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PubMed2002

Explicating the implicit: the local level and the microprocess of change in the analytic situation.

This paper proposes a method of examining the micro-events of the analytic process that borrows heavily from developmental research. The increasing importance of illuminating the microprocess of interaction to understanding the process of change in analytic treatment is emphasised. A set of constructs and terminology is proposed for the study of the moment-to-moment interactive process in psychoanalytic therapy referred to as the local level. A theory of therapeutic action based on 'local-level' process is then explicated. Its central element involves a step-by-step process of 'fitting together', which leads to changes in implicit knowing through alteration of emotional procedures.

Humans↗
PubMed2002

Some implications of Bion's thought: the waking dream and narrative derivatives.

Following up Bion's idea that dreaming is a continuous process that takes place in waking life as well as in sleep, the author develops its theoretical and technical implications. He describes the narrative derivatives of waking dream thought as the means, or interface, whereby access may be had, albeit indirectly, to the constantly forming sequences of alpha-elements. Examples of the formation of these sequences out of childhood memories, present-day experiences and sexual feelings are given. Reference is also made to the notion of the analytic field. The author goes on to demonstrate the clinical value of these concepts both for studying the session's microtransformations and as a means of in-depth examination of the analyst's own mental functioning, including its lapses, in a session. Abundant clinical material is presented to help analysts who normally apply different models of the mind share these ideas. Finally, it is suggested that night dreams result from a further elaboration of the elements formed during waking life.

Adult↗
PubMed2002

Pathways of pleasure: the channel of primal anality.

This article describes a mode of transference relationship in which the analysand has to contend with a psychic mobilisation that results from exchanges with the analyst-object and is related to the activation of pleasure in his/her own mental functioning. The patient's ego feels the internal and external excitations that stem from this mobilisation to be dangerous because of the anxieties about threatening intrusions that they raise. These anxieties arise along the contours of narcissistic flaws that give resonance to early traumatic experiences. The ego protects itself from the danger by organising narcissistic defences that oppose the impulses towards the analyst-object and foster a stagnation of the psychic work. The author puts forward the hypothesis that the patient's ego, not tolerating exposure to drive-related dangers, retracts into a mode of primary anality that is imprisoning and restrictive, setting up a fantasy of narcissistic nidification in which a part of the ego merges with an omnipotent primary object. The purpose of this strategy is to neutralise the excitations - as far as possible - while nevertheless maintaining the element of the drive excitation that forms the basis of the fantasy. The dynamics and the economy of the defensive organisation are examined in detail, as are the questions that these raise. A clinical case illustration is presented.

Adult↗
PubMed2002

Borges, immortality and the circular ruins.

The author explores ideas surrounding immortality and death focusing on the interplay between their development in two stories by Borges ('The circular ruins' and 'The immortal') and their manifestation in a patient. With the help of Borges's stories, the author addresses the desperate necessity experienced by some individuals to search for immortality. This is not just an expression of the universal wish to live forever but, at a deeper level, arises from the impossibility of bearing the mental pain of experiencing ordinary human vulnerability and loss - death being the ultimate expression of such vulnerability. It is suggested that the relentless pursuit of immortality in such individuals expresses an omnipotent phantasy of ridding the self of the emotional pain and fear that arises through being alive. It leads to a denial of the emotional significance of passage of time, of separation and sexual differences. In actuality, the individual's state of not feeling approximates to a complete loss of human identity and emotional death, with no place for any meaningful others. The individual him/herself becomes a 'mere image', living in a delusional world peopled by him/herself and his/ her projections, and ending up trapped inside the circular ruins he/she has generated. The horror experienced at the stark awareness of the individual's emotional death and the wish to re-establish contact with the good internal objects that have been attacked sets in motion the long process of searching for the recovery of a sense of temporality (that would still include the wish for immortality) and, with it, a sense of identity.

Adult↗
PubMed2003

On not being able to dream.

In this paper, the author explores the phenomenon of not being able to dream (as opposed to not being able to remember one's dreams) from three different vantage points. First, from the point of view of psychoanalytic theory, he discusses Bion's idea that the work of dreaming creates the conscious and unconscious mind (and not the other way around). A person who cannot dream is unable to generate differentiable conscious and unconscious experience and, consequently, lives in a psychic state in which he is unable to differentiate waking from sleeping, dreaming from perceiving. The author then approaches the problem of the inability to dream from the perspective achieved by a literary work. He discusses a Borges fiction that creates, in a singularly artful way, the experience of not being able to dream. Finally, the author utilises the vantage point of a detailed account of a clinical experience to explore what it means not to be able to dream. He describes an initial state characterised by the patient's proliferation of unutilisable 'psychic noise' which, over a period of years, led to the analyst's experiencing 'reverie-deprivation' and brief periods of countertransference psychosis. Two analytic sessions are presented and discussed in which psychological work was done that contributed to an enhanced capacity on the part of both patient and analyst for genuine dreaming - both in sleep and in analytic reverie states.

Countertransference↗
PubMed2003

Salieri's dilemma: a counterpoint between envy and appreciation.

Taking as its starting point Klein's concepts of 1957, this paper stresses certain characteristics of envy that have not yet been taken into account in psychoanalysis. Klein described the conflict between envy and gratitude as inherent in the human being; she suggested an interesting link between envy and admiration, but never developed this idea in her theory. The hypothesis that we put forward in this paper is the existence of a particular intolerance-related to envy-of one's own capacity to recognise the valuable aspects of the object. This situation leads to the paradox that the same faculty that allows the patient to appreciate the good qualities of the object is at the same time the source of unbearable pain. The capacity to recognise the good aspects of the object-whether they are perceived or attributed by projective identification-cannot be accepted as a valuable aspect of the self and is taken as a proof of the self 's unworthiness. We think that the description of this intolerance towards admirative appreciation introduces a change in the understanding of idealization simply as a defence against envy and enriches the conflict expressed in the immediacy of the transference - countertransference.

Adult↗
PubMed2003

A contribution to the development of a psychoanalytical methodology for research into language: A systematic study of narration as an expression of sexuality.

Systematic research on language has a solid starting point in Freudian hypotheses on sexuality. This theory is the semantic ground for categorising narrations and providing a basis for the research method. The author places his research in the frame of the systematisation of the Freudian theory of substitute formations in the preconscious. He affirms that these formations are influenced in a particular way by each variant of sexuality. The author proposes an inventory (in Freudian terms) of those variants of sexuality, and he affirms that they can be detected in the discourse. Five universal scenes having the status of a canon, with specific features for each of the ways in which sexuality is manifested, make up narrations. The author describes the features of each narration and provides some examples. He also examines problems related to the use of the method (the coexistence of different variants of sexuality in a single fragment of a narration and the successive steps in the use of the method). The author briefly considers some other problems: the analysis of defences, the study of words and theoretical research. Finally, he examines the validity and reliability of the method.

Adult↗
PubMed2003

Panic disorder and depression: a psychodynamic exploration of comorbidity.

Eight of twenty-one patients presenting for treatment in an open trial of brief psychodynamic psychotherapy for panic disorder also carried the diagnosis of major depression. For the patients who completed the study, depression remitted as well as panic disorder. The authors highlight psychodynamic factors that they hypothesize may contribute to the significant overlap between panic disorder and depression, and describe three videotaped cases to illustrate these points.

Adult↗
PubMed2004

Truth.

Explore the source record for details and available documents.

Humans↗
PubMed2004

Psychoanalytic process and thought: convergence of Bion and Matte-Blanco.

Using the convergence between Bion and Matte-Blanco, in this article the author attempts to stress the view of the psychoanalytical method as promoter of expansion of the ability of the patient to think his emotional experiences. After a brief résumé of the ideas of both Bion and Matte-Blanco, certain points of congruence between the two are emphasised: the way of perceiving the range of phenomena observed by psychoanalysis, intuition as a method for observing this field, the feelings as the raw material for thinking, and the importance of the concept of infinity in psychoanalysis. The way in which the ideas of Matte-Blanco assist in the understanding of Bion's propositions is highlighted. Following these correlations, the author discusses certain questions pertinent to the psychoanalytical method and proposes a model in which the analyst acts as a mediator/catalyst in the process of revision of the ways in which the patient has organised his emotional experiences and the theories constructed to support these hypotheses. Samples of clinical material are presented.

Emotions↗
PubMed1999

Getting in on the act: the hysterical solution.

The author recounts the case of Anna O from a contemporary psychoanalytic viewpoint, incorporating the additional information now available to us about Breuer's treatment of Bertha Pappenheim. Now the erotic transference and Anna O's 'oedipal illusion', which culminated in her hysterical pregnancy and labour, is evident to us, as it was to Freud, who did not publicly share his knowledge of Breuer's unhappy experience with this patient. Ernest Jones, in whom Freud did confide, wrongly dated the conception of the Breuer's baby in his biography of Freud describing it as a sequel to Anna O's treatment. In fact Mrs Breuer's pregnancy was concurrent with the treatment and the author suggests that it significantly influenced its course. Using the case of Anna O and one of his own the author postulates that a feature of hysteria is the use of projective identification by the patient to become in phantasy one or other member of the primal couple. A symbolic version of the primal scene between patient and analyst may then be enacted in the context of the erotic transference-countertransference that characterises these cases.

Fantasy↗
PubMed2006

Attachment theory and psychoanalysis: some remarks from an epistemological and from a Freudian viewpoint.

The author examines Bowlby's attachment theory and more recent versions of it from an epistemological viewpoint and subjects it to questioning on whether they are in line with central concepts of Freudian psychoanalysis. He argues that Bowlby's basic tenets regarding attachment theory, which later attachment theorists never seriously questioned, do not conform to scientific standards, and that psychoanalytic issues such as the dynamic unconscious, internal conflicts, interaction of drive wishes and the role of defence in establishing substitutive formations are either ignored or not treated in sufficient depth. In the light of this, Fonagy's assertion that psychoanalytic criticism of attachment theory arose from mutual misunderstandings and ought nowadays to be seen as outdated is reversed: psychoanalytic criticism can only be regarded as outdated if either basic tenets of Freudian psychoanalysis, or attachment theory or both are misunderstood.

Freudian Theory↗
PubMed2006

The indissociable unity of psyche and soma: a view from the Paris Psychosomatic School.

Depending on whether or not psyche/soma is seen as singular or dual, one may construct different systems explaining man and the world, life and death. In the author's view, the discoveries of psychoanalysis offer a perfectly cogent and unique solution to the famous mind/body problem. In transferring the duality psyche/soma on to the duality of drives, psychoanalysis places the origin of the thought process in the body. In Beyond the pleasure principle, Freud discusses the drastic effect of a painful somatic illness on the distribution and modalities of the libido. He provides a starting point for the Paris Psychosomatic School's psychoanalytical approach to patients afflicted with somatic illnesses. To illustrate the technical implications of this theory the author relates two clinical cases.

Adult↗
PubMed2006

The German specimen case, Amalia X: empirical studies.

The authors provide a perspective on how psychoanalytic process research can be implemented. This is based on a process research model described elsewhere and summarizes the kinds of studies that can be situated on the four levels of the model. The authors summarize multiple empirical studies that were performed in a completely tape-recorded psychoanalytic therapy and have been published. These studies demonstrate the many modalities empirical process research has available to objectively study psychoanalytic process phenomena and their implication for outcome.

Countertransference↗
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↗