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PubMed1997

On situating homophobia.

Premised on the observation that the HIV epidemic has occasioned an increase in both the prevalence and the virulence of homophobic ideation, feeling, and action, this paper surveys some of the ways in which psychoanalytic theory has been widely used in the emerging extraclinical literature on this problem. The problem has been barely addressed in the clinical literature, however, a gap that is discussed. The paper then proceeds, by way of a clinical vignette and a critical examination of some central texts of Freud, to present a clinical/theoretical perspective on homophobia. This perspective leans on Brian Bird's work on prejudice.

Adult↗
PubMed1997

Understanding the patient's use of the method of free association: an ego psychological approach.

While most of our methods of listening have been geared toward unearthing unconscious fantasies, those directed toward the ego's all-inclusive role in effecting the associative process have lagged far behind. It is the thesis of this paper that listening from the perspective of the ego allows the analyst to work more closely with what the patient is ready to understand. Clinical technique, using an ego psychological view, is elaborated, demonstrated, and compared to technique dependent on the reading of signs and symbols of the unconscious.

Adult↗
PubMed1997

The real unconscious: psychoanalysis as a theory of consciousness.

Inquiries into hallucinatory wish fulfillment and the unconscious converge and, by distinguishing the concept of the unconscious in psychoanalysis from that of cognitive psychology, serve to bring out what is most essential to the psychoanalytic conception. Freud's topographical model is used to stress that the psychoanalytic unconscious can be understood only in relation to theories of consciousness and wishing. Moreover, in contrast to the cognitive conception, psychoanalysis holds that the processing of thought in the human mind is inseparable from the activity of desire. This leads to further psychoanalytic reflections on the interrelation of conscious and unconscious, wishing and thinking, and, in consequence, on transference and the mechanism of unconscious fantasy.

Cognition↗
PubMed1997

Negative acting in.

Little has been written on the analysand's failure to act in the session when some form of motoric reaction or behavior seems appropriate and expectable. This phenomenon is conceptualized as negative acting in. Several clinical vignettes are provided. The importance of analytic interventions at these moments of behavioral omission, the possible countertransferential interferences, and the frequent use by the patient of rationalizations are commented on. The point is made that even though the exploration of these nodal points does not always lead to the discernment of psychodynamics, it usually contributes to the fostering of ego-observing capacities. Detection of episodes of negative acting in may pose special difficulties for the analyst, since it requires that attention be focused on events that do not take place, but their exploration is considered important for an analysis of the patient's psychic life.

Adult↗
PubMed1998

Coordinating developmental and psychoanalytic processes: conceptualizing technique.

Throughout childhood and adolescence, psychological growth proceeds in a sequence of progressive hierarchical organizations. Consequently, children are continuously consolidating existing positions or are in transition from one to another. When analytic treatment is proposed, analysts often find themselves in the position of being required to technically coordinate the requirements of the analytic process with those of the ongoing developmental process. While it is the patient who will ultimately bring the needs of both processes together, the approach the analyst assumes to recognizing and addressing these needs can have a facilitating influence on the treatment. Play, for example, is a window on old conflicts and impaired object relationships from the past, but it is also a way in which children consolidate existing organizational hierarchies. Similarly, the analytic interaction provides a pathway to the past, but it is also used by children to provide the building blocks for newly emerging structures. To facilitate further clinical research, a conceptual outline of the relationship between the two processes is provided.

Adolescent↗
PubMed1998

Screen reconstructions: traumatic memory, conviction, and the problem of verification.

Just as formerly recalled screen memories may be remembered again in the course of psychoanalysis, so new screen phenomena can arise during the treatment process. This paper attempts to relate the process of reconstruction and the occurrence of a type of screening. It is proposed that, under certain circumstances, psychoanalysis can result in a mutually determined screen construction that both patient and analyst consider convincing and valid but which may, for the most part, actually be untrue as a result of the screen function. Screen memories arising during the reconstructive process resemble the déjà vu and déjà raconté situation in that the experience is felt with certainty to have actually occurred previously, although a degree of doubt about its having happened can consciously or unconsciously coincide. Factors contributing to the formation of screen constructions include regressive aspects of the analytic situation; superego elements and the experience of an injunction to remember; the wish to witness what took place in the past; direct or indirect suggestive influence by the analyst; a defensive identification with the analyst; and the analyst's theoretical orientation to reconstruction. Like a screen memory having some veridical content yet serving a masking function, a screen construction can have elements of truth. At the same time such constructions may function as a strong resistance of compromise against intense erotic, sadomasochistic, or narcissistic themes in the transference/counter-transference that were painful or conflictual in the past. If screen constructions are assumed to be historically real or valid, they may not be analyzed for their transferential screening role. A previously published case involving a presumably repressed memory of sexual molestation is considered from the perspective of the possible development of a screen reconstruction. Clinical and scientific aspects of seeking extra-analytic confirmation or falsification of reconstructions are discussed.

Adult↗
PubMed1998

The absence of the paternal penis.

Girls' experiences of object loss, in conjunction with female anatomical structure, may lend themselves to a particular genital anxiety regarding openness and emptiness. The relational void in giving up the mother as love object may lead to an internal self-representation of a "hole" to be filled, much as the mouth sucks the pacifier in the absence of the nipple. This image may then be extended to the genital representation. In turning to the father, a girl may find that she lacks a relationship with him in the relational space opened up by the loss of the mother; the penis is symbolically withheld from her in the father's relational distance. This lack of sexual and relational gratification, it is proposed, may be schematized by a female as her body being empty of something. The father's absence--the absence of the paternal penis--may lead to an absence of the mental representation of the vagina and to an inhibition of the role the vagina then plays for a woman in sexual desire. Vaginal repression may serve to disguise object hunger that might otherwise be experienced as vaginal longing. An abbreviated clinical vignette, revolving around a masturbatory fantasy, is offered in partial illustration of the thesis.

Fantasy↗
PubMed1998

Mutual regression: altered states in the psychoanalytic situation.

Regression is one of the most controversial topics in the psychoanalytic literature, and disagreements continue regarding a number of propositions central to the issue. On the one hand are those who maintain a traditional view that analysis facilitates regression, through both its setting and its method. On the other are critics from diverse theoretical schools, Freudian, Kleinian, and interpersonal, who have argued that the setting does not, and that the analyst should not, induce or encourage regression. This paper reexamines the fundamentals of regression and relates the concept to the notion of altered states of consciousness. From a relational position, it is argued that patient and analyst mutually regulate regressive states in each other, and that this is an important aspect of the analytic process. One of the analyst's roles is to facilitate the patient's shift into the state best suited for the task of the moment and, often, to improve the patient's ability to internally and interpersonally regulate and move between various states of consciousness. The analyst's commitment to state control as a mutual endeavor helps safeguard the patient's autonomy.

Awareness↗
PubMed1998

Superego defense analysis in the termination phase.

This paper is a contribution to recent efforts to identify areas in clinical theory and practice in which the analyst's authority is used, rather than analyzed, to achieve therapeutic results. In the termination phase there may occur an intensification of transferences of authority (superego transferences) in response to the aggression inherent in termination. Analysts may develop counterresistances to analyzing these defense transferences, since their analysis exposes the analyst to the patient's heightened aggression at termination. The literature on termination may have contributed to analysts' falling short in analyzing these transferences, by its having accorded internalizing mechanisms a prominence in the therapeutic action of termination that they otherwise lack in contemporary ego psychological theories of therapeutic action. Gray's formulation of the superego as an analyzable defensive activity is applied to events in the termination period, thereby bringing into focus conflicts over aggressive impulses defended against by superego forces. Clinical vignettes from the termination phase of an analysis are presented.

Adult↗
PubMed1998

Perverse defenses in neurotic patients.

Distinguishing perverse defenses from the concept of obligatory perversion allows perverse defenses to be examined in neurotic patients. Perverse defenses against reality, one's conflicts, and relationships with others are connected with affect intolerance, difficulty with analytic collaboration, and analytic impasse. Perverse defenses, including the cultivation of states of distraction, excitement, and pomposity, as well as perverse sadomasochistic relations with others, protect against the unbearable: intense affects, painful ideas, and loving, committed need of a valued, distinct person. Patients' perverse, vindictive refusal to be reasonable provokes perverse countertransference reactions whereby the analyst stands in judgmentally and critically for the seemingly absent demands of reason, morality, and analytic progress.

Countertransference↗
PubMed1998

A new analytic dyad: homosexual analyst, heterosexual patient.

The paradoxical thesis is presented that the extraordinary aspect of the analytic experience of a homosexual male analyst and his heterosexual male analysand is that it was ordinary, that the fundamental processes of transference, countertransference, and analysis of defense and resistance were determinative. The unique variations of these processes with this particular patient are explored. The patient entered treatment unaware of the analyst's homosexuality, which he discovered during the analysis. The course of this discovery, its transformations, its defensive uses, its transference meanings, and its fate in the termination are delineated. Through viewing the patient's reactions to the analyst's homosexuality as potential entry points to the transference, the analytic process was enhanced and facilitated.

Adult↗
PubMed1998

Telephone analysis: out of sight, but not out of mind.

Past traditions and prejudices may have precluded many analysts from openly considering the use of telephone analysis as a viable treatment option. However, at times psychoanalysis by telephone may represent the best treatment available for a particular patient. Use of the telephone in clinical practice evokes complex feelings and raises a number of important issues for both patient and analyst. A case of telephone analysis is presented to illustrate the poignancy of initial telephone contact, issues associated with the decision to do psychoanalysis by telephone, some of the paradoxes and complexities of telephone work itself, and the termination process. Initial resistances by both patient and analyst are discussed, and modification of technique and its applicability to psychoanalysis in general are examined. Indicators for telephone analysis are considered.

Adult↗
PubMed1999

The pressure toward enactment and the hatred of reality.

The pressure toward enactment is investigated in terms of the threats that primitive, pre-thinking states of mind exert on attempts to know and understand. Clinical material and a review of the literature suggest that when the analyst confronts (by thinking) rather than complies (by action) with the hidden demands of omnipotence, he or she triggers and is then subject to the pre-thinking mental realm of concrete sensory bombardment, which can penetrate and obliterate his or her separately thinking mind. One important pressure driving the analyst toward enactment derives from a defensive response aimed at avoiding the threat of such concrete projections.

Acting Out↗
PubMed1999

Oedipal dynamics in panic disorder.

Both research and clinical work have revealed factors that can lead to the onset and persistence of panic disorder. Preoedipal conflicts intensify the danger of oedipal longings for panic patients. Competition with the same-sex parent is linked with angry preoedipal fantasies and associated fears of disruption in attachments. Fantasies or actual successes can thus trigger panic episodes. Regression to a helpless, dependent state such as panic defends against the danger of aggressive, competitive fantasies and actual achievements. However, the regressive state can also be experienced as dangerous, and can be linked with frightening homosexual fantasies. A reactive aggressive oedipal stance can sometimes result, triggering escalating turmoil. The panic episode serves a series of compromise formations in dealing with these conflicted wishes.

Adult↗