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PubMed1994

[Role of the parents in termination of child psychotherapy].

This article explores some causes and conditions which can lead to premature termination of child psychotherapy. Usually the parents decide about the beginning and the end of their child's treatment. Therefore the central issue of this paper is the accompanying parent work of child psychotherapy. By presenting three casuistic examples the author demonstrates how unconscious wishes and needs of the parents can distort their relation to the child and to his therapist. This kind of phenomena needs special attention from the therapist in analyzing the dynamics of transference and countertransference while working with the parents. Otherwise a high risk of premature termination remains, for instance subsequent to an unrecognized unconscious arrangement between the therapist and the parents.

Adult↗
PubMed1994

Abstinence and neutrality: development and diverse views.

Usually, Freud adopted a technical device for personal or practical reasons and only later formulated its theoretical basis. His conception of abstinence initially seemed designed to curb his own troublesome erotic countertransference. These speculations, while having no bearing on the clinical value of abstinence and related neutrality, do emphasise the necessity to assess their utility objectively, on the basis of clinical data. Diverse views of abstinence and neutrality persist in part because early inconsistencies in Freud's conceptions remain unresolved, and in part because these views are derived from the analyst's personality and character, are not based upon clinical data, but are buttressed by iteration. An approach to empirical assessment is suggested using multiple analyst-observers: (1) to develop reliable criteria for four analyst behaviours: abstinence, neutrality, gratification and suggestion; and (2) to evaluate enhancement or impairment of analytic work. Utilisation of this approach in the supervision of candidates would enhance analytic pedagogy and to some degree facilitate a research orientation in candidates.

Character↗
PubMed1994

The man with the bus symptom.

This paper attempts to illustrate the clinical and technical vicissitudes of the psychoanalytic treatment of an adult male patient whose psychopathology alternated between a relatively stable phobic-obsessional structure and a perverse structure. The latter appeared in his life paroxysmally and took the form of riding the buses, when he would engage in various furtive sexual practices with small and adolescent girls. Both psychopathological structures were, of course, manifested in the relationship with the analyst. The description of their interplay in the transference-countertransference and of their relationship with the patient's life history makes up the first part of the paper. The gradual establishment of the perverse acting out in the therapeutic link led to a distortion of the setting which threatened the continuity of the analytic process, giving rise to a pragmatic paradox. This establishment of acting out in violation of the setting, coupled with recourse to the technique of reformulation of the setting, constitutes the main focus of this paper. The significant changes which ensued in the analytic process after this reformulation are then examined.

Acting Out↗
PubMed1994

Transference: erotised, erotic, loving, affectionate.

Within a set of phenomena traditionally problematic for psychoanalysis, four types of erotic transference are outlined with a description of their dynamic genesis and related case histories (transference and countertransference developments, fundamental treatment procedures): erotised, erotic, loving, and affectionate transference. The first type is based mostly on psychotic modalities, the second on neurotic modalities. Both the loving and the affectionate transference, on the other hand, turn out to be clinical forms corresponding to a normal substantially same development, different from each other by virtue of a diverse level of maturation in the Oedipus complex: they often provoke--in analysts--a defensive stiffening which is harmful and--from the theoretical point of view--not above reproach. The work is particularly focused on the analytic evolution of a female patient who develops an amorous transference in which the defensive aspects prove to be less important than the potentially evolutionary ones. The treatment has been based--in particular--on the analytic utilisation of this transference. The last part of the contribution is devoted to the analysts' 'guarantee factors', which permit them to work in psychoanalysis with the 'highly explosive forces' of these transference configurations, maintaining a useful, rigorous, sensitive and sufficiently creative framework.

Adult↗
PubMed1994

Uncharted waters: psychodynamic considerations in the diagnosis and treatment of social phobia.

Despite the prevalence and psychological toll of social phobia, it has only recently been systematically studied. Although major advances in pharmacotherapy and cognitive-behavioral therapies have added to treatment options available for these patients, social phobia still goes unrecognized and untreated. The author examines how particular countertransference reactions to patients may interfere with the recognition and subsequent treatment of social phobia. She notes that the psychodynamic literature has also neglected this topic, although aspects of social phobia are imbedded in previously described neurotic or characterologically disturbed patients. Two case examples are presented that explore psychodynamic issues related to shame, aggression, trauma, and unresolved grief in the etiology of social phobia. The author believes that treatments that more fully integrate psychodynamic principles with pharmacological treatment and cognitive-behavioral methods will be efficacious in treating this diverse group of patients.

Adult↗
PubMed1994

The concept of interpretive action.

Interpretive action is understood as the analyst's use of action (other than verbally symbolic speech) to convey to the analysand specific aspects of the analyst's understanding of the transference-countertransference which cannot at that juncture in the analysis be conveyed by the semantic content of words alone. An interpretation-in-action accrues its specific symbolic meaning from the experiential context of the analytic intersubjectivity in which it is generated. The understanding of the transference-counter-transference conveyed by the analyst's interpretive action must simultaneously be silently formulated in words by the analyst. Three clinical vignettes are presented which illustrate different forms of interpretation-in-action.

Adult↗
PubMed1994

Toward reconceptualising transference: theoretical and clinical considerations.

Two fundamentally different models of transference have emerged, designated herein as the displacement and organisation models. The purpose of this paper is to compare the fundamental features of these two models and to contribute to the development and cohesiveness of the organisation model through the consideration of certain theoretical and clinical issues. Transference is defined here to refer to the primary organising patterns or schemas with which the analysand constructs and assimilates his or her experience of the analytic relationship. While repetitive pathological transferential organisations that are based on traumatogenic experiences variably impede a person developmentally and in conflict-resolution, other transferential organisations are forward-looking crystallisations of developmentally-needed experiences (selfobject transferences). Transference (and countertransference) is viewed as variably co-determined by analysand and analyst. Clinical issues are delineated concerning the process of illuminating the transference in light of the variable contributions of the analyst to the transference, implications for extra-transference, and the differentiation of process and content to determine the meaning of the transference.

Countertransference↗
PubMed1994

Studies in listening: when patients talk about their patients.

The literature is curiously silent about special challenges in the analysis of psychotherapists, including the interactive tensions that result when analysands talk about their own patients. When analysands talk about their patients, the analyst may be deflected away from a focus on the analysand's intrapsychic experience by transient identifications with the analysand's patient and by multiple identificatory processes which press the material away from mutually observed metaphor toward enactment and actualisation. Using detailed illustrations of the clinical process when patients talk about their patients, the author illustrates the manner in which the analyst's listening itself may be drawn into the process of enactment and explores how transference-countertransference interactions alter both the analyst's and the patient's listening. These interactions and identifications are compared to the triadic identificatory processes that lead to what has been called the 'parallel phenomenon' in supervision. Because the challenges that arise when patients talk about their own patients may be of more general significance, they merit further study.

Adult↗
PubMed1994

Freud or Klein: conflict or compromise.

There have been some striking changes in Kleinian technique since the Freud-Klein controversies of fifty years ago. Some of these changes suggest unacknowledged shifts in underlying theory. Some may imply a measure of reversion to Freudian practices, but it is far from clear that such changes apply to the analysis of children. Others--most importantly in the understanding and handling of transference--have widened the existing gulf between the two psychological systems. While Klein herself unswervingly took a global view of transference, regarding it as 'the total situation', the majority of Kleinians have extended this broad clinical concept to include its manifestations in countertransference phenomena. Although, for the most part, Freudians agree that transference phenomena pervade the clinical situation, they take the view that a portmanteau concept obscures the rich variety and diversity of transference, and in doing so fails to take full account of the many forms and intricacies of psychic conflict. This view is illustrated by material from child analysis. It is argued that, where basic differences of clinical practice and the theoretical understanding on which it is based are beyond resolution, it is in the interests of both groups to acknowledge the fact.

Child↗
PubMed1994

The transition process in converting to psychoanalysis.

Numerous psychological factors are involved in converting from psychotherapy to psychoanalysis with the same analyst. The process of making the recommendation and working through reactions to it, both before and after the analysis begins, requires heightened attention to the ensuing transference and countertransference reactions. After reviewing the literature on this area, the author highlights the main factors in this process and presents an illustrative case example.

Adult↗
PubMed1993

Problems with borderline patients in a crisis intervention unit: a case history.

This article describes some characteristics, advantages, and disadvantages of crisis intervention in patients with borderline personality disorder. The theoretical issues are illustrated by a case study of a patient with the disorder. Therapeutic proceedings are analyzed, with special focus on the treatment plan, goal-setting, and termination of therapy. The positive effects of the treatment and the patient's unexpected loss of compliance are discussed. Some suggestions are made about dealing with such patients in the light of mistakes made by the crisis therapist, which produced feelings of inadequacy and incompetence in her, stemming from unresolved transference-countertransference problems.

Adult↗
PubMed1993

The impasse within a theory of the analytic field: possible vertices of observation.

The author attempts to place the problem of the impasse within field theory, showing that a prolonged period of countertransference metabolisation is sometimes necessary before an analytic process seemingly at a standstill can get under way again. Clinical examples are given to demonstrate the emotional difficulties with which the analyst must come to grips. The microprocess of the session and change in the analyst's mind are considered to be the significant loci of any possible resumption of therapeutic progress, provided that hope and patience do not fail, and subject also to the ability to adopt new and original viewpoints in the session.

Adult↗
PubMed1993

Convergences and divergences in contemporary psychoanalytic technique.

A broad survey of the psychoanalytic field reveals both convergences and divergences in technique. The major convergences include earlier interpretation of the transference, increased focus on transference analysis, as well as growing attention to countertransference analysis and increasing concern with the risks of 'indoctrinating' patients. Greater emphasis is found on character defences and the unconscious meanings of the 'here-and-now'. Also noted are trends toward translating unconscious conflicts into object-relations terminology, as well as toward considering a multiplicity of royal roads to the unconscious. Regarding divergences, significant controversies continue about the importance of the 'real' relationship, and the therapeutic versus the resistance aspect of regression. Divergences also continue regarding reconstruction and recovery of preverbal experience, drawing the lines between psychoanalytic psychotherapy and psychoanalysis, the role of empathy, and the relation of historical to narrative truth.

Countertransference↗
PubMedDate not supplied

[Methods and transference in short term psychoanalytic therapy].

The therapist's emotional reactions and attitudes in time-limited short-term therapy are presented. Limitations of time and scope this kind of therapy must be dealt with emotionally by the therapist; emotional reactions and attitudes can be expected to vary according to the therapist's personality structure; schizoid, depressive, compulsive or hysterical. Transference in time-limited short term therapy can be very intense but is easier to indendify. This has implications for countertransference reactions caused by the patient's transference.

Adjustment Disorders↗
PubMed1993

Truth and reality in psychoanalytic discourse.

In this paper, I examine the influences of two philosophical theories of truth--coherence and correspondence--on the current debate on the search for 'common ground' and on specific aspects of clinical practice. Results from a previous empirical study of analysts' approaches to transference interpretation are described in order to illustrate the way in which a network of clinical concepts is held together by explicit and implicit beliefs concerning the nature of subjectivity, truth and reality. Excerpts from interviews of psychoanalysts of varying orientations practising in different geographical locations indicate the complex interrelationships between concepts of analytic neutrality, extra-transference, the real relationship, countertransference, the death instinct and the therapeutic alliance. These findings suggest that the coherence versus correspondence theories of truth may constrain rather than enhance the investigation of the differences and commonality between varying analytic theories, schools and clinical practices.

Attitude to Death↗
PubMed1993

The inner experiences of the analyst: their contribution to the analytic process.

As an illustration of the inner experiences of the analyst as they operate in the analytic situation, this paper presents a single analytic hour in some detail. By means of this clinical material, the author seeks to demonstrate how the thoughts, fantasies, memories, bodily movements and autonomic responses that he experienced in this hour affected his interventions, the kinds of transference-countertransference interactions that developed in the session, and the unfolding of the analytic process.

Adult↗
PubMed1993

The prisoner's prisoner: the theme of voluntary imprisonment in the staff of correctional facilities.

The staff of correctional facilities voluntarily work in prisons. It seems plausible that the professionals, officers, and administrators engaged in such employment may have unconscious feelings of a desire or need for punishment. This topic does, in fact, appear common in the jokes and casual conversation in such facilities, perhaps indicating such an underlying theme. Indeed, those employees who were willing to discuss their experience in more depth corroborated the hypothesis. A sense of a need or desire for punishment in a staff's members may profoundly affect the prisoner's transference with the staff, and the staff's countertransference. These feelings may affect the many important decisions of correctional and clinical staff in prisons and related settings.

Career Choice↗
PubMed1996

Analyst and patient at midlife.

Increasingly it seems that analysts and their patients are in the midlife period. If analyst and patient are both going through a midlife crisis involving similar issues, this may have repercussions in the analysis. Turning to the literature for guidance reveals a paucity of papers concerning the clinical application of midlife developmental theory. This article explores such an application by describing the effect of two midlife changes-time urgency and role reversal with respect to aging parents-on the transference-countertransference in the analyses of two middle-aged patients.

Adult↗