patients' need for help with punitive self-critical attitudes. Such help has not always been sufficiently provided by psychoanalysts, owing to an unrecognized failure of neutrality. Historically, a gradual overemphasis on the concept of an unconscious sense of guilt has acted as a barrier to the appreciation of shame. An alternative concept, punitive unconscious self-criticism, which stands in contrast to constructive self-criticism and is common to the painful affects of guilt, shame, humiliation, and depression, can facilitate helpful analytic treatment. Heinz Kohut's contributions are examined. His analytic stance is differentiated from his theories of development. In the former, characterized by an affirmative attitude, he takes a position of functional neutrality toward shame and pays consistent though unstated attention to the effects of punitive unconscious self-criticism. The affirmative attitude can be employed without adoption of Kohut's self psychology, i.e., without abandoning the basic psychoanalytic approach to mental conflict and development. The concept of punitive unconscious self-criticism and the concept of divergent conflict, provide sufficient explanatory power. Clinical examples are used to illustrate these ideas.

Adolescent↗