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PubMed1991

Where's the beef? Putting personality back into personality assessment.

This article attempts to demonstrate the value of using a psychoanalytic theory of personality for psychological testing. This approach has more clinical utility than a solely research-based one. It recasts test data into conceptually related constructs that have internal consistency to each other and are directly relevant to psychotherapeutic treatment. Such theoretical recasting serves an organizing function, an integrative function, a clarification function, and a predictive function for the clinical inference process. Furthermore, a psychoanalytically oriented approach to testing allows for the expansion in sources of data that one considers in the testing situation. Five different sources of data emerge from the testing situation once one refocuses on theoretical constructs rather than test signs. These include test scores, test content, the patient-examiner interaction, patient behavior, and examiner countertransference.

Journal Article↗
PubMed2000

Martin Mayman's early memories technique: bridging the gap between personality assessment and psychotherapy.

In this article, we describe Martin Mayman's approach to early childhood memories as a projective technique, beginning with his scientific interest in learning theory, coupled with his interest in ego psychology and object relations theory. We describe Mayman's contributions to the use of the early memories technique to inform the psychotherapy process, tying assessment closely to psychotherapy and making assessment more useful in treatment. In this article, we describe a representative sample of research studies that demonstrate the reliability and validity of early memories, followed by case examples in which the early memories informed the therapy process, including issues of transference and countertransference.

Female↗
PubMed1992

Obstacles to effective case management with AIDS patients: the clinician's perspective.

A social work clinician filled the role of case manager with multiple functions of discharge planner, client advocate, counsellor and educator in her work with a young male AIDS patient and his family. Material from this case is used to illustrate seven problem areas identified as obstacles to effective case management: (1) The stigma of AIDS and homosexuality (2) Lack of adequate family support (3) Impact of AIDS dementia (4) Ethical dilemmas in discharge planning (5) Conflicts in the advocacy process (6) Lack of adequate resources and (7) Countertransference issues. Clinical observations are integrated with the existing social work literature which focuses on providing services to AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Treating the chemically dependent health professional.

Chemical dependence among health professionals is a significant problem, with a lifetime prevalence of approximately 10-15%. A physician who undertakes the challenge of treating other physicians for chemical dependence must have firm boundaries, and must be willing to provide extra time and patience. Denial of symptoms, countertransference and other pitfalls have been cited as prominent potential problems. Although there is evidence that physicians in general have excellent outcomes following chemical dependence treatment, mismanagement can be disastrous. Standards are suggested for centers that wish to treat this population.

Ambulatory Care↗
PubMed2006

Psychotherapeutic issues with "kinky" clients: clinical problems, yours and theirs.

People whose sexual repertoire includes BDSM, fetish, or other "kinky" practices have become increasingly visible, on the Internet, in the real world, and in psychotherapists' offices. Unfortunately, the prevailing psychiatric view of BDSM remains a negative one: These sexual practices are usually considered paraphilias, i.e., de facto evidence of pathology. A different, affirming view of BDSM is taken in this paper. After defining BDSM and reviewing common misconceptions, a variety of issues the practitioner will face are described. These include problems of countertransference, of working with people with newly emerging sexual identities, working with spouses and partners, and discriminating between abuse and sexual "play."

Attitude of Health Personnel↗
PubMed2005

Visual art therapy's unique contribution in the treatment of post-traumatic stress disorders.

This paper describes visual art therapy as an integrative and unique approach, which is most appropriate for the multidimensional treatment of post-traumatic stress disorder (PTSD). The unique contribution of visual art therapy in the treatment of PTSD is expressed in three major areas: (1) working on traumatic memories, (2) the process of symbolization-integration, and (3) containment, transference and countertransference. Two case descriptions of traumatized patients treated in visual art therapy are presented.

Art Therapy↗
PubMed2001

[Hypno-analysis: On the integration of hypnotic elements in individual uncovering psychotherapy in patients with anxiety disorder].

Following a short history of the development of the therapeutic techniques of psychoanalysis as derived from the basic rules of hypnosis, the apparent contradictions between the two approaches are called into question, with particular reference to the importance and efficacy of suggestion and suggestibility in both methods. How the integration of hypnotic interventions can both intensify and at the same time shorten the process of analytic therapy is demonstrated by two vignettes. The range of indications for the use of hypnosis as a complementary measure is currently restricted to the analysis of resistance and of the making conscious of past traumatic experiences that are involved in the psychogenesis of anxiety disorders. Particular importance is attached to the careful establishment of the indication and then psychoanalytic working-through of the accompanying transference-countertransference-dynamics following the completion of the hypno-analytic phase and in the course of the ongoing uncovering therapeutic process.

Adult↗
PubMed2003

[Relapse in depressive disorders--is there a need for maintenance psychotherapy? ].

OBJECTIVES: Patients with depressive disorders who enroll in typical short-term clinical studies have a high risk of early relapse (30-70 %) and chronicity (ca. 20 %). Factors which contribute to this risk are residual symptoms at termination, previous recurrent episodes, chronic stress, etc. Pharmacological strategies offer a multitude of means of relapse prevention, while in psychotherapeutic interventions there is a dearth of such recommendations. Studies on relapse-preventing continuous contacts (maintenance therapy), for example, are very rare. METHODS: We present empirical data on risk factors for early relapse and chronic course in depressive disorders together with general strategies for relapse prevention. Results of controlled studies with maintenance psychotherapy will then be reported. RESULTS: Psychotherapeutic maintenance strategies have been shown to be successful in several controlled studies. Furthermore, recent studies show typical moderating mechanisms for better resilience against stressors in formerly depressed patients. The typical setting under study was monthly sessions over a period of at least 8 months and up to three years. In case of severe risk factors continuous pharmacotherapy also has to be taken into consideration. DISCUSSION: The issue is discussed in respect to differential indication (primarily long-term therapy vs. a rather quick change to maintenance contacts of low frequency). Moreover, the ethical questions of inadequate dependency as well as the clinical aspects of transference-countertransference dynamics are viewed.

Antidepressive Agents↗
PubMed2001

Working through envy: some technical issues.

The author argues that envy appears in an analysis as a hostile, life-destroying force and is directed at the good qualities of the object, often manifesting in the patient's need to devalue analytic work that has been helpful. An intractable negative therapeutic reaction can thus become a persistent feature of an analysis. Sometimes powerful envy is silently operating beneath the surface, with the patient feeling continually wronged and mistreated by the object. The author argues that bringing the projected envy into the patient's personality structure is an important aspect of successful analysis, but that various technical problems have to be considered before painful insight can be achieved into the division in the patient's self. Presenting material from a relatively long analysis, she discusses some technical issues in dealing with these processes. Interpretation of envy can be a delicate matter, requiring consideration not only of how to interpret, but also of the nature of the countertransference and the form of the interpretation. A transference interpretation directed solely at the patient's self-destructive behaviour and destructiveness towards the object carries the risk of further stimulating the destructiveness, even if it is correct; it is also important to bring the patient's libidinal aspect into the interpretation.

Adult↗
PubMed2001

Some difficulties in the analysis of a withdrawn patient.

The author discusses some difficulties that arose in the analysis of a seriously disturbed patient who found talking about himself extremely problematical. He defended against awareness of conflicts, ideas and affects while being tormented and overwhelmed by them. He seemed to have acquired an inhibited character that was not, however, schizoid. He related to others in a wary, quarrelsome, yet passive way. It became apparent that his sense of identity was confused. Attention to archaic fantasies led to the uncovering of a parthenogenetic unconscious fantasy involving identification with his mother and the attempted eradication of the mental function of his father. Experiences of differentiation led to extreme anxiety including risk of failure of ego functions with the arousal of latent psychotic anxieties. Interpretation of the content of sessions became possible only after several years: until then interpretation of defensive processes aimed at preventing contact or change predominated. Disclosure of 'unofficial' communications by the patient, expressed as lapses of vigilance by his severe superego, revealed his crises and feelings. These idiosyncratic, muted appeals for help became a vehicle through which interpretation of content and its transference meaning became possible. Some confusing transference and countertransference experiences in the analysis are described.

Adult↗
PubMed2002

The exclusion of the other. A clinical contribution to an object-relations theory of obsessional defence.

The author begins by noting that the subject of obsessions and obsessional neurosis seems to have fallen out of favour with the analytic community in spite of the important part it played in the formation of Freud's theories, and notwithstanding the significance of its mechanisms in the maturation of the ego. He then discusses some theoretical considerations regarding the development of the taboo on touching and, by extension, contact. Attention is drawn to the parallels with autistic functioning emphasised by other authors. Particular importance is attached to the distinction between internal and external reality that arises during the anal-sadistic phase and that leads to polarisation and splitting in obsessional neurosis. Following a discussion of the transference-countertransference situation with obsessional patients and of their concretistic experience in the treatment situation, as also featured in the literature, an extensive case history exemplifies the author's contentions and shows how the patient concerned developed during the course of his analysis. After pointing out the importance of the avoidance of identifications as a mechanism of obsessional defence, the author concludes the paper with a brief comparison of obsessional and hysteriform functioning and a characterisation of the obsessional defence as the excessive recourse to perverted thought functions so as to ward off paranoid anxieties.

Adult↗
PubMed2003

Between the frontier and the network: notes for a metapsychology of freedom.

The author examines the paradigm of the frontier and encounters the establishment of the paradigm of the network, a tendency that currently runs through diverse fields of thought. The network is not proposed as a globalising structure that would neutralise what is different, but as integration based on preservation of what is plural and its transformations. The author moves between these two paradigms in psychoanalytic metapsychology and clinical practice. The concept of frontier is intrinsic to the entire theory: repression, which separates the unconscious from the preconscious, the barrier against stimuli, the delimitation of spaces and agencies. But psychoanalysis is also a precursor of the paradigm of the network, with its concepts of unconscious, free association and evenly suspended attention. She points out that it is psychoanalysis that, in the area of scientific thought, subverts the radical split between subjects and their objects of observation, through the concepts of transference and countertransference, thus inaugurating a revolutionary theory of knowledge. This perspective can later be seen as a forerunner of changes in other disciplines. This text legitimises the contribution of psychoanalysis to thinking and knowledge, as well as the potential of a therapeutic method that provides the tools for crossing frontiers, unknotting and weaving networks, operating in the face of risks of pathological consolidations, thus holding to its unavoidable commitment to freedom.

Attention↗
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

Reader and story, viewer and film: on transference and interpretation.

Two sides in Freud's attitude towards literature and art are presented: Freud the sensitive listener, whose interest in art is a potential springboard for a rich interdisciplinary dialogue; and Freud the conquistador, whose wish for power in 'invaded' territories is related to troublesome aspects of 'pathography' and 'applied analysis'. The unique contribution of psychoanalysis may not be discovering objectively the true unconscious content of works of art, but rather enriching the exploration of the potential transitional space evolving between artist, work of art and readers or viewers, enhancing our sensitivity to multiple meanings and complex emotional influences of art. This requires exploring our own subjective experiences of art, which may be described as transferences (when art is mostly perceived as a source of insight) or countertransferences (when artists and their work are basically experienced as troubled patients). Transference (broadly defined) and interpretation tend to intermingle, both in the clinical analytic encounter, and in any reading/viewing of art, be it by laymen, analysts or other scholars. Several examples from the psychoanalytic study of literature and film are given, and three pairs of contrasting interpretations are studied, concerning Kafka's The metamorphosis, Minghella's The English Patient and Polanski's Chinatown.

Art↗
PubMed2003

The use of observation in the psychoanalytic treatment of a 12-year-old boy with Asperger's syndrome.

The author describes some aspects of a once-weekly psychoanalytic psychotherapy of a 12-year-old boy diagnosed with Asperger's syndrome. The patient's emotional and cognitive development had been impaired since early life, possibly due to an internal deficit and to the likelihood of inadequate environmental holding. He was unaware of having difficulties but was underachieving academically, was socially isolated and often visibly unhappy in his life. The patient's denial, splitting, and projection of emotion and insight presented the therapist with the difficult task of how to reach him. In order to communicate with him emotionally, the therapist created a modified technique which reflected the patient's development from part-object to whole-object relationships. This development became apparent in the sessions and was interpreted in the transference relationship. An account of the patient's early years was pieced together from a detailed commentary of what was being observed and intuited by the therapist during the sessions, as well as by an understanding of the countertransference. By the end of two years' treatment, the patient's sensitivity and creativity, which had been buried beneath a self-sufficient, autistic-like encapsulation, finally began to emerge in his communications with his therapist.

Asperger Syndrome↗
PubMed2004

Another language, another place: to hide or be found?

The author examines some specific features of the analytic encounter when both patient and analyst are émigrés from the same cultural and linguistic background. This can result in splitting processes that operate silently and are difficult to reach, but can also provide rich material, as they offer the couple the opportunity to work through the pain and the guilt over what is lost--ultimately the lost mother--murdered and betrayed. Working through the split faces the analyst with important technical considerations, bearing in mind that the shared cultural identity can conceal itself in the more undifferentiated features of the couple's psyche and be projected on to the setting. As such, it needs to be put to analytic scrutiny if the treatment is to avoid a stalemate. These are specific cultural defences deployed in the problematic existential encounter with the foreigner/other within oneself. Using clinical material from two cases, the author shows how the couple's access to a dual linguistic signifying system can enrich the analytic dialogue, but can also result in enactment. Careful monitoring of the transference-countertransference relationship is essential to the progress of the analytic work.

Adult↗
PubMed2004

Hans Loewald: a radical conservative.

Hans Loewald's work was relatively marginalized in its day and it is little known outside the United States. It is, however, assuming increasing importance in American psychoanalysis. Loewald's attractiveness as a theoretician is due, in no small part, to his rigor and synthetic reach. He is able to accomplish the difficult feat of remaining non-sectarian and systematic at the same time. Indeed, Loewald's work contains an integrative vision that is unusual in today's fragmented psychoanalytic world. This author tries to show how Loewald attempts to reconcile many of the rigid oppositions that often become reified in analytic controversies: structural theory versus relational psychoanalysis, traditionalism versus revisionism, oedipal versus pre-oedipal, modernist versus postmodernist and hermeneutical versus scientific. The article examines how Eros, understood in terms of the psyche's synthetic strivings, plays a major role in Loewald's theory. The author also situates Loewald's position within contemporary psychoanalytic discussions of epistemology. These discussions tend to criticize the objectivism of modern science-and analysis in so far as it models itself on science-and stress countertransference and the subjectivity of the analyst. Loewald's argument, however, runs in the opposite direction. Because of his concern with the autonomy and individuality of the patient, he is concerned with the clinical dangers rising from an overemphasis on the subjectivity of the analyst.

Guilt↗
PubMed2004

Sándor, Gizella, Elma: A biographical journey.

In recent years, particularly with the publication of the Freud-Ferenczi correspondence, it has become clear that the rich theoretical dialogue between Freud and Ferenczi, a dialogue that may be seen as constitutive for psychoanalytic discourse in recent decades, was intensely intertwined with their complex personal relationship. Two women--Gizella Pálos, who eventually became Ferenczi's wife, and her daughter Elma, who was both Ferenczi's and Freud's analysand, and with whom Ferenczi fell in love--played a crucial role in shaping the Freud-Ferenczi relationship. Their own voices, however, have so far been barely heard. This paper is a preliminary report of a biographical research project which aims to complete the puzzle, by getting to know better Gizella, Elma and their family, with the help of numerous original sources, many of them unpublished till now. The emerging picture tends to confirm Ferenczi's initial view of Elma as a person of depth and integrity, rather than Freud's view of her as fundamentally disturbed; countertransference-love, it is suggested, may have facilitated fuller perception rather than clouding it. The question of the impact of Elma's 'confusion of tongues' with Ferenczi and with Freud on her subsequent life is also discussed.

Correspondence as Topic↗