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PubMed1995

The preconceptual organization of emotion.

The suggestion is made that emotions organized on a preconceptual level are psychic constructs different in kind, as well as degree, from emotions organized on a more abstract conceptual level. For many people the regressive alteration in ego functioning that gives rise to these emotional constructions represents a characterological way of handling conflict. Emotions organized on a preconceptual level and rigidly maintained through primitive defenses ward off a host of fears ranging from castration to dedifferentiation. The shift from the preconceptual world of sensation to the conceptual world of abstraction complements the resolution of oedipal themes and is essential for free and easy movement between reality-based interactions and the imaginary experience of both self- and object representations in the transference. Structural and dynamic aspects of these emotional constructions are discussed and their relation to a person's experience of reality is explored through transference material taken from different points in an analysis. The problem of the analyst's use of concepts to refer to preconcepts is also discussed, as is the issue of enactments.

Adult↗
PubMed1995

Beginning a psychoanalytic treatment: establishing an analytic frame.

The opening phase of analysis has received scant attention. Freud initially included, as essential, the establishment of an analytic process via the method of free association in the opening phase. However, his stance in relation to this process we can now characterize as authoritarian, and as influenced by suggestion and manipulation. Recent literature, while contributing to the understanding of the range of dynamics possible when beginning an analysis, continues to ignore the manner in which the method of free association may be used by both participants in establishing an analytic frame. Two clinical examples of how this latter process may be inaugurated are given, and reasons for the drift away from it are suggested.

Adult↗
PubMed1995

The analytic role: a mediating influence in the interplay of transference and countertransference.

Recognition of the analyst's subjective involvement has led to profound reconsideration of the nature of mutative process. How is it that the analyst can be personally involved in an unconscious way, yet also be an "objective" participant in the relationship? The paper proposes that the analyst's subjectivity is mediated by his or her role. The analytic role conditions how the analyst listens, experiences, and behaves, leading to interactive outcomes different from that expectable from unmodified subjectivity. The paper describes the analytic role in terms of contributions from metapsychology, clinical theory, and tactics. Each affects the function of the analyst-at-work in a different way. The analytic role, learned during training, is maintained by a combination of internalization and ongoing involvement in psychoanalytic activities. A clinical illustration demonstrates how a typical transference-countertransference enactment is influenced by the analytic role. The vignette suggests ways in which the concept of role modifies the effect of subjectivity. Three recent viewpoints--those of Renik, Ehrenberg, and Hoffman--that challenge previous theories of mutative process are discussed in terms of the analytic role. In each case, consideration of role clarifies the nature of the innovative technique or view, and seeming contradictions between it and existing clinical theory.

Adult↗
PubMed1995

A classic revisited: clinical and theoretical reflections on Stone's Widening scope of indications for psychoanalysis.

Leo Stone's "The Widening Scope of Indications for Psychoanalysis" has had a major influence on the way almost two generations of American psychoanalysts have been taught to think about and practice psychoanalysis. Contemporary elaborations and extensions of the ideas contained in Stone's paper have, however, been used to move us steadily toward a shift in the treatment paradigm that underlies the way psychoanalysis is currently being conducted. This contemporary tendency to enlarge the scope of the mode of action of psychoanalysis, in order to accommodate the wider range of patients being treated today, blurs those aspects of psychoanalytic technique that distinguish the unique psychoanalytic perspective from the more general psychotherapeutic perspective. Several ideas contained in Stone's paper are considered as a basis for clarifying this distinction and the technical implications deriving from it. Two clinical vignettes are presented to illustrate these issues.

Adult↗
PubMed1995

Transferences of deception.

Three characteristic transference configurations are identified that frequently emerge in the analyses of patients for whom deception and inauthenticity are central themes. These configurations are labeled (1) imposturous, (2) psychopathic-paranoid, and (3) psychopathic-unreal. Patients who develop these transferences have actively split the object world along two distinct axes. The first split has occurred along the lines of pleasure and unpleasure. The second divides objects along the lines of the experience of reality, with some objects felt to be charged with exaggerated, painful meaning, and others felt to be devoid of meaning and affect. This split, which arises as a way of managing painful object relations, is then woven into fantasy and defense at many developmental levels. Material from the analyses of two patients is presented to demonstrate the interplay of the three transference configurations, the fantasies that underlie them, and the clinical importance of analyzing the second split.

Adult↗
PubMed1995

Psychological-mindedness as a defense.

Many patients seen today use sophisticated capacities for psychological reflection and premature synthesis to ward off knowledge of more primitive conflict and islands of unintegration. They show a precocious talent for free association, a talent they perversely misuse. Similarly, they enjoy access to a rich fantasy life, even as they subtly impoverish it. Effective therapeutic work requires that they suffer "traumatization"--experiences of dedifferentiation that undermine their considerable capacity to know what they feel and think. Structural and process variables interact with content variables in complex and ambiguous ways. As a consequence, estimates of the authenticity and "fit" of personal and interpersonal experiences and behaviors of both partners in the therapeutic encounter become necessarily involved. Such factors may increase the possibility of misunderstandings, but also of more authentic and firmly grounded understandings. Similar issues are eventually revealed in these patients' early lives, where psychological and other formulaic understandings were prematurely applied to offset overwhelmedness and other unarticulable experiences; the patient's talents for ambiguity, irony, self-soothing, or responsiveness to others were, in effect, exploited at the expense of full psychological growth. Versions of this clinical presentation may be increasingly common in a new generation of analyzable patients. Clinical work with them is facilitated by a synthesis of contemporary developmental, structural, and object relations theory.

Adult↗
PubMed1995

Karl Abraham, Sigmund Freud, and the fate of the seduction theory.

Even after Freud had turned his attention away from the seduction theory of neurosogenesis, his close pupil and colleague, Karl Abraham, initially sought to investigate child sexual trauma further. In two of the very first articles on child sexual molestation, Abraham proposed that sexual abuse was particularly common among neurotic and psychotic patients as a result of a "traumatophilic diathesis," a trauma-related conceptual precursor of the repetition compulsion. In their correspondence, Freud trenchantly criticized many aspects of Abraham's papers on the subject of sexual trauma, in contrast to his public endorsement of Abraham's work in this area. For largely transferential reasons that this paper attempts to elucidate, Abraham did not encourage dialogue regarding persistent questions on the seduction issue, ceased publishing on that topic, and for some time controlled his apparently deep rankle over Freud's criticisms and failure to acknowledge Abraham's contribution to the concept of the repetition compulsion. Despite their close friendship and shared intellectual enthusiasm, Freud's response to Abraham's 1907 papers, as well as Abraham's almost uniformly positive disposition toward Freud, apparently prevented Abraham from further developing his observations and ideas on seduction and also lent background to their later clash. Subsequently, there was virtually no further psychoanalytic investigation of the subject of child sexual abuse until the issue arose briefly with Ferenczi in the early 1930s, and only occasionally after that for the next fifty years. The death of Abraham, and then Ferenczi, shortly after disputes with Freud may be among the factors that had an inhibiting effect on an earlier reconsideration of the seduction theory by others. Abraham's previously unheralded concept of traumatophilia has relevance to current clinical controversy regarding constitution and sexual trauma.

Austria↗
PubMed1996

An aspect of transference: the struggle to become an analysand.

The patient's efforts to enter into a collaborative relationship with the analyst, to become an analysand, are burdened with difficulties, of which a major one is the not infrequent intrinsic structuring of certain aspects of transference--its functional, secondary autonomy, or independence of its historical roots. The effect is to confuse and misrepresent, through a struggle by the patient that dissembles the major purposes of the work. The struggle is a function that has become independent of its historical origins, and is now less an anxiety-driven defense than an automatized, concrete seeking of a vaguely plausible, rationalized satisfaction and security. It represents the patient's effort to work his or her way to closeness with the surrogate, but with distancing by means of control and domination. It lacks the symbolism and metaphor of unconscious derivatives. A mutual responsiveness by the analyst is a potentially undesirable outcome. Recognizing an interactional process, there is the necessity of clarifying a future-oriented process by a patient, who is working over the establishing of a dominant self-image of integrity and security without intimacy. Illustrative vignettes and a comparison with role responsiveness are included.

Defense Mechanisms↗
PubMed1996

Analysis, reanalysis, and self-analysis.

This paper describes a training analysis which required a reanalysis. An evaluation of the circumstances leading to the need for further psychoanalysis for the practicing analyst is detailed. A discussion of the value and necessity for self-analysis following analysis is presented. The description of a specific technique for conducting a self-analysis is rendered.

Dreams↗
PubMed1996

The mental organization of primitive personalities and its treatment implications.

A description is presented of the mental organization of primitive personalities (American borderlines, British paranoid-schizoid), as well as a generic course of analytic therapy I have sometimes experienced with them. Their mental organization may be qualitatively rather than quantitatively different from that of less disturbed persons. The differences are mostly attributable to a rudimentary psychic differentiation and integration, and compensatory pathological relationships. This configuration is hypothesized to have a unique developmental course, originating from a combination of constitutional factors and adaptation to a pathogenic interpersonal environment. Failure to appreciate the qualitative differences between the minds of the analyst and his less disturbed patients, on the one hand, and the mind of the primitive personality, on the other, may lead the analyst to employ unsuitable modes of analytic intervention with unfortunate consequences.

Borderline Personality Disorder↗
PubMed1996

Metalinguistic analysis of therapeutic discourse: flight into a second language when the analyst and the analysand are multilingual.

The choice of a particular language for the conduct of analysis becomes an important theoretical and clinical question when both the analyst and the analysand are multilingual and share the same languages. Shift from one language into another language during analysis is an equally important question. This paper offers an analysis of the flight into a second language by both the analysand and the analyst within the transference-countertransference matrix. The focus of the discussion is the communicative nature of the mother tongue vis-à-vis a second language. The author argues that unconscious fantasies and memories of early childhood experiences are built into the mother tongue and are brought to life in the analytic dialogue by way of that language. Shift into a second language is viewed as primarily defensive in nature. It is, however, noted that a second language may at times provide the only space where the analyst can meet the patient out of each of certain personal and cultural ghosts. Finally, since the mother tongue is viewed as the preverbal register of the transitional space, it is suggested that the working through of preoedipal issues be ultimately carried out in that language.

Adult↗