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PubMed1995

The infantile in the analytic relationship.

The author examines the narcissistic and relational aspects of the preconscious functioning of the analytic couple in order to bring out the drive-related, developmental and structural elements of the infantile in their relationship. She considers that any disruption of the specific tone of an analysis indicates a change in the level of drive excitation, which is experienced unconsciously in the transference and countertransference as the loss of a significant internal object and gives rise to a representational deficiency. Where this is due to the impact of the infantile-in-the-patient on his own preconscious, the analyst suffers a blind spot. As long as he can desist from using 'blocking representations', the effect will be to repress the unrepresented wish and at the same time to create a framing and containing preform beneficial to the treatment. In the author's view, the analyst deals with his blind spot by a 'work of the negative' à la André Green, through denial of his fantasy of seduction by the infantile omnipotence of the analysand. This model can also be used to investigate the termination criteria of the analyst's own analysis and the economic situation of repression in the psychoanalyst's work.

Countertransference↗
PubMed1996

The passions and perils of interpretation (of dreams and texts): an appreciation of Erik Erikson's Dream specimen paper.

The author reconsiders Erikson's 'Dream specimen' paper as a forerunner of subsequent reader-response criticism, constructive writings on the exploration of countertransference and our contemporary debates about the constructions of meaning in the analytic and literary situations. He regards Erikson as deconstructing our interpretive efforts with texts and with patients; we are to move away from an interpretive process in which we pin down meanings towards opening up the ongoing exploration of multiple meanings. By emphasising self-reflexive questioning and joyful play between texts and readers and analysands and analysts, Erikson contributed to opening up the pleasures of both psychoanalysis and literary criticism. Although he wonders whether Erikson may have wished to move his own creativity beyond conflict, the author heartily endorses his encouraging us to enjoy playing with our materials--texts, dreams and analyses.

Countertransference↗
PubMed1996

Transcending old age: creativity, development and psychoanalysis in the life of a centenarian.

The author of this paper presents therapeutic work with an elderly patient during the tenth and eleventh decades of her life. The author's focus is on the interplay of the creative, developmental and therapeutic processes in the revision of psychic structure. The paper depicts the experience of very old age, particularly the confrontation with mortality. It notes transference and countertransference reactions to the elderly patient. Poems the patient wrote during the last ten years of her life convey her experience of the described processes. The paper gives further confirmation to the recently acquired appreciation of the suitability of elderly individuals for psychoanalytic treatment.

Adaptation, Psychological↗
PubMed1996

The Irma dream, self-analysis, and self-supervision.

The Irma dream has special historical significance. Erikson and others have placed it in historical, social, and cultural context. The manifest dream was elaborated in terms of analytic surface with analysis of form and content, patterns and movement in time and space, etc. There are, however, limits to textual reinterpretations. Further psychobiographic consideration of the Irma dream highlights issues of transference, countertransference and their sources in unconscious conflict and trauma. The Irma dream was initially a secret dream which represented the initiation of a self-analytic and supervisory process. Freud's revealing the dream and imagining the commemoration of the discovery of "the secret of the dream" marked the termination of formal self-analysis within analysis interminable.

Countertransference↗
PubMed1995

Psychological vicissitudes of theory in clinical work.

The author discusses the ways in which psychoanalytic theories, like other theories, attempt to systematise the understanding of observations. Freud remarked that systems also have unconscious meanings. The author discusses these unconscious vicissitudes of psychoanalytic theories of both clinical and more abstract kinds, at various levels of psychological function. Learning psychoanalysis repeats in some respects the developmental processes of learning about 'reality'. The role of authority and superego function in learning and utilising theories is emphasised. The enduring unconscious relationship of theory to authority contributes to adherence to, misapplications of, and rejection of theories, as well as to anti-theoretical attitudes. The concept of an 'analysing instrument' illustrates the way in which a useful exploratory idea may acquire prescriptive and constrictive implications. Analysis of the analyst's attitudes towards theory and its applications is an aspect of countertransference analysis.

Authoritarianism↗
PubMed1997

The verbal squiggle game in treating the seriously disturbed patient.

The psychoanalytic treatment of the seriously disturbed patient depends on working through the countertransference. If the analyst regresses without debilitating anxiety to early levels of psychic development, as does the analysand while reliving his or her early traumatic psychic development, both analyst and analysand may be able to enter states of reverie simultaneously and to communicate with one another in a type of verbal squiggle game. In this variant of Winnicott's written squiggle game, each may easily communicate with the other with quick shifts from the autistic-contiguous, paranoid-schizoid, and depressive positions. During such unusual periods of exquisite understanding, very early pathological experiences can be relived, understood, and repaired.

Acting Out↗
PubMed1997

The control case: a unique analytic situation.

Control cases conducted by candidates as part of their training are different in many ways from other analyses. The most important difference is that candidates must receive credit for cases in order to graduate. To study how training requirements influence candidates' analytic technique, a survey was conducted of all candidates at Columbia who were treating at least one control case. Sixty percent of respondents reported that the need to obtain credit had influenced their technique in at least one of their cases in one or more of the following areas: interpretation, fee setting, charging for missed sessions, scheduling of sessions, writing up the case, and presenting in supervision. Thus, training requirements. specifically the need to obtain credit for cases, affected the analytic technique of a majority of candidates surveyed. This effect is better conceptualized as a shared common experience of training than as a specific countertransference reaction in individual candidates.

Adult↗
PubMed1977

Symbiotic block with psychotic patients.

An impasse, which I term symbiotic block, occurs commonly in psychoanalytic psychotherapy with psychotic patients. Three cases, representing different levels of psychotic transference relatedness, are chosen to exemplify this phenomenon. This impasse is defined in terms of undifferentiated symbiotic transference-countertransference phenomena which interfere with the separation-individuation process. The resolution process is defined in terms of concretizing issues of self-object differentiation and causality. A brief review of the literature is presented, along with discussion of the nature of the phenomenon and some key technical points.

Adult↗
PubMed1977

Alienation: character neuroses and narcissistic disorders.

Various defensive adaptations are described that patients with structural defects involving the self-representation (character neurotics) use to adapt to the external world, often achieving an organization sufficiently stable to lead to considerable success. Externalization rather than projection is used. The differences between these two psychic processes are important for our understanding of character neurotics. Projection signifies placing impulses or parts of the self into external objects whereas externalization involves creating or finding a reality to support the defences, including projecting. The patient externalizes his infantile traumatic environment to construct a current world after his early environment which he finds both threatening and familar. Clinical material illustrates how the process of externalization operating within the transference context may lead to special technical problems. One type of character neurotic demonstrates a special type of externalization which supports overcompensatory feelings of self-aggrandizement, which are in effect, narcissistic defenses. To varying degrees, all character neurotics have some narcissistic defenses. Countertransference problems are also discussed.

Adaptation, Psychological↗
PubMed1977

On Guntrip's analysis with Fairbairn and Winnicott.

Guntrip's paper is an account of his ananlytic experience, first with Fairbairn and then with Winnicott. Although attempting to be objective, he cannot disguise the fact that he is frustrated and dissatisfied. He raises this question: "How complete a result does psychoanalytic therapy achieve?" The question Guntrip is, in effect, asking himself, is: "What went wrong?" We suggest the following points: The failure of both analysts to recognize a very specific form of resistance and to deal with an unusual transference situation. Fiarbairn's insistence on giving oedipal interpretation to a patient who, as Winnicott recognized, did not have an oedipus complex. The failure of both analysts to recognize Guntrip's infantile megalomania; to expose his insistence that the blame for his neurosis must be attached to a "totally" bad mother; and the failure to recognize the intensity of his sibling rivalry. Psychoanalytic therapy is not merely "correct" interpretation and "correct" technique. It involves the interaction of two human beings. The countertransference of Fairbain and Winnicott prevented their perceiving and dealing with the essential problem of this exceptionally gifted patient.

Countertransference↗
PubMed1997

Empathy and 'empathism'.

The author begins by tracing the history of the concept of empathy in psychoanalysis, noting that, largely through the influence of Kohut, it began to feature prominently in the literature from the late 1950s on and has since tended, wrongly in his opinion, to be regarded as an all-purpose instrument to be deployed at will. What is often described in theoretical contributions as empathy should in the author's view more properly be called concordance. On the clinical level, the idea that the analyst must deliberately seek to empathise with the patient is stated to have gained currency, but the author argues that such an attempt to achieve empathy by force can lead only to 'empathism', which is a dogmatic, hyperconcordant attitude whereby the inexperienced analyst in particular thinks he can control the process better. Clinical material is presented to show how some patients set out to induce 'empathism' in the analyst for defensive reasons and how the analyst's concordance, until analysed, may lead to an impasse. The author stresses that genuine empathy is a state of complementary conscious-preconscious contact based on separateness and sharing; covering not only the patient's ego-syntonic subjectivity but also his defensive ego and split-off parts, its achievement requires prolonged hard work on the countertransference and a capacity for contact with the analyst's own primitive aspects. The paper ends with a consideration of the possible obstacles to empathic contact.

Adult↗
PubMed1996

Toward further analytic understanding of lesbian patients.

Psychoanalytic understanding of lesbianism has been excessively welded to unitary dynamic and etiologic themes, while actual dynamics vary among lesbian patients. Clinical material will illustrate this variety. Limitations in past theories and countertransference issues will be discussed. It is proposed that dynamics in lesbian patients should not be confused with pathology, and that an object choice originally embedded in conflict can become secondarily autonomous or remain fluid.

Adolescent↗
PubMed1997

Modes of therapeutic action.

The dialectic in psychoanalysis between theories about the mutative effects of interpretation and psychological knowledge and those concerning the effects of interpersonal interaction constitutes an important tension for approaches to psychoanalytic technique. This essay briefly summarises the thinking around these alternative conceptualisations of therapeutic action, and introduces a new empirically derived model, that of 'repetitive interaction structure', which attempts to bridge therapeutic action by insight and by relationship. Interaction structure is a way of formulating those aspects of the analytic process that have come to be termed intersubjectivity, transference-countertransference enactments and role responsiveness. The concept operationalises important aspects of interpersonal interaction, and can help specify the two-person patterns that emerge in an analysis. Patient and analyst interact in repetitive ways; these patterns of interaction, which are slow to change, probably reflect the psychological structure of both patient and analyst, whether psychic structure is conceptualised in terms of object-representations or compromise formations and impulse-defence configurations. Therapeutic action is located in the experience, recognition and understanding by patient and analyst of these repetitive interactions. Interaction structures stress the importance of the intrapsychic as a basis for what becomes manifest in the interactive field. Clinical illustrations from a psychoanalysis are provided, and research on repetitive interaction structures is described.

Adult↗
PubMed1998

A long-term psychotherapy group for children with chronic medical illness.

Group psychotherapy for children with chronic medical illness can be a powerful tool in facilitating their social and emotional adjustment to their condition. In this article, the author addresses the theoretical issues in developing and managing such a group, drawing on his experience with a long-term psychotherapy group of four children of varying ages and medical conditions. Themes arising from this group included universality of experience, understanding the disabilities of others, sharing, relationships with parents, and grief and loss. In addition to addressing developmental tasks of individual group members, the author presents therapist-related issues (e.g., transference, countertransference, the cotherapy relationship, and the therapist-parent relationship). The author concludes that participation in an ongoing psychotherapy group can provide medically ill children with considerable opportunity for growth, understanding, meaning, and adaptation.

Adaptation, Psychological↗
PubMed1976

Victim, victimizer: interaction in the psychotherapy of borderline patients.

Borderline and narcissistic patients suffuse relationships with intense pregenital aggression to which the therapist, despite his level of training or self-understanding, is not totally immune. Aggression is considered an energetic expression of the narcissistic defense against vulnerability. The therapist is subject to a continuing siege of projections and projective identifications. Vigilance against repetitive sadomasochistic interactions is a necessary and often wearying extension of therapeutic concern. Most necessary, too, is the willingness to make second efforts at understanding the patient's vulnerability. Such understanding comes from attentiveness to countertransference feelings.

Adult↗
PubMed1976

Equus and the psychopathology of passion.

Peter Shaffer's play Equus is discussed in terms of its views on the concept of passion. The major characters show clear indications of psychopathological expressions of passion. Alan's pathology is highlighted by his psychotic identification with Equus and his binding of the horses. Dr. Dysart's pathology is seen in his greatly inhibited sense of passion. He envies Alan's passion and shows "countertransference" toward treating him. Both characters are studied in terms of level of object relations, ego functions, and unconscious fantasy.

Adolescent↗
PubMed1998

Reality and danger in psychoanalytic treatment.

In recent papers there has been considerable interest in the disclosure of the analyst's erotic countertransference. In our view this discussion touches a more fundamental issue: must something "real" take place between analyst and patient in order for real change to occur? And if what takes place is "real," will it not be dangerous and potentially destructive? Tracing the history of psychoanalytic understandings of what is "real" in the patient's life and what is "real" in the transference, we explore these questions in a clinical vignette and discuss the implications of this issue for our understanding of the process of psychoanalytic treatment.

Countertransference↗
PubMed1998

A fe/male transsexual patient in psychoanalysis.

The author describes the analysis of a transsexual who had undergone a vaginoplasty as a young man and had since been living as a woman. The complexity of the psychic reality is epitomised by the analyst's difficulty in deciding whether to use masculine or feminine grammatical forms to refer to this patient. The author tells how she assumed the fantasy role of parents expecting a baby whose sex they did not yet know. She discusses at length her hesitation about accepting a transsexual patient into analysis and reports how she overcame her misgivings after analysing her own countertransference and consulting the literature. Noting that this borderline analysand resorted to both psychotic and neurotic mechanisms, the analyst decided to rely on the capacity for symbolisation and mental representation evinced in the latter. On the psychotic level, the delusional neo-reality of the appearance of a woman sought to replace the unbearable reality of being a man, whereas the neurotic part was aware that s/he could never really be a woman. The author observes that in this analysand sexualisation served to conceal a fundamental narcissistic fault. She also describes how she worked with her own madness to help the patient emerge from a situation of paradoxical fusion with the mother in madness.

Adult↗